National Medical Director’s Clinical Fellow Scheme 2018/19

Information Pack

December 2017

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Contents

Overview of the scheme Page 3

Eligibility criteria Page 4

Selection criteria Page 5

Application guidance Page 8

Recruitment timetable Page 11

Host organisations Page 12

Frequently Asked Questions (FAQ) Page 14

Additional reading material Page 19

Personal reflections from clinical fellows Page 21

Contact us Page 26

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Overview of the scheme

Thank you for your interest in the National Medical Director’s Clinical Fellow Scheme. The scheme is now in its eighth year and has had the privilege of supporting over 170 aspiring medical leaders during this time. The scheme is sponsored by the National Medical Director and is managed by the Faculty of Medical Leadership and Management. Clinical Fellows work in an apprenticeship model to the most senior personnel in national NHS and healthcare-related organisations. This offers an unparalleled experience and the opportunity to develop a range of skills including: policy development, project management, research and analysis, writing and publishing.

“An unbeatable experience for the senior medical leaders of tomorrow”

Posts are located in and around London and in the North of England and are selected through a single recruitment process, details of which can be found overleaf. Successful candidates will attend a comprehensive induction programme to prepare fellows for their year ahead and are supported by action learning sets across the year. Building on the strong links of previous fellows, Clinical Fellows will gain opportunities for joint working with fellows from UK wide counterpart schemes in Wales, Scotland and Northern Ireland and across other disciplines. Clinical Fellows work collaboratively on projects throughout the year and to organise ad hoc events to meet prominent figures and arrange visits for colleagues to their host organisations to share learning. Posts commence on 1 September 2018 and run for one year. Clinical Fellows are responsible for negotiating a secondment from their current employer to the host organisation. It is wise to negotiate this as early as possible upon appointment. FMLM accepts no responsibility for any contractual arrangements. Full details can be found within this information pack. For more information about the scheme, you can sign up and join past and present clinical fellows for a webinar to hear about their experiences - details regarding this can be found on the FMLM website. With best wishes,

Peter Lees Chief Executive and Medical Director

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Eligibility criteria

Essential criteria Evaluation stagei Qualifications CV Applicants must have: • MBBS or equivalent medical qualification Eligibility Application form

Interview Applicants must: • be eligible for full registration with, and hold a current licence to practiseii from,

the GMC at time of intended start dateiii • have 12 months’ experience after full GMC registration, and evidence of

achievement of foundation competencies with resultant award of a FACD5.2 or equivalent, in line with GMC standards / Good Medical Practice by intended start dateiii

• must not have completed specialist training by intended start dateiii (GP trainees please see FAQs on eligibility)

• be eligible to work in the UK or participate in this scheme according to visa requirements

Fitness to practise References CV Applicants will be:

• up to date, fit to practise safely and aware of own training needs Language skills Application form

Interview Applicants will have: • demonstrable skills in written and spoken English, adequate to enable effective

communication • undergraduate medical training undertaken in English; or the following scores

achieved in the academic International English Language Testing System (IELTS), in a single sitting, no more than 24 months prior to the date of application: o overall 7.0, Speaking 7.0, Listening 7.0, Reading 7.0, Writing 7.0

• adequate communication skills, but where evidence is not in one of the above forms, alternative supporting evidence of language skillsiv must be provided

Career progression Application form Interview Applicants must:

• be able to provide complete details of their employment history • have evidence that their career progression is consistent with their personal

circumstances • have evidence that their present level of achievement and performance is

commensurate with the totality of their period of training • have not previously resigned or been removed from a post or programme Application completion Application form ALL sections of the application form completed FULLY according to written guidelines.

i ‘When evaluated’ is indicative, but may be carried out at any time throughout the selection process. ii The GMC introduced the licence to practise in 2009. Any doctor wishing to practise in the UK after this date must be both registered with and hold a licence to practise from the GMC at time of appointment. iii ‘Intended start date” refers to the date at which the post commences, not (necessarily) the time an offer is accepted. For 2018/19 posts this will be 1 September 2018, unless a different start date is specifically indicated in advance by the employing organisation. iv An example of alternative evidence could be testimony from a clinical/educational supervisor, in the form of a signed letter (this will be subject to review by any organisation to which you apply).

