Following the launch of the GMC’s Medical professionalism matters report, our Chair Prof Terence Stephenson reflects on the crucial role of doctors as leaders in protecting and promoting professionalism.
Given that medicine is a profession – that is, a highly trained group of people who others come to for advice, given without fear or favour – it has to be independent in order to provide the service patients expect.
That being the case, the profession must be led by its members. There are examples all around us where professions have had that taken away. Being a teacher used to be a more highly respected profession, but now looks like it is led by OFSTED. Bankers were once respectable members of society who you would turn to for advice. Now it seems that their professional life is determined by the tabloids.
So who leads our profession? My problem with that question is that it implies that doctors are passive. Clearly that’s not true; the medical profession is comprised of highly-trained specialists, heavily invested in their own training and development, who make life and death decisions every day, often based on grey data. These are not passive people. To a large extent every doctor plays a leadership role every day.
For me, there are five ways in which doctors can lead.
• National leadership: How do we rise to the challenge of one of the toughest years on record for the NHS? Several institutions have a role to play, from trade unions and regulators to Royal Colleges – but it will be about how we come together in harmony.
• Local leadership: Doctors need to be on the ship navigating the storm, not shouting about rocks from the clifftops. We can all predict the service going to hell in a handcart and most clinicians have argued for service reconfiguration for a decade or more, but it will be interesting to see how medical leadership fares against ‘NIMBYism’ when the sustainability and tranformation plans (STPs) are published. And yet doctors are natural problem solvers – we need to start devoting some of that energy to solving problems locally in the way we work.
• Clinical leadership: Walking the walk. Do I treat my trainees and students with respect? How do doctors of my generation treat women and BME staff grade doctors? As leaders we must all safeguard public trust in the profession. It is precious and can be easily lost, and once lost it cannot be recovered.
• The leaders of tomorrow: We need to start thinking about what we’re doing to these sparky, enthusiastic medical students who we’ve knocked the fizz out of by the time they’re an F1. At UCL I have seen lesson plans and presentations from students that can teach doctors with decades of experience about complex subjects like child protection. We need to harness that – these will be tomorrow’s consultants and leaders.
• Crisis leadership: Hippocrates defined ‘crisis’ as the turning point in a disease, when fever broke. Never waste a burning platform. Yes, we’re in a difficult moment but let’s talk about solutions. An adequately funded health service is crucial of course, as is 1,500 new doctors in ten years’ time. But there are other solutions: we can work smarter with better IT, maximise doctors’ talents by freeing them up from administrative tasks, and look at how primary and secondary care can actually click.
These changes require doctors to shape and lead transformation, not stand on the side-lines pining for the halcyon days that never were. As a trainee in the 1980s there was little formal teaching, minimal supervision, no appraisal or mentoring, brutal hours and less visible consultants than now.
Together, as a profession, let’s lead and help create a better NHS.
Prof Terence Stephenson originally delivered this speech at the GMC conference on 6 December 2016.