Intended for healthcare professionals

Opinion Dissecting Health

Scarlett McNally: Conferences can help talented clinical leaders to change the NHS

BMJ 2024; 385 doi: (Published 11 June 2024) Cite this as: BMJ 2024;385:q1236
  1. Scarlett McNally, professor
  1. Eastbourne
  1. scarlettmcnally{at}
    Follow Scarlett on X @scarlettmcnally

While travelling around the UK this conference season, I’ve been considering the differences between today’s conferences and those I attended over the 30 years before the covid pandemic. There’s palpable joy in watching people connect. Social media and the internet have helped to democratise knowledge, meaning that those who can’t attend in person can gatecrash electronically by following a hashtag, as presenters’ best slides and posters are displayed on social media.

The difficult bit is what happens after the conference. What we learn feels good at the time, and it all makes sense. But then the detail fades, and we’re left with the guilt of knowing what we should be doing but not being able to do it. This adds to a sense of moral injury as delegates return to their overcommitted NHS jobs.

So, how can we apply the amazing work that others present at conferences? For most initiatives it’s not the knowledge that’s important but the unspoken practicalities. We need gems of detail about how things have worked in another place or context. Only a few ideas survive the chasm1 between the early adopters and acceptance by the majority. We need clinical leaders who can take a risk by adopting innovative ideas and initiatives while incorporating their team’s views and harnessing their energy.

The NHS thrives most from this radical, inclusive type of clinical leadership. Helen Bevan—an NHS change analyst, leader, and facilitator—states that only 3% of NHS staff are the “super connectors” who drive change and allow ideas to flourish.2 We need to free up time, space, and money for our critical clinical leaders, action takers, and decision makers to allow them to focus on innovation.

Talent pipeline

I wrote recently in The BMJ that £1.1bn had been spent on clinical negligence claims in maternity care in 2022-23.3 During a recent conference that I helped to organise, a speaker told the Medical Women’s Federation about other huge amounts being spent. The NHS spends millions on non-disclosure agreements, multimillion pound payouts for unfair dismissal,45 and salaries of staff who have been suspended during lengthy disciplinary processes. So, the money exists—it’s just being spent in the wrong place. It would be better spent on secretarial support or doctors’ assistants. Supporting doctors and senior clinicians into clinical leadership would be a big win for the NHS, but to do this they need adequate time, administrative and managerial support, recognition, clear expectations, and probably role sharing—which doesn’t currently happen.

We should develop our pipeline of talented people. Looking around that conference hall of women doctors and medical students, I was struck that we don’t do enough to promote and learn from the 49.5% of licensed doctors who are women and the 53.7% from ethnic minority backgrounds.6 The NHS Workforce Race Equality Standard7 and the BMA’s report on sexism in medicine8 show that racism and sexism are rife in the NHS. Unless we encourage people from non-traditional backgrounds to apply and make the roles achievable, we’ll lose these talented people.

There are too many examples of the “glass cliff,”9 where women or people from minoritised groups are inadvertently set up to fail—but recognition and practical support would help early leaders from all backgrounds. The Medical Women’s Federation, where I’m currently president, has already suggested ways to maximise the skills of the NHS workforce.10 Promoting diversity can be challenging, and we haven’t harnessed it enough to deliver better healthcare. We could build on the practicalities in the posters and coffee break discussions between conference sessions, to transform how we deliver services.

To do that, we need to propel our key diverse talent into roles where they have the time, space, funding, and support to lead implementation of practicable ideals, such as those presented at conferences. Our patients, staff, and the UK economy deserve that.


  • Competing interests: Scarlett McNally is a consultant orthopaedic surgeon with an MBA in health service management, deputy director of the Centre of Perioperative Care, and president of the Medical Women’s Federation.

  • Provenance and peer review: Commissioned; not externally peer reviewed.