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Selection criteria

Essential criteria Desirable criteria When evaluated Qualifications (as above) Additional related qualifications,

e.g. intercalated degree, BSc, BA, Masters, MBA, PhD, BMedSci or equivalent

CV Interview

Academic / Professional • Primary medical qualification • Full registration with GMC • Doctor in, or eligible for, training • Must have completed both years of

foundation training by intended start dateiii • Must not have completed specialist training

intended start dateiii (GP trainees please see FAQs on eligibility)

• Academic Publications/presentations

• Academic prizes, distinctions, first-class degrees

CV Interview

Leadership and management • Evidence of involvement in leadership and

management commensurate with experience, with reflection on personal impact

• Demonstrates an understanding of NHS management and resources

• Evidence of effective team working and leadership, supported by multi-source feedback or other workplace based assessments

• Interest in/knowledge of the importance of leadership and management for clinicians, understands and applies FMLM standards for leadership and management

• Evidence of achievement outside of medicine

• Evidence of effective leadership in and outside medicine

• Evidence of altruistic behaviour e.g. voluntary work

• Evidence of organisational skills – not necessarily in medicine

Application form CV Interview Reference form

Quality/Service Improvement/Audit • Evidence of involvement in quality

improvement or completed audit cycle which:

o has had an impact o focused on patient safety and clinical

improvement • Good knowledge of the English healthcare

system including education, research, service provision, regulation, career structures, medical politics and ethical issues

• Demonstrates understanding of the basic principles of audit, clinical risk management, evidence-based practice, patient safety, and clinical quality improvement initiatives

• Interest in/knowledge of the delivery of safe effective healthcare services

• Evidence of publications/presentations/ prizes in quality improvement

• Experience of using quality improvement tools to deliver measurable quality improvement

• Quality improvement project exhibits innovation in challenging situations

• Clear insight into issues facing English healthcare services

• Understanding of population health

• Experience of guideline or policy development

Application form CV Interview Reference form

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Education and Teaching • Evidence of interest in/experience of

teaching • Evidence of feedback for teaching • Evidence of interest in/experience of

coaching and mentoring

• Attendance at teaching courses • Evidence of regular teaching or

formal teaching roles • Organisation of teaching

programmes • Evidence of regular coaching or

mentoring • Attendance at coaching

training

CV Interview Reference form

Skills • Quick to understand new information and

adapt to new environment • Clarity of thought and expression • Demonstrates basic computer literacy,

including electronic communication • Communication skills:

o demonstrates clarity and prioritisation in written/spoken communication

o capacity to adapt language to the situation, as appropriate

o able to build rapport, listen, persuade and negotiate.

• Problem solving and decision making: o capacity to use logical/lateral thinking to

solve problems/make decisions, indicating an analytical/scientific approach

• Writing experience: o clinical and/or non-clinical

topics o peer reviewed publications

and/or other communication medium (e.g. blog, letters etc.)

• Experience of presenting complex information

• Leadership skills gained within the NHS or elsewhere

• Demonstrates information technology skills

Application form CV Interview Reference form

Personal • Shows initiative, drive and enthusiasm (self-

starter, motivated, shows curiosity, initiative) • Commitment to personal and professional

development • Seeks and acts on feedback regarding own

effectiveness and areas for development • Reflects on past performance, and applies

learning to current practice • Managing others and team involvement:

o able to work in multi-professional teams o ability to show leadership, make

decisions, organise and motivate other team members; through, for example, quality improvement and completed cycle audit projects

• Organisation and planning: o capacity to manage/prioritise time and

information effectively o evidence of thoroughness (is well

prepared, shows self-discipline/commitment, is punctual and meets deadlines)

o capability to work with long time scales

• Achievements outside of medicine

Application form CV Interview Reference form

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for delivery within agencies with differing priorities

• Coping with pressure and managing uncertainty: o capacity to operate under pressure o demonstrates initiative and resilience to

cope with changing circumstances Probity – professional integrity • Demonstrates probity (displays honesty,

integrity, aware of ethical dilemmas, respects confidentiality)

• Capacity to take responsibility for own actions

Application form Interview Reference form

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Application guidance

Application stage

Applications must be received online by 17:00 on Thursday 18 January 2018. Applications received beyond this time will not be accepted.

