NHS providers have always struggled to appoint senior clinicians as chief executives, particularly doctors. This is despite the rhetoric of politicians and the launch of several national programmes aimed at achieving just this. We can all think of a handful of CEOs who came from the medical ranks of the NHS (let’s exclude those appointed from overseas health systems for now), but we are probably all thinking of the same handful. In a public health system with around 250 provider organisations and 150,000 doctors, the odds must surely be in our favour to lead the way in placing doctors at the helm? And yet we don’t seem to be able to do it.

Sir David Nicholson did a big push on this when he was Chief Executive of the NHS and only last year, this formed part of Jeremy Hunt’s speech at the NHS Providers conference. If we are to believe the words of our system leaders, there is clearly no lack of appetite or political will to make this happen. But simply saying it doesn’t make it happen.

As experienced head-hunters, we face this challenge time and time again. Our clients ask us to find senior medical leaders to come and run their hospitals. Great, think we - a potential candidate pool of around 300 people, maybe more. But then we and our client start to think harder about the leadership challenges of the role – financial turnaround; a senior team stuffed full of interims; poor CQC ratings; a challenging STP relationship; possible merger or at least a forced collaboration on the cards; and maybe a major IT implementation as well.

CEO roles are tougher now than they have ever been and we cannot expect candidates to take on these roles without the right preparation and experience.

Simply reaching the level of Medical Director within a trust is not enough anymore. Preparation for senior leadership and management needs to start from the beginning. With every rung of the ladder, there needs to be further development in leadership and the management of people and resources. Not just to develop more CEO candidates for the future but to equip doctors with the skills they need to improve the way they provide services and contribute to the longer term sustainability of the NHS. If we are going to give them this responsibility, we need to give them the tools to deliver otherwise we set them up to fail.

Another harsh reality is that CEO roles are just not attractive enough. It isn’t about the money – although, it’s not unusual for senior NHS doctors to earn less when they become chief executives – it’s about perception. The ‘do-ability’ of the role. The high risk of failure. The long-term reputational damage if it goes wrong.

It is time we start to learn from others. From the home-grown NHS doctors turned CEOs and from the imported leaders who made the switch in overseas health systems and who now run some of our highest profile providers. How much do we really study the careers of these individuals to identify what skills and experience they have gained to make the transition possible? And beyond an individual level, what can we learn from other health systems – commercial sector and international – about how to make medical CEO appointments the norm rather than the exception?

Over the coming months, we will be speaking to a selection of medical leaders who have themselves made the transition into CEO roles. We will be asking them why they wanted to move into wider healthcare management roles and what events in their career really helped to shape their thinking and prepare them to make the leap.

Watch out for our findings!

Carmel Gibbons

Carmel Gibbons is a London based Partner and Head of the Healthcare practice. She is also a member of the Public Services and Not for Profit practice. Her work focuses mainly on senior appointments...

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