Intended for healthcare professionals


Junior doctors: tapping into leadership talent

BMJ 2015; 351 doi: (Published 21 December 2015) Cite this as: BMJ 2015;351:h5612
  1. Alex Till, psychiatric trainee, School of Psychiatry, Health Education North West (Mersey), Liverpool
  1. AlexTill54{at}


Talent management is not just about nurturing a few high flyers, says Alex Till. All junior doctors should be considered talented and their leadership potential harnessed

Developing medical leadership is of growing national interest in the NHS. However, with a chronic shortage of good leaders, establishing strong medical leadership remains one of the greatest challenges facing healthcare organisations and is exacerbated by the lack of a systematic approach to both leadership development and talent management.1

What is talent management?

When developing leadership, talent management is crucial. Talent was traditionally thought of as existing only in individuals of particular value or high potential. However, a more inclusive approach is increasingly being adopted whereby rather than a selected few, all employees are considered talented.2

A non-hierarchical definition should be adopted so that through a combination of competence, commitment, and contribution, all individuals should be considered talented.3 This non-hierarchical approach echoes today’s focus on collective, shared, or distributed leadership, which emphasises that every individual has both the potential and the responsibility to develop exemplary leadership skills.4

Engaging clinicians

At all levels, talented individuals actively seek organisations that afford them meaningful opportunities for growth and development.5 At a time when attracting and retaining top leadership talent within the NHS is challenging, organisations must develop dedicated training opportunities to engage, nurture, and develop leadership talent. However, rarely adopted, talent management largely remains rhetoric within the NHS.

Although doctors in training with high potential are occasionally encouraged by senior clinicians, they are mainly viewed as transient employees as they rotate around organisations. This short sighted view means that we are failing doctors who are willing to contribute beyond basic clinical care. Alongside inhibiting their leadership development, this attitude stifles career progression, demoralises a large and influential part of the medical workforce, weakens their commitment to the organisation, and leaves doctors in training feeling underutilised and undervalued.6 This must be overcome.

Leadership skills can (and should) be learnt.1 Doctors in training must be developed early in their careers, with leadership fostered at every level.7 Such development must be considered essential and comprise an active talent management strategy with processes designed to attract, identify, engage, motivate, develop, and retain employees.28 Successfully implemented, this strategy will be mutually beneficial to all: the individual, the organisation, and, more broadly, the NHS as a whole.9

An active talent management strategy

Organisations must overcome the conflict faced by clinicians between leadership roles and their clinical responsibilities.10 The latest evidence shows that for doctors in training a talent management strategy must incorporate time, apprenticeships, standards, feedback, and assessment.

Time—The provision of protected time away from direct patient care, similar to that offered to consultant clinicians through dedicated supporting professional activity time, should be considered essential. With service provision prioritised “time stealers,” including staff shortages and administrative burdens, inhibit leadership development opportunities for trainees as they are constantly required on the shop floor.11

Apprenticeships—Leadership development must extend beyond external courses and postgraduate education to embody an apprenticeship model.7 With 70% of learning relying on experiential opportunities, senior clinicians, and particularly those with formal leadership positions, should look to mentor or be “buddied up” with trainees (modelling a transformational leadership approach) to maximise their development and help them acquire leadership skills and behaviours.71012

Standards—Through instigating standards, the NHS Leadership Academy and Faculty of Medical Leadership and Management have taken the essential first steps towards articulating the core values and behaviours required by healthcare leaders to professionalise medical leadership.1314 These standards continue to be refined and expanded with supplementary guidance on how to help support the development of medical leadership and how individual performance can be measured. Clinical and educational providers must continue to acknowledge and emphasise the importance of leadership as an integral part of the day to day role of being a good doctor.

Assessment and feedback—Despite the Medical Leadership Competency Framework being incorporated into postgraduate training curriculums, there is no standardised approach across specialties to assess leadership skills. Overcoming this is vital. A comprehensive and systematic approach to leadership development and assessment must be formally adopted. Implemented throughout training, leadership standards should be incorporated into appraisal, revalidation, and annual review of competency progression for trainers and trainees respectively, as an integral part of the process.

Regulation—The standards for clinical leadership and its development should be upheld and incorporated into existing systems of quality assurance. This should form a core part of a well led service and should be monitored and regulated by the Care Quality Commission.7

The path ahead

Leading and managing within the NHS is now harder than ever as it becomes an increasingly complex organisation.1 All doctors, whether or not they hold formal leadership roles, need to be able to show leadership skills. Doctors in training must take responsibility for their own leadership development and for the degree to which they engage with their organisation, viewing themselves as a powerful agent for change who relishes and seeks opportunities to lead.15

However, it can be difficult for junior doctors, as transient employees, to understand the culture and informal networks within trusts while maintaining clinical practice. The organisations who train doctors and for whom they work must proactively provide a supportive environment, nurturing and guiding them towards development opportunities.

Talent management must progress beyond rhetoric within the NHS. It must be proactively addressed and nurtured by both local and national organisations equivocally across specialties. Developing leadership and establishing a culture of collective leadership must be considered essential if we are to be successful in developing strong clinical leaders throughout every level of NHS healthcare.


  • Competing interests: I have read and understood BMJ’s policy on declaration of interests and declare that I have no competing interests.