To apply, please visit the clinical fellow scheme webpage. Your application must consist of submission of both the following evidence:

• Online application form • CV Online application form – Candidates will provide personal and professional information. Candidates should refer to the person specification in this document and the FMLM leadership and management standards for medical professionals when answering all questions.

CV – This must be no more than 3 sides of A4 in length (minimum size 11 font), and must include the contact details of 2 referees. CVs longer than 3 sides will NOT be marked and will NOT contribute towards your shortlisting score. Please ensure you remove photos from your CV.

Notes: • Successful candidates should be able to express important information concisely. Your CV and

application answers will be scored based on the person specification provided. • All criteria will be judged appropriately against each candidate’s career level. Evidence will be

sought to support possession of the criteria outlined in the person specification through the application form, CV, interview and references.

• Shortlisting is conducted against rigorous criteria and is undertaken anonymously. • For FMLM members – please ensure that you do not unsubscribe to bulk emails. This will prevent us

from sending you correspondance regarding your application.

Data protection

The data we collect is held by the National Medical Directors Clinical Fellow Scheme (a joint partnership between the Faculty of Medical Leadership and Management (FMLM) and NHS England. The information you supply, including, where relevant, sensitive personal data relating to you will only be disclosed to other individuals and organisations for the purposes of running and administrating the scheme. FMLM will only share your information to individuals and organisations involved in the running and administration of the scheme.

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Interview stage Interviews will be held in central London on 13-14 February 2018. Please ensure that you are available to attend an interview on either date, no alternative dates will be offered.

Ahead of the interview:

• You will be asked to complete your post preferences before interview. Please note that due to the competitive nature of the scheme, you should only rank placements you are prepared to accept as it may mean that you need to relocate. We are unable to facilitate changing posts or moving between a North and South of England post.

• You must bring the following supporting material on the day of your interview: o two completed reference forms in hard copy format. A structured form will be provided to

shortlisted candidates. Referees should be choosen as follows: one from your current or most recent employer and the other can be of your own choice.

o a passport photograph of yourself. o written consent of OOPE from your TPD (or equivalent) that OOPE will be supported/approved

for the purpose of participating in this scheme.

At the interview: • The interview process will last for approximately one hour and is comprised of:

o a scenario task; and o a question and answer based panel interview.

Please note: The scenario task will not be released to candidates in advance of the interview. Also, if directly contacted, current Clinical Fellows will not discuss any specifics or provide additional details around any part of the selection process.

Offers will be made as soon as possible following the interview process, after which formal secondment arrangements can begin. Posts will commence on 1 September 2018.

Important note: Out-of-programme experience

• Applicants currently in training programmes must inform their respective Local Education Training board (LETB) or Deanery and Trusts of a possible out-of-programme experience on application to this scheme to allow timely conversations regarding arrangements for secondment.

• You will need to confirm that you have discussed possible out-of-programme experience with your Training Programme Director (TPD) on your application form.

• Applicants that are invited to interview are required to bring written approval of out-of-programme experience.

Please note that FMLM will not participate in the arrangement of out-of-programme experience, candidates are expected to facilitate this directly with their LETB/Deaneries.

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Post-Interview arrangements In most cases, the fellowship will be arranged as a secondment from your employing organisation as an out-of-programme experience (OOPE). Those in training programmes – successful candidates currently in training programmes must inform their respective Local Education Training board (LETB) or Deanery and Trusts of a out-of-programme application immediately on appointment to the scheme to allow timely conversations regarding arrangements for secondment. Successful candidates should contact their nominated HR leads to notify them of appointment and need to arrange a secondment contract. Those NOT in training programmes/completed foundation training YR2 without a successive training post – successful candidates who are not currently in training programmes and will not require OOPE will need to negotiate a secondment contract with their current employers. This may involve a contract extension for one year for the purpose of facilitating a place on the scheme. If this is not possible, it is the successful canddiates responsibility to make every effort to find an alternative arrangement and ensure negotiations with the relevant organisations.

