Intended for healthcare professionals


Bridging the gap between junior doctors and senior managers: the RCP’s chief registrar scheme

BMJ 2017; 356 doi: (Published 18 January 2017) Cite this as: BMJ 2017;356:j209
  1. Kathy Oxtoby, freelance journalist
  1. kathyoxtoby{at}


A scheme developed by the Royal College of Physicians is giving junior doctors nearing consultancy the opportunity to improve their clinical leadership skills. Kathy Oxtoby reports

The Royal College of Physicians (RCP) has created the role of “chief registrar” to let junior doctors who are nearing consultancy gain management experience while working less than full time in their normal clinical roles.

Launched in May 2016, the scheme, which is part of the Future Hospital programme, has since expanded from its original pilot. In November 2016, it became open to trusts across the UK.

Continuing in frontline clinical practice, chief registrars help bridge the gap between junior doctors and senior managers, as well as positively influencing patient outcomes, staff fulfilment and motivation, and organisational performance. The role can be taken on in or out of programme and lasts between 12 and 18 months, offering 40% to 50% protected time.

The November 2016 cohort of 22 chief registrars across 17 NHS trusts are developing practical solutions to local problems. The initiative is designed to put juniors at the heart of quality improvement and service redesign, using frontline experience to tackle some of the toughest challenges currently facing the NHS and the junior doctor workforce.

Overseeing projects relating to service redesign, workforce transformation, quality improvement, patient safety, and education and training, chief registrars are supported by a development and training programme, delivered by the RCP and the Faculty of Medical Leadership and Management.

“The role has allowed me to see the bigger picture”

Orod Osanlou is deputy chairman of the RCP (London) trainees committee, a registrar in clinical pharmacology and therapeutics and general internal medicine, and honorary lecturer at the University of Liverpool. And he has also taken on the role of chief registrar.

Osanlou heard about the scheme during his work for the RCP council. He decided to take on the role because he wanted the chance to actively improve health services.

During his interview, at Warrington and Halton NHS Foundation Trust, the senior panel, which included the trust’s medical director and its chairman, made it clear that they wanted someone who was “energetic, self motivated, and who required minimal supervision,” he recalls.

Having been appointed to the role, one scheme Osanlou introduced was designed to improve patient flow at his trust by creating a weekend discharge team.

He began a weekend ward round run by higher medical trainees, rather than a consultant, and after an eight week trial period demonstrated a saving of 78 bed days a month. He also conducted a patient satisfaction survey which showed that 100% of patients thought the weekend discharge ward round was appropriate, while 99% of patients said that it had improved their hospital experience.

Osanlou says that the role “opened my eyes to how different parts of the NHS work and allowed me to see the bigger picture. And I’ve learned how to approach problems in the NHS, how to try and solve them, and that lots of little steps make a difference.”

“A chance to change systems to make them better for you and your patients”

Emily Bowen, a specialty trainee year 7 in geriatrics, recognised the role of chief registrar would be valuable to her career. Bowen believed that her management training did not equip her for the realities of working as a consultant.

“I had a basic understanding of some of the management skills, such as quality improvement or writing a business case, but had not had the opportunity to put those skills into practice,” she says.

Bowen was contacted by a consultant she had worked with who told her about the chief registrar initiative. “I thought it sounded like an exciting opportunity, and a chance to develop skills I felt I hadn’t been able to so far, such as writing a business case.”

Having applied for the role, Bowen prepared for the interview by looking at information on the RCP website and reading documents such as the Francis Report to get up to speed with recommendations about good management in medicine.

Having been appointed to the post she admits that she has found it a steep learning curve, but it also taught her “a lot about communication skills, teamwork, and it’s given me the opportunity to get across the views of junior doctors at trust board level.”

Her chief registrar role allowed her to make a real difference to junior doctors’ lives—for example, recognising the importance of having a flexible workforce, she instigated a change to hospital rotas and now registrars work across two hospital sites rather than one.

To doctors thinking of applying for this post, Bowen believes that it is “a brilliant opportunity and a real chance to change systems to make them better for you and your patients.”


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

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