Leadership and management

Leadership in the NHS is undergoing a significant shake-up right now, so it's worth knowing both the established landscape and what's changing in 2026.

Why it matters

The NHS is one of the world's largest employers, and leadership isn't confined to formal management roles — clinicians at every level are expected to lead: a junior doctor leading a ward round, a consultant leading a multidisciplinary team, a GP leading a practice, or an executive leading a trust. This is often called "shared" or "distributed" leadership — the idea that leadership responsibility runs throughout the organisation rather than sitting only with people who have "manager" in their title.

The traditional model For years, the main reference points were:

The Healthcare Leadership Model — nine dimensions (e.g. inspiring shared purpose, leading with care, holding to account) developed by the NHS Leadership Academy, used for 360° feedback and development.

The Medical Leadership Competency Framework, later folded into work by the Faculty of Medical Leadership and Management (FMLM), which focused specifically on doctors as leaders — demonstrating personal qualities, working with others, managing services, improving services, and setting direction.

NHS Leadership Academy programmes (Edward Jenner, Mary Seacole, Elizabeth Garrett Anderson, Nye Bevan) offering tiered development from first-time leaders through to board level.

What's new in 2026

A new NHS Leadership and Management Framework has been launched by the NHS College of Leadership and Management alongside new NHS Staff Standards, including the first national staff standard for line management, applicable to both clinical and non-clinical roles.

It replaces the older patchwork of models with three components:

1. A leadership and management code

2. A set of national standards and competencies

3. A self-assessment tool to aid in evaluating managers against what is expected standards of practice.

It's designed to establish, for the first time, a clear and consistent approach to leadership and management across every level of the NHS, and has been tested with more than 150 NHS organisations across all seven NHS regions.

A few practical points:

All NHS organisations are expected to start implementing the Framework from summer 2026, adapting local training, appraisal and recruitment processes to align with it.
A new self-assessment tool is available now, and a new national 360° feedback tool is planned for winter 2026/27, replacing the existing Healthcare Leadership Model 360° tool.
The existing NHS leadership competency framework for board members remains in place for 2026/27 for governance purposes.

Levels of leadership you'll typically see referenced

Personal/clinical leadership — leading your own practice, team, or patients' care.
Team/service leadership — leading a department, ward, or clinical service (this is where most consultant leadership expectations sit).
Organisational leadership — trust-wide roles like clinical director, medical director.
System leadership — working across Integrated Care Systems, involving multiple organisations.

Leadership styles

There's no single "correct" leadership style for a consultant — the best leaders flex between styles depending on the situation. Panels are generally more interested in whether you recognise which style a situation calls for than in you having one fixed style. The main styles worth knowing:

Directive/authoritative - clear instructions, fast decisions. Right for emergencies and genuine crises; overused elsewhere, it shuts down input and burns trust.

Democratic/participative - inviting the team into the decision. Builds buy-in and surfaces better options; too slow for urgent situations.

Coaching - developing individuals over time rather than directing tasks. Excellent for junior doctor development; not a substitute for decisive action when something needs fixing now.

Affiliative - prioritising team relationships and morale. Valuable after a difficult period or conflict; on its own, it can let poor performance go unaddressed.

Pacesetting - leading by personal example and high standards. Effective with a skilled, motivated team; can alienate a team that's already stretched or under-resourced.

Laissez-faire - stepping back and letting the team self-manage. Works with a highly experienced team; looks like absence or avoidance with anything less.

Good leadership looks like

Makes a decision and owns the outcome, good or bad

Gives credit to the team, takes responsibility for failures personally

Asks for input before deciding, when time allows

Is consistent — same standards applied to everyone

Notices when someone is struggling and does something about it

Comfortable saying "I don't know" or "I got that wrong"

Develops people even when it isn't required of them

Poor leadership looks like

Avoids decisions, or quietly blames others when things go wrong

Takes credit for success, distributes blame for failure

Decides in isolation, then presents it as consultation

Applies rules differently depending on who's involved

Only notices performance once it's become a formal problem

Defends a position rather than admit an error

Sees junior staff as pairs of hands rather than people to grow

Leadership and Management training

Should You Undertake Formal Leadership Training?

For a trainee preparing for a Consultant role, formal leadership and management training can be valuable. Becoming a Consultant involves much more than clinical decision-making — you will be expected to lead teams, manage conflict, influence colleagues, understand how services work and contribute to improvement.

However, completing a leadership course by itself is not strong leadership evidence.

The stronger combination is:

Learn the principles → apply them in practice → reflect on what happened.

If you have access to good formal leadership training during training, it can be worth doing. Some regions offer free courses, while there are also paid courses available.

The priority, however, should not be collecting leadership certificates. One useful course, combined with genuine leadership experience and good reflection, is likely to be much more valuable than several courses with little practical application.

It is also worth checking the person specification for Consultant jobs in your specialty. Some roles may specifically ask for evidence of leadership or management training, while others may not.

Looking at previous job specifications can be particularly useful before you reach the end of training. It allows you to identify what employers are looking for and use the remaining time in training to fill any gaps in your experience.

The aim isn't to collect certificates. It's to develop the skills, experience and evidence that will make you a better Consultant.

Associated
Sample
Questions

What is leadership?
What makes a good leader?
Give an example of when you have demonstrated good leadership in a clinical setting
What are you doing to develop your leadership skills, and where do you think you still need to grow?
Tell me about what you have learnt about leadership in your training?
What would you change about training in leadership?
As a senior in the department try are viewed as a leader. What is your leadership style?
If you were forced into a different leadership style – how would that make you feel?
Describe a situation where you made a difference to your department
What are your qualities of leadership that will help engage your team and help the department drive forward with innovation?
How important is it to have good working relationships with management/executive team?
Tell us about a QI project you’ve lead that you found challenging – how did you overcome these challenges?
If you were working in a regular team within your department and you felt their performance was not adequate how would you go about improving it?
You notice that your team isn’t working to the high standards you expect, how would you approach this?
You are asked to set up a new service in your department. How would you go about doing this?