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Recruitment timeline

The recruitment timeline* for the 2018/19 scheme is as follows:

Dates* Stage

6 December 2017 Applications open 11 January 2018 ‘What’s it all about?’ Webinar 18 January 2018, 17:00 Applications close 26 January 2018 Candidates notified of shortlisting outcomes w/c 5 February (TBC) 2018 Host Evening 9 February 2018 Candidates to submit post preferences 13-14 February 2018 Interviews 19 February 2018 Candidates notified of interview outcomes March – July 2018 Contract arrangement window 1 September 2018 (annual start date regardless of weekday)

Fellowship commences

3, 4, 5, 10, 11, 12 September 2018 Induction Programme

*some dates may be subject to change

Candidates should ensure they ‘save the date’ for attending the Host Evening and Interviews in case of being shortlisted. Both are critical events in the recruitment process.

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Host organisations and posts

Host organisations

The scheme provides doctors in training with the unique opportunity to spend one year working with the most senior executives in leading national healthcare-affiliated organisations.

Posts are predominantly located in and around London with some posts based in the North of England. A list of host organisations for 2018/19 is provided below for information. This list is not exhaustive and final host organisations and posts will be confirmed in January 2018.

Host organisations for 2018/19 Location

BMJ London BUPA London and Leeds Care Quality Commission (Primary Care) London Care Quality Commission (Secondary Care) London Department of Health London Ernst and Young London General Medical Council London or Manchester Health Education England London, Leeds Health Foundation London Health Select Committee and National Audit Office London Macmillan Cancer Support London NHS England London NHS Improvement London NICE London, Manchester

Posts

The nature of each post will change from year to year depending on each host organisation’s workstreams. Job descriptions will be released to shortlisted candidates. Some hosts may provide further information, after the host evening takes place, via a webinar which we will signpost applicants too.

Shortlisted candidates will be invited to a Host Evening, whereby they are able to meet and hear from leaders of each host organisation to find out more about the organisation and opportunities for clinical fellows.

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Post preferences

• Shortlisted candidates will be asked to rank the host organisations that they would be prepared to work at prior to the interview after recieving job descriptions and the Host Evening.

• If successfully appointed, there will then be a matching process based on performance at interview and ranking preferences. You will only be offered the post that you have been allocated, there is no scope to change your post so you must consider your preferences carefully before you submit these.

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Frequently Asked Questions (FAQ)

Eligibility

1. I am approaching or just past my CCT date – am I still eligible to apply? The scheme is open to doctors in training who have completed both years of foundation training by 1 September 2018. Applications from all specialties are welcome. You are eligible to apply providing you have full GMC registration and do not expect to gain CCT around or before 1 September 2018. Candidates who have completed their training by 1 September 2018, regardless of the number of years of training they have undergone, are not eligible for this scheme. You must clearly state your expected CCT date on your application.

2. I am a GP with three years training. Do the CCT eligibility criteria still apply to me? We would encourage GPs to apply to the scheme. Those at ST1/2 and those at ST3 with an expected CCT completion date around or before 1 September 2018 are eligible to apply. Please note that if successful, an appointment to the scheme during ST1/2 would extend training at the grade they have reached and this would also apply at ST3 to ensure completion of the scheme within the training envelope.

3. I am a Foundation Year 1 doctor. Can I apply? Unfortunately, you are not eligible to apply, as you will not have gained your Foundation competencies (certificate FACD 5.2) before 1 September 2018. We hope that you do consider applying for the scheme in future years.

4. I do not have a medical degree. Can I apply? This scheme is only open to applicants with a primary medical qualification, in training and full GMC registration.

5. I am a dentist, can I apply? This scheme is only open to applicants with a primary medical qualification, in training and full GMC registration at this time. Dentists may wish to consider other opportunities such as the Chief Dental Officer’s Clinical Fellow Scheme, more information about this scheme can be found on the FMLM website.

6. I am in public health, can I apply? If you are in training, hold a primary medical qualification and full GMC registration then you may apply.

7. I am an SAS doctor, can I apply? This scheme is open to doctors in training, with a primary medical qualification and full GMC registration by 1 September 2018.

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8. I am a doctor, but am currently not in a training programme. Am I eligible?

