Regulating doctors, ensuring good medical practice

Leadership and management for all doctors (2012)

Leadership and management for all doctors (2012) sets out the wider management and leadership responsibilities of all doctors in the workplace, including:

  • responsibilities relating to employment issues
  • teaching and training
  • planning, using and managing resources
  • raising and acting on concerns
  • helping to develop and improve services.

The guidance came into effect on 12 March 2012 and replaces Management for doctors (2006).

Read the guidance online or open a pdf version of Leadership and management for all doctors (pdf).

Use the tabs below to explore the concept of shared leadership; find resources that help doctors with difficult discussions with their patients; view a PowerPoint presentation; and read about the background to the development of the guidance.

Shared leadership

What do we mean by leadership?

Being a good doctor means more than simply being a good clinician. Every day, doctors provide leadership to their colleagues, and vision for the organisations in which they work and to the profession as a whole.

The definition of leadership has undergone an evolution in recent years. We recognise that some doctors are formal leaders who are accountable for the performance of their team, department or organisation.

But we think that the responsibility for identifying problems, solving them and implementing the appropriate action is shared by the team as a whole. This is what we mean by shared leadership.

On this page you can see how shared leadership works in practice for all doctors and where to go for further information.

Leadership in practice

The examples below, taken from the Medical Leadership Competency Framework* illustrate how doctors show leadership when working within teams at the undergraduate, postgraduate and continuing practice stages.

Undergraduate stage:

  1. Student B took part in an audit of Accident & Emergency (A&E) waiting times which she did with one of the nurses. She was able to see how each member of the team played a vital role in ensuring all patients were seen quickly, and how the A&E staff tried to identify which patients needed to be prioritised and seen by the most appropriate member of the team.

Postgraduate stage:

  1. Dr H is a trainee in the care of older people. On her ward there are several patients who are medically fit for discharge but, due to their home circumstances, remain in a hospital bed. The ward nursing staff are keen to move these patients on but staff working in the community have assessed the problems and think that solutions may take time to arrange. The clinical case meeting is tense as the inpatient and community staff come into conflict. Dr H takes an informal chairing role and helps the team look at a range of ways to meet the needs of individual patients and their carers through a team effort. She is able to acknowledge the feelings and the good intentions of all concerned, which helps bring the team meeting to a satisfactory conclusion.

Continuing practice stage:

  1. Dr A is a consultant in A&E. He had a complaint from a relative who felt that her mother was ignored because she was ‘old and confused’. She was upset by some remarks she had overhead, which indicated that her mother’s clinical condition was not being taken seriously. Dr A went to visit the family at home and was struck by the difference in the patient, who was dressed in her own clothes and not confused at all. He went back to the department and, with one of his nursing colleagues, was able to review the attitudes of staff to patients who were confused. They worked with the elderly care team in the trust to run workshops and give feedback on practices and policies to significantly improve the experience of the frail and elderly who attended the A&E department.

Now that you have seen these, you can also review other examples that illustrate how leadership is demonstrated within each of the five domains of the Medical Leadership Competency Framework in terms of:

  • Demonstrating Personal Qualities
  • Working with Others
  • Managing Services
  • Improving Services
  • Setting Direction  

* Medical Leadership Competency Framework © 2010 NHS Institute for Innovation and Improvement and Academy of Medical Royal Colleges. All rights reserved

Do you want to know more?

There is a large – and growing – body of resources related to leadership within medicine. Below you can find out more about leadership and how it is relevant to your work as a doctor.

Our own Leadership and management for all doctors sets out the wider management and leadership responsibilities of doctors in the workplace, including in relation to employment issues, teaching and training, planning, using and managing resources, raising and acting on concerns and participating in service improvement and development.

© 2010 NHS Institute for Innovation and Improvement and Academy of Medical Royal Colleges. All rights reserved.The Medical Leadership Competency Framework (2010), developed by the Academy of Medical Royal Colleges and the NHS Institute for Innovation and Improvement, describes the leadership competences doctors need in order to become more actively involved in the planning, delivery and transformation of health services.

