• medical leadership
• professionalism
• health policy

The UK has been on an interesting 35-year journey with regards to the role of doctors in healthcare leadership. Recent history begins in 1983 with a seminal report by the late Sir Roy Griffiths,1 deputy chairman of the food retailer Sainsburys for the Thatcher Government. In a very succinct document, Griffiths stated that ‘[doctors’] decisions largely dictate the use of all resources and they must accept the management responsibility which goes with clinical freedom’. He suggested medical ‘involvement in securing the most effective use and management of all resources’ and crucially went on to recommend ‘The nearer that the management process gets to the patient, the more important it becomes for the doctors to be looked on as the natural managers’.

Griffiths’ call for medical leadership was not widely welcomed by the profession, and while the number of medical specialties was expanding and new medical colleges emerging, there was, until relatively recently, no such formal recognition of medical leadership and management by the profession. It is hard not to see this as an error of judgement and a significant factor in subsequent diminution of the influence of doctors in the UK. This was recognised in a speech in 2016 by the then Secretary of State for Health2 who argued that the UK is an international outlier: ‘… what is striking when you look at the pool of potential NHS leaders of the future is just how few have a clinical background’. Controversially, he went on to say ‘we should today ask whether the NHS made a historic mistake in the 1980s by deliberately creating a manager class who were not clinicians rather than making more effort to nurture and develop the management skills of those who are’. It …