Learning from afar

I am an Australian public health physician working as Director of Medical Services at a medium-sized public facility in Newcastle, New South Wales. As well as its university teaching hospital role, the Calvary Mater Newcastle is the tertiary cancer care and research centre for a population of about 900,000 people spread across an area the size of England (providing more than 300,000 outpatient services annually). Local primary care organisations, our hospital and the wider public health authority are working together to better integrate health care services for our community. 

I became a member of the Faculty of Medical Leadership and Management (FMLM) in 2013, and in 2014 a Fellow of its antipodean counterpart in training for medical leadership – the Royal Australasian College of Medical Administrators (RACMA). In June this year I travelled to the UK keen to understand how other health systems are being redesigned in response to the pressing imperatives of an ageing population, community expectations, disjointed health care delivery, constrained resources and unequal health outcomes, and how doctors are being trained to meet those challenges. While in the UK, I met with FMLM, the North West London Whole Systems Integrated Care team, GP leads in Shrewsbury and medical leaders, improvement experts, workforce managers, service planners and third sector innovators in Edinburgh, Fife and Glasgow.

In all my discussions there were at least three topics in which FMLM was key and which I believe could influence thinking in Australia. These concerned valuing medical leadership, the structure of the National Medical Dierctor's Clinical Fellow Scheme, and professional standards and certification of medical leaders and managers.

Recognition of the role and value of expert medical leadership

I understand that in the past few years NHS England took steps to ensure that medical leaders had national roles in being part of the solution to the challenges facing the NHS. In Australia RACMA is working to get that level of inclusion of trained medical leaders at the policy and quality top table. However there seems less appreciation about the roles trained medical leaders can have, such as in brokering clinician engagement to effect the system re-design required to meet the looming challenges of the coming decades. There is worry that the lack of investment in medical leaders in strategic roles across Australia will undermine the efforts of many to implement the approaches and services needed to deliver the outcomes patients and their carers want.

Training for medical leadership – the National Medical Director's Clinical Fellow Scheme

In Australia and New Zealand having consultant-level skill in medical leadership and management is recognised as a specialist qualification, awarded as a Fellowship of the RACMA after rigorous examination against a comprehensive set of competencies. Alternatively, a doctor already a specialist in their own field or with management experience can undertake a year of coordinated training modules and be awarded an Associate Fellowship.

However, there is as yet nothing on offer by RACMA equivalent to the National Medical Director's Clinical Fellow Scheme. I think there may be great merit in young doctors in training being funded to take a year out of their clinical training to experience and learn in health system settings while being mentored as emerging leaders, producing at least one project outcome during their post. Like in the UK host organisations could include hospitals, health services, health insurers, non-health sector organisations, and peak health bodies, potentially with graduates being awarded the Associate Fellowship RACMA upon completion. I could see a time when registrars in Australia and New Zealand are seeking qualifications and experience in medical leadership to give them an edge on their resume in their bid for consultant positions. I have started discussing this idea with the President of RACMA, Dr Lee Gruner.

FMLM medical leadership and management standards

I was most interested to learn about and read the Leadership and management standards for medical professionals, launched in February. I understand also that work is underway to develop a process to assess and award levels of certification to medical leaders and managers against the standards.

Essentially in Australia and New Zealand RACMA already does this in the Fellowship exam, and supports training of clinical leaders in the AFRACMA programme also. But I do wonder if there is potential for a third way: a college-based credentialing program which reviews a person's credentials as presented, assesses those credentials against the RACMA competencies, and certifies on a one-off basis that a person has achieved a certain level of medical leadership capability. It appears to me that FMLM may well become the go-to organisation for a clinician or employer seeking to qualify a doctor’s leadership capacity, and I think opportunity exists for my own college to have a similar function. RACMA is an expert organisation regarding health system clinical leadership training and management, and just as FMLM has done, such a programme could fill a leadership accreditation gap among our medical colleagues and other organisations. 

I am so grateful for the time so many people gave to meet and speak with me, and the hospitality shown to me. I will reflect for some time on all I learnt about the NHS, the role of the third sector, clinical engagement, and new models of care for vulnerable people. I have started to tell others about numerous clever ideas to address seemingly universal challenges. I am sure that I (and Australia!) could learn a great deal from our colleagues in the UK and I look to continuing to learn from afar (while hoping to return soon). 

Special thanks to:

• The FMLM team, including Dr Jane Povey, Donna Hickford and Kirsten Armit
• The North West London Whole Systems Integrated Care team
• NHS Education for Scotland Programme Director Dr Stuart Cable and colleagues I met in Scotland.