 

e-learning for HealthLeAD is a free e-learning resource based on the MLCF to help clinicians develop understanding of their role in contributing to the management and leadership of health care services.

The Faculty of Medical Leadership and Management have developed a comprehensive online collection of resources to help doctors in their day to day leadership roles.

The NHS Institution for Innovation and Improvement have produced a useful summary of what is meant by shared leadership: Shared Leadership: Underpinning of the MLCF (pdf).

NHS Wales are working through their Leadership & Organisational Development Directorate to support existing leaders and develop leadership talent.

The National Leadership Unit delivers a range of leadership development programmes and activities across NHS Scotland, including through supporting the development of policy and strategy.

If you are a medical educator you may also like to review:

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Discussion tools

Tools for discussing resource constraints with patients

All doctors must make the care of patients their first concern. However, the treatment options that can be offered to patients are sometimes limited by resource constraints or by the criteria established through local and national policies.

When this is the case, it will be necessary to discuss with patients the options for continuing their care.

In paragraph 85 of Leadership and management for all doctors we say that doctors must be open and honest with patients, and those close to them when appropriate, about the decision-making process and the criteria for setting priorities in individual cases.

We also outline, in paragraph 86, that when issues arise about allocating resources, doctors should try to resolve them by discussing options with their patients, and others as appropriate. Underlying all our guidance in this area is that doctors should be open and honest with patients when resource constraints may affect the treatment options that are available to them.

Read more about resource allocation within Leadership and management for all doctors.

This page is intended to help individual doctors by linking to useful resources available online that will aid discussions with individual patients, including information on patient decision aids and individual funding requests.

Useful resources for discussion

The National Institute for Health and Clinical Excellence (NICE) website is a useful and comprehensive resource on the most effective and cost efficient ways to prevent, diagnose and treat disease and ill health. In particular, NICE have developed patient and public versions of all of their clinical guidance that summarise their recommendations to healthcare professionals.

The Scottish Intercollegiate Guidelines Network (SIGN) develop guidance for use in Scotland about appropriate health care for specific clinical circumstances and have a section of their website for patients.

The Scottish Medicines Consortium (SMC) provides advice to NHS Boards and their Area Drug and Therapeutics Committees (ADTCs) across Scotland about the clinical and cost-effectiveness of all newly licensed medicines, all new formulations of existing medicines and new indications for established products.

The National Prescribing Centre has also produced a range of resources which can help doctors in their discussions with patients, including:

NHS Evidence, another website developed by NICE, holds a range of case studies which highlight initiatives to improve productivity or efficiency in patient care.

Patient decision aids

Patient decision aid’s (PDA’s) are designed to help patients understand the value of treatment options by presenting evidence-based estimates of the benefits and risks. These may be particularly useful when exploring the rationale behind resource decisions.

A range of PDA’s are available from the National Prescribing Centre and NHS Direct websites.

Individual funding requests

An individual funding request (IFR) is a request to fund the treatment of an individual that falls outside of the range of treatments that have been previously agreed by the Primary Care Trust (PCT). Such decisions are taken on a case by case basis.

Guidance on individual funding requests can usually be found through the NHS Choices website. For information about how such requests apply in Wales, visit the NHS Wales website.

The NHS Confederation has also produced Priority setting: managing individual funding requests which aims to help organisations review current priority-setting processes and establish such a framework if needed. In addition to the individual guidance produced by PCT’s, it provides a useful basis for understanding how and why IFR’s operate in the NHS.  

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Powerpoint

This PowerPoint presentation provides the background to the development of the guidance and highlights what is new within the revised version.

Please note - To view the speaking notes for the presentation, you will need to save it to your computer and open the presentation from there.

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Background

Development of the guidance

Leadership and management for all doctors (2012) replaces Management for doctors (2006).

In developing Leadership and management for all doctors we also consulted on Raising and acting on concerns about patient safety (2012) and Writing references (2012).

Read about the development of these pieces of guidance (371kb, pdf), which explains the process we undertook during the review.

You can also read the results of an audit (228kb,pdf) undertaken of the process for analysing the responses we received during the consultation.

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