always very clear. This may meanthat chief executives and otherboard members are not certainabout what they can expect fromthe medical director.Our seminar participants thoughtthere were a number of functionsthat should be contained inthe role, regardless of how it isdesigned, including:•leading the formation andimplementation of clinical strategy•taking a lead on clinical standards•providing clinical advice tothe board•providing professional leadershipand being a bridge betweenmedical staff and the board•providing translation, assessingthe mood and, crucially, creatingalignment between theorganisation and doctors (this canbe a particularly delicate task,especially where it is necessary tochallenge medical colleagues)•outward-facing work with the PCT,strategic health authority (SHA)and other external organisations.A number of other important rolesare sometimes delegated, but oftenseen as the medical director’sresponsibility:•clinical governance•acting as the Responsible Officerfor revalidation•quality and safety•education•medical staffing planning•disciplinary issues concerningdoctors.
Future of leadership:
Developing NHS leadership: the role of the trust medical director
“Being a medical directorhas become a full-time job. The role has changeddramatically in the last tenyears and the work increasedexponentially”
•What preparation is needed forthe role?•What should the career path look like and what is the route for exitor progression?•How can more people beencouraged to take up thechallenge? To look in more depth at thesequestions, with NHS medical director,Sir Bruce Keogh, we ran two seminarsand conducted in-depth interviewswith current medical directors,deputy directors and clinical divisionmedical directors. We were joined byprimary care trust (PCT) medicaldirectors, who brought someimportant insights, but it becameclear that there is considerablediversity in the roles of PCT medicaldirectors and that their differentresponsibilities and challenges makegeneralisation difficult. Some of theideas in this paper are relevant toPCTs, but further work is needed tounderstand the specific challengesthey face.
Clarity about the medicaldirector role
It is hard to sell a role to potentialapplicants or get the best from it if there is insufficient clarity aboutwhat it entails. The role of medicaldirector can be designed in differentways and its exact nature is notWe also heard that some medicaldirectors get involved in Caldicottguardian roles, infection control andresearch and development.One common feature was theinvolvement of the medical directorin the immediate problems andcrises connected to the day-to-dayrunning of the organisation. Whilethis is unavoidable, there may be toomuch of a tendency for staff to‘delegate upwards’, making the rolemore stressful than necessary anddetracting the medical directorfrom more strategic issues. The medical directors we spoke tothought that the role had changedconsiderably in a short space of time,reflecting the merger of trusts,increasing managerialism and there-introduction of the internalmarket. They told us new skills arerequired to meet these challenges.
Structure and support
The size of the medical director roleis significant and potentially too largefor one individual, particularly inlarger and multi-site trusts. The levelof support provided is thereforecrucial in determining effectiveness– everything from high-levelmanagerial support from managersand associate medical directors tomore basic back office andadministrative support.We heard of a range of models forthe level below medical director,including associates and deputies.Examples of medical directors withboth wide and narrow spans of control include:•direct lines to divisional medicaldirectors