“Doctors need to step up”—why are there still so few medical chief executives in the NHS?

When Navina Evans, a consultant psychiatrist at East London NHS Foundation Trust, was asked by the trust’s chief executive, the forensic psychiatrist Robert Dolan, to consider starting the journey potentially to take his place, she was taken aback.

Evans was fulfilled in her clinical work and told The BMJ that it had “never occurred to her” as a possibility. After thinking it over, she told Dolan that her answer was no. “Go away, think again, and come back with a different answer,” he replied.

She remains “so very grateful” that she did. Dolan’s instincts for talent were right: after spells as chief operating officer and deputy chief executive, Evans succeeded him in 2016. For the past two years she has been named second most influential chief executive in the NHS by the Health Service Journal.1

She has a strong message for doctors who feel how she once did. She finds it sad when she watches Question Time, reads Twitter, or goes to dinner parties and hears doctors talk about how awful working in the NHS is. “Doctors need to step up,” she says. “We need to come together and believe that we can actually make a difference and change the narrative.”

The number of clinical NHS chief executives is growing. In one survey of 129 NHS chief executives in England 8.3% of those appointed before 2015 were medically qualified, but in 2015-17 the proportion had grown to 10.5%.2 In a later survey of 78 chief executives a third were clinically trained, mostly as nurses and doctors, with a few as pharmacists and other health professionals. …