Examples of clinical and care professional leadership in practice

How three systems are using clinical and care professional leadership in practice and the steps they are taking to deliver the five principles.

18 April 2024

Distributed and diverse leadership is a fundamental building block for all integrated care systems (ICSs). It can help shape, design, and support the way services are delivered for the future providing new opportunities for staff and local people. This can be most impactful at place and neighbourhood level.

The broadest range of clinical and care professionals need not only to be supported in their roles but fully integrated into decision-making, planning and service design.

"We cannot afford to not diversify our leadership. CCPL is an enabler. It’s cross cutting and it involves itself in every piece of work that we are doing. It is not an add on."

When leadership is fully inclusive and can be seen and heard at all layers of a system, patient outcomes improve, and health inequalities can be tackled effectively. 

Clinical and care professional leadership (CCPL) as a principle should be embedded within all ICSs. It should not just be seen as a ‘nice to have’ but as something that underpins and sustains every aspect of health and care.

In 2021, NHS England published ICS implementation guidance on effective clinical and care professional leadership and set out two core expectations on what systems should be doing to implement CCPL: 

  • Each ICB is expected to agree a local framework and plan for clinical and care professional leadership with ICS partners and ensure this is promoted across the system. 
  • Individuals in clinical and/or care professional roles on the ICB board, including the nursing director or medical director, should ensure leaders from all clinical and care professions are involved and invested in the vision, purpose and work of the ICS.

Alongside the two core expectations, the guidance sets out five core principles of what ‘good’ CCPL might look like in an ICS. The principles in full, are: 

  1. Ensure that the full range of clinical and professional leaders from diverse backgrounds are integrated into system decision-making at all levels, supporting this with a flow of communications and opportunities for dialogue. 
  2. Nurture a culture that systematically embraces shared learning, supporting clinical and care professional leaders to collaborate and innovate with a wide range of partners, including patients and local communities. 
  3. Support clinical and care professional leaders throughout the system to be involved and invested in ICS planning and delivery, with appropriate protected time, support and infrastructure to carry out this work. 
  4. Create a support offer for clinical and care professional leaders at all levels of the system, one which enables them to learn and develop alongside non-clinical leaders (eg managers and other non-clinical professionals in local government and the VCSE sector), and provides training and development opportunities that recognise the different kind of leadership skills required when working effectively across organisational and professional boundaries and at the different levels of the system (particularly at place). 
  5. Adopt a transparent approach to identifying and recruiting leaders which promotes equity of opportunity and creates a professionally and demographically diverse talent pipeline that reflects the community served and ensures that appointments are based on ability and skillset to perform the intended function.

Read how these three systems are applying the principles of CCPL to improve services across their areas and provide better experiences for their people and patients. 

  • Leicestershire, Leicester and Rutland ICS (LLR) took the five principles of CCPL and worked inclusively with health and care professionals across the system to create their own professional leadership strategy and vision. 

    They have established a Professional Leadership Forum to help drive and deliver this work. 

    It’s governed by a clinical executive group whose chair sits on the ICB board, enabling their principles, actions and learning to feed directly into ICB decision making.

    Following extensive local engagement on their vision, they decided to look at how CCPL can be used as a vehicle for change and transformation in different parts of the system – and in getting more people involved. Progress is being made in several ways: 

    • The System Senate: where a range of health and care professionals come together to test and explore new ways of working, unpick and work through business planning and prioritisation based on their experiences and challenges.  
    • New partnership and collaborative groups: leading various workstreams across the ICS to drive transformation and change. 
    • Wicked Issues Forum: a place to bring challenges and ideas, where health and social care colleagues can co-create innovative solutions and share ideas and organisational development.
    • Working with non-clinical functions to help deliver their professional leadership strategy: the Professional Leadership Forum recognises the value of working with non-clinician ICS functions – including the ICS People Board, LLR Academy and Organisation Development colleagues – and is connecting across the system to ensure effective, joined-up and holistic delivery of its principles.

    "There is now better recognition that the clinical needs to be considered alongside finance… the clinical voice is getting stronger through the system, with more conversations around the importance of distributed leadership starting to happen.”

    CCPL in action

    The ICS new triage initiative, the Unscheduled Care Coordination Hub (UCCH), has encouraged a multi-professional, distributed leadership model that is helping to reduce pressure on ambulance services and improve care for patients.

    The UCCH was set up as a 'one-stop shop' to give patients access to the right care at the right time. It is run by a hub team: a group of professionals from EMAS, DHU Healthcare, Leicestershire Partnership Trust, Leicester City, Rutland and Leicestershire County adult social care and the LLR board, who can view the demand  for emergency ambulances in real time, and interact with crews on scene to provide viable alternatives to hospital. 

