Being a chief registrar in a community-based NHS trust

Dr Jonathan Mamo reflects on his experiences as chief registrar at Solent NHS Trust, and the importance of clinicians developing leadership and management skills in today's NHS. 

The NHS is currently experiencing extreme turbulence. Never has it needed educated leaders and managers more than now. The desire for clinicians to be effective and motivated leaders and managers is increasingly evident and as a result of this, leadership and management is becoming an integral part of many medical careers. 

The importance of this was highlighted in the Francis report with a desire to ensure the continued quality improvement of NHS services. Contrary to popular belief, clinical experience on its own may not be sufficient to prepare healthcare professionals to take placements or jobs which incorporate, or require, managerial qualities. Fortunately, there are multiple opportunities for doctors-in-training to acquire specialist skills to take on challenging leadership roles.

The Royal College of Physicians (RCP) recognised this in the 2013 Future Hospital Commission report, which recommended directed training in leadership and management for future clinical leaders. The recommendation to establish a senior leadership role for doctors-in-training that encompasses service and quality improvement, improvement of junior doctor engagement and morale, and improved educational opportunities, resulted in the chief registrar scheme. The aim of the scheme is to prepare senior doctors-in-training for much-feared managerial and leadership positions, and endow them with the confidence and motivation to pursue these roles. 

I commenced my post as chief registrar for Solent NHS Trust in September 2017. Taking on the role has been a steep learning curve; it has opened up a whole new world previously unseen as a doctor-in-training, such as high level senior management meetings. 

Contrary to popular belief, clinical experience on its own may not be sufficient to prepare healthcare professionals to take placements or jobs which incorporate, or require, managerial qualities.

Dr Jonathan Mamo, chief registrar

Overcoming barriers to change

Over the past decade there has been a growing awareness within the medical community of the need to improve care quality. There is also a clear need to effectively translate evidence into practice. Anyone who works within the NHS and who has attempted to conduct some element of quality improvement has undoubtedly experienced barriers to change.  

Change can challenge the beliefs and expectations of patients, carers and staff, which can sometimes lead to fear and resistance. This might be because people have been in post for a long time, or because the new arrangements are unfamiliar. I have found that the title of 'chief registrar' has been a magic key to accessing resources, people and meetings to facilitate change and improvement projects. 

Working in a community-based trust

Whereas most chief registrars in the 2017/18 cohort have been recruited in acute hospital trusts, I work in the mainly community-based Solent NHS Trust, which covers a wide area across the New Forest, Southampton and Portsmouth and comprises multiple sites across a large area. Each site has their own working culture, but they all work towards a goal of improving the quality of life of the patients for whom they care.

Motivational levels have varied between sites, with some teams being extremely motivated and running their own quality improvement projects, whereas others are somewhat more resistant to an outsider (although still a clinician!) getting involved and suggesting areas of improvement. In general, I have found that quality improvement opportunities have presented themselves fairly regularly, and have simply required some planning, a team and some direction.

The desire for clinicians to be effective and motivated leaders and managers is increasingly evident and as a result of this, leadership and management is becoming an integral part of many medical careers. 

Dr Jonathan Mamo, chief registrar

Community hospitals such as those covered by Solent NHS Trust provide continuous care to a wide variety of individuals. One of the challenges for professionals working for the trust is the distance between each of the sub-units making up the trust. The role of chief registrar relies on communicating with and, more importantly, meeting, junior doctors. This is difficult when junior doctors are dispersed across a large geographic area. 

This difficulty is compounded by the fact that educational meetings for junior doctors are split according to specialty, so there are limited opportunities to meet other doctors working in other specialities. This segregation can lead to an element of isolation and often results in a real-time physical division, further increasing the risk of professional isolation. 

These constraints mean that communication with colleagues is mostly limited to electronic means, which feels somewhat impersonal at times. Unfortunately I don’t meet as many junior doctors face-to-face as I would like to; but regular email communication allows as close to a real-time discussion as possible.

Different viewpoints

I have been chief registrar for 4 months now, and in this time I have become more confident in my ability to facilitate change in some small way. Some issues have required very small changes and solutions rather than big projects; and in some cases, just needed a different viewpoint. Leading and supporting improvement as chief registrar has enhanced my educational and professional development. Over the past few months my understanding of being a manager and a leader – particularly how to motivate, negotiate and propagate change – has grown and developed.

I am thankful for the teaching, guidance and experience of all the managers and leaders of my trust, which have already been hugely educational at this early stage. The managerial team at Solent NHS Trust has shown unprecedented interest and incredible motivation, which has greatly facilitated my role within the organisation. 

The projects I am working on include developing a quality improvement educational framework, providing educational opportunities in preparation for end-of-training, and a developing a ‘celebration of clinical excellence’ programme. Despite the challenges, I look forward to the next few months, with a view to achieving positive change in many areas and presenting the results at the RCP’s Innovation in Medicine conference in June 2018.  

Recruitment for the next cohort of chief registrars is now open and I would encourage senior trainees, with even a slight interest in leadership or management, to apply. The development programme and on-the-ground learning is extremely rewarding and, I have no doubt, has been better preparation for future clinical leadership positions than I would have received as part of a regular medical training programme.

Dr Jonathan Mamo is a chief registrar and specialty trainee in rehabilitation medicine at Solent NHS Trust