The scheme is open to all doctors on a UK recognised training scheme who have completed both years of foundation training or equivalent by 1 September 2018 across all specialties. This can include candidates currently out-of-programme, e.g. pursuing a higher degree. You are eligible providing you have a primary medical qualification, full GMC registration and do not expect to get a CCT on or before 1 September 2018. We ask candidates to clearly state their GMC number and CCT date on the application. If successful, you will be seconded from your current Trust/employer (or the Trust that would employ you from September 2018). If this is not possible, it is your responsibility to make every effort to find an alternative arrangement and ensure negotiations with the relevant organisations. In previous years this has proved effective, so this should not deter you from applying to the scheme.

Training

9. I am currently applying for a training post that starts in August. What should I do? You should continue with that application in parallel to this one. If you are successfully appointed as a clinical fellow, you may find yourself in the difficult position of having to give up the training post. You will then need to contact your deanery to discuss either resigning from your clinical post, or possibly deferring it under exceptional circumstances. Please be advised that if you are successfully appointed as a Clinical Fellow and you choose to give up a training post, you will have to re-apply the following year.

10. I have a clinical training post. Would I have to give this up? This depends on your stage of training and your deanery regulations. The Gold Guide stipulates: “The start of training may only be deferred on statutory grounds (e.g. maternity leave, ill health)” (section 6.19) and that time out-of-programme “OOP will not normally be agreed until a trainee has been in a training programme for at least one year of training (unless at the time of appointment, deferral of the start of the programme has been agreed for leave on statutory grounds)” (section 6.97). Hence trainees entering the first year of core or specialty training may not be permitted to defer their clinical post by their deanery. For successful candidates, this may mean giving up your clinical training post and reapplying in the next round. Those entering higher training posts (e.g. ST3+) may also not be permitted to defer their clinical post by their deanery. For other grades, depending on your training arrangements, you should arrange to come to this role as an out-of-programme experience (OOPE, or equivalent). Given that most deaneries stipulate six months’ notice for OOPE placements, you must start this conversation with your deanery early (i.e. on submitting your application form).

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11. During the year, can I combine participation on the scheme with my clinical training or can I participate in the scheme on a less than full time basis? The scheme is designed as an intensive programme. However, requests for less than full-time/LTFT basis will be considered by host organisations on a post by post basis and the decision as to whether or not this could be accommodated will reside with them. While clinical work is not guaranteed, in exceptional cases it may be possible to negotiate to undertake the occasional clinical session with the host organisation.

12. Can I count this role towards my training? In general, no. Most people see this as valuable out-of-programme experience, rather than contributing to clinical training. Depending on your specialty, however, it is possible that you could arrange for all or some of this post to count towards training, but this will probably require prospective Royal College and GMC approval.

13. Can international or EEA doctors apply? The scheme is open to all doctors in training, across all specialties who have full GMC registration, are in training and eligible to work in the UK or participate in this scheme according to visa requirements. Applicants who do not have GMC registration at the point of application must ensure they obtain full GMC registration by the time of appointment (w/c 19 February 2018). If you are uncertain whether your visa entitles you to work in the UK and participate in this scheme, please seek further information from the UK Visas and Immigration website at www.gov.uk/government/organisations/uk-visas-and-immigration

Application

14. Can I defer entry to 2019? We are unable to accept applications for deferred entry to the scheme. All posts will commence in September 2018. The scheme has previously been supported by many deaneries, with successful approval for Out-of-Programme Experience across several specialties and grades of training. Therefore, if you are interested in the scheme you are encouraged to apply this year and defer your current training post. Please bear in mind that if you are a Foundation Year 2 Doctor and depending on your deanery, you must be willing to give up your training post and re-apply in the next round.

15. Can I speak to any of the current Clinical Fellows in person or over the telephone? Given the number of applicants for this scheme, we are unable to provide contact details for current Clinical Fellows. However, if shortlisted, you will have the opportunity to meet current Clinical Fellows during a Host Evening (see timeline), hear about their personal experiences of their placements and the scheme and ask any questions you may have.

You can also join an interactive webinar to hear from past and present fellows on their experience of the scheme, motivation for applying etc.

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If directly contacted via other channels, current Clinical Fellows will not discuss any specifics or provide additional details around the selection process. Please see previous FAQs for details on eligibility.

