Frontline staff are uniquely placed to lead in identifying gaps in the healthcare system and develop solutions. Unfortunately many entrepreneurial clinicians must choose between their training and systems improvement. Our study investigates the perceptions and impact of the NHS encouraging entrepreneurship from within its own ranks.

A systematic literature review assessed the cause and extent of the challenge. A quantitative questionnaire evaluated the views of 161 frontline HCPs including students. Seven key themes were investigated including potential benefits of entrepreneurship, awareness of programmes, and support for entrepreneurship in medical training and education.

Respondents agreed on the potential for entrepreneurship to bring about ‘reduction of healthcare costs’ and ‘improved efficiency of healthcare delivery’ across all demographics. Increased distrust of HCPs was highlighted as a drawback, as was fear of ‘financial risk’ and ‘potential brain drain’. Lack of formal infrastructure was described as leading to an increased complexity of career development pathway, and an increased risk of burnout. 52% of respondents were not aware of any of the listed entrepreneurial programmes, supporting our preliminary literature findings of low awareness. When considering who should support HCP entrepreneurs, the majority of doctors indicated a preference for it to come from the NHS alone (79%).Many students recognised the importance of entrepreneurship, yet had limited exposure and agreed that further support and education should be provided in medical schools to develop their skills for their future work as doctors.

Implementation presents a challenge because collaboration is notoriously difficult in a fragmented system. Further research is required to build on our investigations but overall we found that the NHS could unlock many benefits if it were to encourage entrepreneurship from within its own ranks and propose recommendations for its future enablement.