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16 October 2017
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Want to improve the NHS? Just ask a junior doctor

The junior doctor years are a vital juncture in the professional and personal development of any clinician.  These years determine who these individuals will be, as professionals, consultants, general practitioners and future healthcare leaders. They provide not only a unique contribution to the care and management of patients in the NHS but have the potential to be a crucial force in the shaping of the future of healthcare.  Over the past two years, I have had the privilege of witnessing first-hand the work of committed, motivated doctors pushing boundaries and transforming patient care across the UK.

As chair of the Faculty of Medical Leadership and Management’s Trainee Steering Group (TSG) I am consistently impressed and genuinely humbled by the drive of committee members to support other trainees’ development in leadership and management. TSG members organise events and conferences, create free training and education resources and run trainee surveys and focus groups.  Junior doctors at all levels embrace the opportunity to work closely with senior leaders motivated by a genuine desire to improve the systems they work in and provide others with the tools to do the same. 

Another example is the Royal College of Physicians and FMLM’s Chief Registrar scheme where junior doctors have led significant service reconfigurations, improved patient care and experience, saved hundreds of thousands of pounds and demonstrated tangible improvements in morale and standards of training within their units.1 Stepping into these new positions demonstrates enormous courage. Darzi Fellows, regional leadership fellows and quality improvement fellows across the UK are driving forward innovation and advances in the delivery of patient care.  The Chief Pharmaceutical Officer's Clinical Fellow scheme which launched in 2016 sees early career pharmacists and doctors work together seamlessly developing novel solutions to problems, supporting each other’s professional development and demonstrating in a very tangible manner the benefits of inter-professional working.

As I lead focus groups with junior doctors across London, I have met with a range of trainee and trust doctors. These junior doctors strive to be exceptional professionals, to improve their places of work, to teach and train others, and to contribute to research, innovation and the advancement of medicine.  Through my roles, I have also had the opportunity to visit a number of trusts, one of these visits unintentionally coincided with last year’s junior doctor industrial action.  The drivers for the strike action were exceedingly complex and are not the subject of this article.  What was clear on that day, however, was unwavering support for colleagues, an aspiration to create a working environment where the needs of patients are best served and an unshakeable commitment to the ideals of a national health service.

Working in an environment where there can be little or no recognition of your contribution can be difficult. The drive for efficiency in the NHS is a necessity in times of spiralling healthcare costs but can be demoralising for staff working at the edge of their capabilities.  In addition to the external challenges we face daily, there are the internal conflicts which we must also learn to manage.  The unexpected death of a patient, the mistake we wish we hadn’t made and the inherent vulnerability of occupying a profession, which despite our best efforts, invades our consciousness long after the shift has ended. None of this is easy.

For me, I have found my roles as chair of the TSG and clinical fellow at the RCP and FMLM life changing.  While I know there is more to learn I feel much better equipped to meet the challenges that lie ahead. I understand better how to make positive, sustainable changes and influence the systems in which I work.  I have been fortunate to gain experience in raising capital, controlling budgets, managing projects to completion, creating critical new relationships and developing skills in influencing and negotiation.  Simple things like learning how to chair a meeting or how to run a workshop have enabled me to be significantly more effective. Alongside developing the technocratic skills, I have benefitted unequivocally as a person, and a professional, from the mentoring I have been fortunate to receive.  The graciousness, respect and honesty of these relationships have enabled me to navigate difficult and challenging situations.

For junior doctors to be genuinely influential in shaping the future of the NHS, I believe it is critically important that we open these opportunities to all, whether it be through research, leadership, health informatics or medical education.  Supporting this talented, committed and passionate group of professionals to have a real say in the running of our health service is essential for all healthcare leaders.  In turn, it is our responsibility as junior doctors to step up, take on those challenges and advocate for the best quality of patient care at all levels in the system. 

While I have attempted to summarise my experience, what is described here is just the tip of the iceberg.  Every day, tens of thousands of junior doctors work with colleagues to deliver the highest standards of care, demonstrating empathy and compassion, knowledge and expertise and respect and dignity for those in need.  A critical priority for healthcare leaders must be to develop the systems and processes through which these individuals can be supported to reach their greatest potential.  I leave you with the words of one of the significant leaders of our generation who highlights the benefits of meaningful engagement.  

Young people will always manage to achieve the impossible - whether that is on the football field or inside a company or other big organisation. If I were running a company, I would always want to listen to the thoughts of its most talented youngsters, because they are the people most in touch with the realities of today and the prospects for tomorrow.

              Alex Ferguson


  1. Exworthy, M. and Snelling, I. (2017) Evaluation of the RCP’s Chief Registrar programme, Available at: (Accessed: 16 October 2017).


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About the author

Judith Tweedie's picture

Judith Tweedie

Jude is the Chair on the FMLM Trainee Steering Group. She was a National Medical Director's Clinical Fellow with FMLM and the Royal College of Physicians of London.

Jude trained in cardiology and general internal medicine in Belfast, Northern Ireland. Alongside general training, she also undertook advanced specialist modules in echocardiography and cardiac magnetic resonance imaging.

Jude completed her undergraduate medical degree at the University of Aberdeen. During this time she attained an intercalated degree researching novel techniques in the diagnosis of paediatric asthma. Foundation and core training were undertaken in Glasgow and Edinburgh before returning to Belfast for registrar training. 


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