Nearly a year into a senior clinical leadership role, you get past the honeymoon phase and into something more useful: clarity. What’s genuinely moved the needle, what’s grindingly slow, and what’s structurally broken well beyond any one individual or department.
This isn’t a victory lap and it isn’t a whinge. It’s an honest stock-take of progress, friction, and why—despite everything—the job is still worth doing.
The Good Stuff (and there’s plenty of it)
1. New colleagues, new energy
Fresh appointments matter more than people like to admit. New consultants and senior staff bring different expectations, fewer legacy grudges, and a willingness to engage with service redesign rather than defend “how we’ve always done it”. That shift alone changes the tone of meetings, decision-making, and momentum.
2. Fragility fracture care is improving
This has been a quieter win. I think the trend looks to be improving, but this is a cross-specialty effort as we try to build better pathways, tighter coordination, and clearer ownership which we hope is starting to translate into safer, more consistent care for a high-risk cohort. It’s not glamorous work, but it’s clinically meaningful and system-smart. But there is still a lot to do as the path we are on is narrow and vulnerable.
3. Elective productivity: trending the right way
No magic bullets here—just disciplined attention to lists, case-mix realism, theatre utilisation, and collaboration rather than blame. Productivity hasn’t exploded overnight, but the direction of travel is right, and that’s what matters. Sustainable improvement beats heroic one-offs. But once again the cross-divisional efforts are recognised but the easy wins are now being replaced by a more grinding focused need to shift culture and perception.
4. Virtual Fracture Clinic (VFC): genuinely transformative
This has been one of the most unambiguously positive changes. The protocol development developed by one of my newer colleagues has meant that the b usy waiting room has been replaced by calmness. We now have more controlled clinic volumes with
- Better patient experience
- Reduced unnecessary face-to-face follow-ups
- More predictable workflows for clinicians
- Fewer bottlenecks in fracture clinics
It’s rare in NHS transformation to find something that helps patients and staff at the same time. VFC does exactly that.
5. Length of stay: slow gains, real gains
Nobody sensible expects dramatic drops without beds, community capacity, and workforce alignment. But incremental reductions—especially at the margins—add up. LOS improvement is a game of small wins and persistence, and the trend is finally moving the right way. I’ve looked at the raw data myself and I think there is a good trend towards where we need to be but my target is a midway point between where we were at the start and the aspirational targets set by GIRFT.
6. Procurement cost savings without clinical compromise
Smarter procurement isn’t about buying cheaper—it’s about buying better and buying once. Rationalising consumables, challenging entrenched preferences, and aligning with evidence has delivered savings without degrading care. This is low-drama, high-impact leadership. A majority of changes were not even felt by my colleagues as my work with procurement team focused on optimising our current deals. But working across multiple Trusts on regional potential is exciting.
7. Rota optimisation: less chaos, more realism
Rotas will never be loved, but they can be fairer, clearer, and less brittle. Better modelling, fewer assumptions, and honest conversations about cover have reduced friction and improved resilience. It’s not perfect—but it’s no longer firefighting by default. The work I have done is to mitigate the impact on colleagues. Trying to align a 1:8 oncall with a 1:2 rota at one site and a random 1:5 rota at another has been challenging but most are on board and progress is underway.
8. Digital lead role and stronger QIP / audit / research structure
Digital leadership has become more than a title. It’s enabled:
- Better data visibility
- More credible QIP projects
- Cleaner audit cycles
- A bridge between frontline clinicians and system-level strategy
This has also raised the profile of the department in ways that matter beyond day-to-day service delivery.
9. Departmental digitalisation: from talk to traction
Not everything needs an app—but plenty of things need to stop living in spreadsheets, inboxes, and people’s heads. Incremental digitalisation has reduced duplication, improved transparency, and made improvement measurable rather than anecdotal. My involvement with the Trust AI committee is an exciting part of the job,.
The Hard Stuff (context matters)
These issues aren’t unique. They’re structural, national, and familiar across the NHS.
1. Demand continues to outstrip resource
Patient volumes keep rising. Workforce, beds, and theatre capacity do not. No amount of local ingenuity fully compensates for that mismatch. The job becomes one of harm-reduction and prioritisation rather than perfection.
2. Challenging interactions with difficult colleagues
Every department has them. Highly transactional behaviours, selective engagement, and occasional bad-faith interactions consume disproportionate energy. Managing this professionally—without letting it derail the wider service—is part of the role, however tedious.
3. The invisible grind of leadership
Job planning disputes. Re-explaining decisions. Re-running arguments. Governance paperwork. Meetings that exist because something might go wrong rather than because something will improve. This is the unglamorous reality of senior NHS roles and a common source of frustration.
None of this is exceptional. That doesn’t make it any less draining.
The Bottom Line
Despite the friction, the experience has been overwhelmingly positive.
There is genuine satisfaction in seeing:
- Patients moving through better pathways
- Teams working more coherently
- Data starting to support, not sabotage, decision-making
- Digital tools shifting from novelty to infrastructure
Most importantly, there’s a real sense of making a positive difference—incremental, imperfect, but tangible.
That’s the work. And a year in, it still feels worth doing.