How clinical leadership makes a system

This week at IH, we delved into the NHS England archives and listened in to a podcast series focusing on integrated care systems.

A podcast entitled ‘How clinical leadership makes a system’ caught our attention, featuring a panel of speakers including (at the time of recording) Dr Amanda Doyle, GP and leader of the Lancashire and South Cumbria ICS, Professor Des Breen, medical director for South Yorkshire and Bassetlaw ICS, and Andrea Mann, one of a group of nurses appointed as a primary care network clinical director.

Here, we’ll take a look at some of the topics explored within the podcast.

Why does clinical leadership make a difference in an organisation?

Andrea said: “Clinical leadership is key, as it is really different to a management role. It’s about understanding patient population needs, tailoring the services we deliver, bringing in clinical expertise and experience and bringing together different skill sets as a team. This facilitates added value from clinical leaders, closeness to patients and communities, and ability to gain insights around how the system impacts people at all levels.”

Des commented: “I think our leadership community should be both clinical and non-clinical as each one brings a new skillset to the equation – although we’re focusing on PCNs, clearly leadership is at all levels of the system, from general practice to community pharmacy, to a PCN level, place level and ultimately to an ICS. I’ve been working in the health sector since 1983 and [the formation of ICSs] is the biggest change I have ever seen in terms of actually ‘doing the right thing’ in terms of concentrating on population health management, tackling inequalities and examining the wider determinants of health.”

“This is the biggest change I have ever seen in terms of actually doing the right thing…”

Des added that ICS working “requires huge change in the behaviours, in both the non-clinical and clinical community, to deliver that change; re-designing the delivery of care and care pathways across borders in a way we have never done before. We need to make our workforce more digitally enabled than ever before.”

Getting a variety of roles involved in leadership

Des said: “I think we just need to give people permission… It is so crucial that this clinical leadership should be seen as multidisciplinary, because it is the way we are going to re-define pathways and the way we design care. The focus needs to shift to competency vs traditional clinical roles.”

Amanda noted that there is now recognition around the need for different roles and skillsets to deliver care.

“We’ve seen some of the clinical templates which have been designed by non-clinical teams which have not worked,” she said. “It’s about finding the balance and working differently with different people to get the best out of them, the best skills and an end product – whether that’s a new pathway, a new template, service, etc. It’s not just one person leading, it’s a whole team approach. 

Amanda added: “When we talk about the population health management approach, a big part of that is to change the way people work. To do that, you’ve got to be able to engage clinicians effectively. It helps if you speak the same language and understand the challenges they are facing. Clinical leaders can really add value in that culture change and engaging other clinicians in looking at things differently.” 

On his own leadership experience and the changes he saw at the start of the ICS journey, Des said: “I don’t think the health and social care sector has been very good, traditionally, at trying to select its leaders and manage their talent. Systems now are trying to do that better. As far as development is concerned, we have to give them the time and resources to do that. We’ve got to put in mechanisms to develop them both at a system level – so they understand this new way of working – but also to develop them as individuals. Particularly in primary care, we’ve got some very varied individuals with a wide spectrum of experience from different backgrounds. The challenge is to tailor support to the diverse workforce otherwise we will fail.”

Andrea said: “Also, having a good career pathway is important – some areas in the system have really good pathways and really do support their workforce and actively encourage them to develop their skills, training from external leadership. Some areas still have quite isolated workforces and have no exposure to the external meetings that are going on and limited chances to network with other leaders, or to seize some of the opportunities that are out there.”

How do we ensure there are good leaders?

Des commented: “Development needs will be different at different parts of the system, so if you’re working say at an ICS level, the skillsets are very different. It’s about how we harness and develop that… how we manage talent, clinical and non-clinical in a different way, because not everyone is suited to the same things. Leadership is not linear.

We need to be able to select leaders, develop them in a multitude of ways and make sure that they are given objectives and support. It’s about coaching and mentoring, buddying arrangements, giving them different options and admin support, supporting them when things don’t go right. It’s also about having a proper exit strategy for leaders should they feel the role is not right for them.”

Amanda added: “Connecting them to the right people is key – having someone in the system that you can put them in contact with if they are needing support. Early on in your career, it can feel daunting and the language is very complex. Debriefing after these meetings to understand what things mean, what has been discussed and how will this affect them in their roles will help them to grow in confidence.”