16. Do I need reference forms? If you are invited to attend an interview, we will require two references to be brought in a sealed envelope to your interview. Structured reference forms will be sent to candidates when shortlisted, please note that references provided in any other form will not be accepted. These references should help to support your CV and application form. Failure to bring references to your interview may result in your application being rejected. stakeholder

Interview

17. I am unable to attend either interview dates, is there an alternative? Due to the nature of the selection process we are unable to offer alternative interview dates or telephone/video interview format.

Host organisations

18. How will I be selected for a host organisation? If shortlisted, you will be asked to rank the host organisations that you would be prepared to work at prior to the interview. Please note the Fellowship is designed to provide successful candidates with generic, transferrable skills. If successfully appointed, there will then be a matching process based on performance at interview and ranking preferences. You will only be offered the post that you have been allocated, there is no scope to change your post so you must consider your preferences carefully before you submit these.

19. How many posts outside London are planned? The number and location of posts for 2018/19 has not yet been finalised. Details of host organisations for 2018/19 will be made available to shortlisted candidates prior to interview.

Employment, contracts and expenses

20. What is the salary? Successful candidates will be paid according to the appropriate NHS graded pay scale in place during their fellowship as at 1 September 2018. It is the responsibility of the fellow to negotiate employement and salary arrangements.

21. Will I get relocation, daily commuting or travel expenses if selected for a post? Once in post, work related travel expenses are normally reimbursed by the host organisation. Relocation and daily commuting fees are not usually covered. However, employment contracts vary so if appointed you will need to consider your contract and discuss expenses with your employer

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and host organisation. FMLM are unable to reimburse travel and accommodation expenses for interviews.

22. Do I need to relocate? This will depend on your current location and where your host organisation is based. It is advised therefore that you rank placements you will be prepared to take, which may mean that you need to relocate. For example, if you live in Norfolk and you successfully secure a place in a host organisation in Manchester, you should be willing to relocate to Manchester for the duration of the scheme. FMLM are unable to facilitate movement between offices of the same host organisation.

23. Will I have to move between offices in the same organisation? Some organisations have more than one site/office; this may be both within and outside of London. You may be expected to travel between sites by your host organisation.

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Additional reading material

Please see the FMLM website for more details about this year’s Clinical Fellows. You may also be interested to read the following articles written by past and present fellows: Gemba Iona Thorne | National Medical Director’s Clinical Fellow 2017/18 (CQC) https://www.fmlm.ac.uk/news-opinion/blog/gemba A harsh spotlight on the undergraduate curriculum Lewis Peake| National Medical Director’s Clinical Fellow 2017/18 (FMLM / Royal College of Physicians) https://www.fmlm.ac.uk/news-opinion/blog/a-harsh-spotlight-on-the-undergraduate-curriculum Leadership is about people Ashling Lillis|National Medical Director’s Clinical Fellow 2016/17 (Macmillan Cancer Support) https://www.fmlm.ac.uk/news-opinion/blog/leadership-is-about-people The first steps on the path to medical leadership Sumeet Hindocha|National Medical Director’s Clinical Fellow 2016/17 (NHS Improvement) https://www.fmlm.ac.uk/news-opinion/blog/the-first-steps-on-the-path-to-medical-leadership How to make the most of the leadership challenges you face as a trainee Deborah Kirkham | National Medical Director’s Clinical Fellow 2016/17 (BMJ /NHS England) http://careers.bmj.com/careers/advice/view-article.html?id=20020642 Seeking the heat: junior doctors must take affirmative leadership action Alex Till | National Medical Director’s Clinical Fellow 2016/17 (FMLM / RCP) https://www.hsj.co.uk/comment/seeking-the-heat-junior-doctors-must-take-affirmative-leadership-action/7001813.article I want to be one of the architects of the future Miriam Fine-Goulden | National Medical Director’s Clinical Fellow 2015/16 (NHS England) https://www.fmlm.ac.uk/news-opinion/blog/i-want-to-be-one-of-the-architects-of-the-future Doctors without borders – my year at Bupa Jemma Batte | National Medical Director’s Clinical Fellow 2015/16 (BUPA) https://www.fmlm.ac.uk/news-opinion/blog/doctors-without-borders As a junior doctor, why am I interested in medical leadership? Luc Bugeja | National Medical Director’s Clinical Fellow 2015/16 (NHS England) https://www.fmlm.ac.uk/news-opinion/blog/as-a-junior-doctor-why-am-i-interested-in-medical-leadership

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The mutual benefit of clinical fellows to arm’s lengths bodies Nick Aresti & Rishi Duggal et al., | National Medical Director’s Clinical Fellow 2015/16 (CQC) https://www.hsj.co.uk/topics/workforce/the-mutual-benefit-of-clinical-fellows-to-arms-lengths-bodies/7012812.article Being a clinical fellow in the North Katie Smith | National Medical Director’s Clinical Fellow 2014/15 (GMC) https://www.fmlm.ac.uk/news-policy-and-opinion/opinion/blogs/being-a-clinical-fellow-in-the-north

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Personal reflections from clinical fellows

Leadership is not for the faint hearted

By Judith Tweedie (2015/16)

For the past year, I have been a National Medical Director’s Clinical Fellow with the Faculty of Medical Leadership and Management (FMLM) and the Royal College of Physicians (RCP). I applied to the scheme as an ST7 cardiology trainee working in Belfast, wanting to experience a different set of challenges outside clinical medicine. It has been without doubt one of the most extraordinary years of my life.

Throughout the year, I was privileged to be involved in a range of really interesting projects. One of them was delivering the recruitment process for the 2016/17 intake of clinical fellows. This was a surprisingly complex process, public facing and with serious consequences if things went wrong. I led a team of nine other clinical fellows and we set ourselves high standards throughout the process as we wanted this to be a really positive reflection of the clinical fellow scheme as a whole.

As a team we delivered a 20% increase in applicants and reduced the time to shortlisting by half, with fewer people involved.

One of my core projects at the RCP was developing the chief registrar scheme, which established a new role for physicians in training. The role is designed to allow them to split their time at their trust between clinical activities (60%), and protected leadership and management activities (40%).

I was able to get involved with the project at a number of levels: developing strategies and business plans, recruitment and engagement of trusts and trainees, developing and delivering educational components, and providing practical support for the chief registrars.

Through these projects and other work I have learnt a lot about education, finance, project management, business planning and communications, but there are three really core lessons that will stay with me for the rest of my career.

Leadership is not for the faint hearted

It takes courage to stand up, to follow your convictions and to go against the tide. What I realised this year is that it doesn’t just happen; it is an active decision you make because you believe in the importance of what you are doing. Sometimes that courage or bravery can be very big or

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obvious but equally as important is making the decision to have a difficult conversation with a colleague or telling the boss they have got it wrong.

Also, you won`t always get it right and when you do there will be still be critics, there will still be different ways of doing things. I have found that quite challenging because it is different to clinical medicine. It is much more personal and much more about you and the behaviours you have displayed. But it is part and parcel of leadership.

Feedback is your friend (even when it doesn’t feel like it)

I have been through a bit of a journey with ‘feedback’ this year. At the beginning, I found it quite challenging, I was quite defensive and not really taking it on board. I quickly realised that wasn’t going to lead to much improvement and I started to open up. For a short period I swung too far the other way and I was treating the smallest of remarks as a damning indictment. In the meantime I have rebalanced and found myself in a nice position in the middle. Now I proactively look for feedback and use it as a tool to improve because I have realised it will teach me something valuable, either about myself or the other person, but generally both.

It is important to build relationships

It is slightly unusual that I came to an out of programme training scheme to realise this but when you remove all the formal layers of authority, all you are left with is relationships. I have definitely learnt the importance of taking time to celebrate success as a team, of making an effort to say thank you and recognise contributions, and of acknowledging the need to make sacrifices to maintain a relationship. I really look forward to taking this back to clinical medicine.

There are two sets of relationships which have been incredibly important to my learning this year: 1) the mentoring I have received from people such as Peter Lees, and Jane Dacre, which has been life changing; 2) and the connections I’ve made with the other clinical fellows, from whom I have learnt a lot.

In summary, the biggest learning was that I now believe anything is possible. This past year I have undertaken challenges and put myself into situations that I categorically would not have thought I was capable of 12 months ago. My view of what I can achieve and what is possible has completely changed but regardless of what I do in the future, I will be a better person, doctor and colleague for having done this fellowship.

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My year as a clinical fellow

By Jon Holley (2015/16)

I have officially changed. I didn’t notice it happen but when I look back at my National Medical Director’s Clinical Fellow year at NICE I can see that my perspective, my knowledge, my attitudes, my skills and even my very self have been transformed by this unique experience.

The journey I have made over the year is from a tired and demoralised junior doctor to an inspired and aspirational one; from irritated at the system to understanding it, and from intimidated to confident and empowered.

Before I started the scheme I thought: “You’re doing it all wrong, it is so clear what needs to be done, why aren’t you doing it?” Now, after I have journeyed a bit more, I see things differently and that is what I want to try and get across in this blog.

I often describe the fellowship to those I am trying to impress as ‘an immersive year in health policy and system leadership and management’. The inevitable response is: “Well what did you actually do?” Therefore, I thought I should try and give a good answer.

What I did can best be expressed in terms of the experience I gained and the outputs I produced. So, because I enjoy drawing things, I decided to make some visuals to attempt to convey the content of my year.

This is everything at NICE that I felt contributed to my leadership and management experience: regular meetings, conferences, events, national meetings, training days, work streams.

The big ones here for me were becoming comfortable with meetings, learning how they are best chaired, and using them to get things done. There was also the chance to go where many fear to tread, into the inner workings of NICE; an insight that has been invaluable.

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This slide is the same but represents the experience I gained outside of the day job. Things such as action learning sets, training days, induction, meals, trips, away days, events, shadowing and pitching.

Beyond any doubt, the highlights here were the camaraderie of the fellows, the relationships we made, the kind leaders who had a meal with us, and the chance to pitch ideas to the likes of Prof Sir Bruce Keogh and Prof Tony Young.

Some of the more tangible outputs that I produced as part of the day job and made the year worth the investment for me, include:

• Infographic slide sets for the trauma guidelines • A prototype for the National Information Board’s app assessment framework • A blog • And a few other creative projects along the way.

What I want to focus on here is what made the difference in the journey I talked about earlier and that is all around ideas.It turns out my ideas / ideas implemented ratio at NICE was 0.44. This was where I really gained that understanding of how difficult it can be to get things done in the systems we have to operate within, but also that there are tricks and methods to employ to give you a better chance of getting agreement to go ahead with your ideas.

I realised that leadership is more than just solving problems with good ideas. You have to understand your idea, be able to pitch it in five different ways, bring people with you, keep the vision big enough to get people excited but small enough that it seems doable, and sometimes you have to choose which ones to put your energy behind and which to sacrifice.

It is in this that I found the answer to my question “It’s so obvious what needs to be done, why aren’t you doing it?”

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Firstly, it is difficult, and secondly there is much more complexity than you initially thought. I do still hang on to the idea, however, that there is an element of learned helplessness that remains around this; there is a fine line we all have to walk between choosing our battles and fighting them by thinking bigger.What is interesting is that my ideas / ideas implemented ratio outside of the day job was 0.67.

We set up Collaborative Quality Improvement – a national initiative for delivering crowdsourced multi-site quality improvement projects which is being evaluated with a proof of concept project in September.

And we organised TEDxNHS with the aim to bring together people with inspirational stories and aspirational ideas once a year, to give them a national stage so we can hear them and leave inspired to think differently, dream bigger and design better for the population we serve.

It was in leading these projects that I felt I had the most impact this year and this points to a struggle, a question that a lot of us have had.

“Do I stay within the system, a complex web of bureaucratic institutions, or step outside where I have the freedom to innovate and be creative?” Some of the fellows have chosen to leave and others to stay, but what I am interested in goes beyond the choice of individuals and addresses the choice system leaders make next.

It is quite clear that those I worked with at NICE were able to give me space to have ideas, test them out, and run with them as part of my job but outside of the usual remit of the organisation. My achievements outside NICE were only possible because of the freedom and support I was given to pursue them.

My answer to the ‘stay or go’ question is to challenge our leaders to keep giving people like us space to try ideas. The fellowship is an ideal way to do this, but we can go further by building creative space for innovation and ideas into our institutions. This might mean giving time and a budget to five of the most creative people in those organisations and letting them generate and test new ideas.

For me, space for ideas has been instrumental in my journey from tired, demoralised, and irritated to inspired, aspirational and empowered.

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