    For instance, patients can be referred to  same day community unscheduled care such as advanced practitioners within two hours, virtual wards, community step beds that offer health and therapy interventions, urgent treatment centres, same day emergency care, frailty services, community mental health and social care. 

    The hub serves the whole of LLR and gives EMAS a single point of access. The team works face to face in one location to make informed, shared decisions about category three, four and five calls.

    They can access clinical records across multiple agencies, including recent health checks, visits and treatment to help decide the most appropriate action. It employs all five of the CCPL principles to great success, with 98 per cent of cases reviewed by the hub (over 3,000) diverted from ambulance call lists to alternative care providers and 85 per cent of patients remaining at home after their intervention.

  • Norfolk and Waveney ICS’s overarching ambition is to grow and nurture new talent, identify aspiring leaders and get them ready to take up leadership roles in the future. 

    They have put CCPL at the heart of what they do and believe their clinical and professional leaders are an enabler for change. They have created a CCPL Assembly of 20 members with different levels of training, experience and background from across the system, to lead the work. 

    The Assembly’s work plan is based on the five core CCPL principles and they have  created a forum for all their CCPL place leads, where they meet monthly to talk through provide mutual support and learning, and plan to do the same for their local primary care network (PCN) leaders. 

    The ICS committed to deliver lifelong professional learning and development for their clinical and care professional staff by: 

    • supporting leaders to work through dispersed networks rather than top-down hierarchies
    • developing a capacity for health and care leaders to be insatiably curious
    • creating opportunities for leaders to learn more widely and fostering a culture of perpetual learning and critical reflection 
    • using respected, local programmes delivered by partner organisations
    • developing combined cohorts to help create collective understanding and build relationships through learning.

    To support this work, they have set up a CCPL faculty,  which has have started to run several leadership and learning programmes: 

    • a consolidator programme for existing leaders. This includes time out for established leaders and a 'complex conversations’ programme for this group
    • an equaliser programme – bringing together disadvantaged leaders and offering bespoke activities to create opportunity
    • a propagator offer – looking to create the next cohort of system and local leaders 
    • an incubator offer – for people who are just starting their leadership growth, creating opportunities to understand who they are and what they'd like to do and space for them to do it. 

    “If you don’t create an opportunity to build leaders into your system, which CCPL offers, industrialising and democratising leadership, you will never get to the next level. You need the hearts and mind of people leading within your system.”

    CCPL in action 

    As part of the Incubator training programme for new leaders, the ICS delivers regular Lunch and Learn sessions on different aspects of leadership. They cover a number of different topics including culture, demystifying leadership, trust, communication and positive leadership. 

    The ICS has also developed a Journal Club for disadvantaged leaders, enabling them to conduct a Leadership Academy 360 degree assessment. The leaders select a resource to study, and then book a session and review the article together. This learning takes place monthly, is facilitated and provides CPD points. 

    Next steps for Norfolk including looking at how CCPL can support with some of the key challenges around health inequalities and around the differences between leadership in health and leadership in social care and how those can be brought more closely together. 

  • In Surrey Heartlands there is a big focus on Principle 2 and across the system they are starting to develop a culture of collaboration, innovation and continuous improvement. They have focused their Health and Care Professional Leadership (HCPL) implementation on three key areas: 

    • developing leaders
    • connecting people
    • creating the conditions for HCPL. 

    The HCPL Forum is working hard to embed a culture of shared learning and have established a suite of forums and networks to help to encourage that. So far the system is developing and delivering:

    • an HCPL community of practice
    • a patient safety specialist network
    • a multi-professional leaders’ programme 
    • the Growing System Leaders programme
    • knowledge exchange events 
    • the Surrey Improvers Network. 

    “It has been a revelation to recognise that the conditions in which you bring people together can make the most difference. Letting people speak, be listened to, be included is so powerful.”

    Surrey Heartlands ICS has developed its own flagship leadership development programme called Growing System Leaders - an intensive, six-month programme that sets out to develop a sustainable talent pool of holistic leaders from across all corners of the system. 

    The programme is truly collaborative and non-hierarchical, inviting colleagues from any grade and across all sectors to join the scheme. With a huge amount of focus being put on engaging and recruiting voluntary sector and district council colleagues, the programme purposefully includes a diverse range of organisations and professionals.

    The course includes a ‘project lab’, which focuses on tackling a selection of real, live challenges at neighbourhood team level. The cohort works together in small groups with clinicians and non-clinicians working and learning alongside each other to directly tackle some of the biggest local challenges, all through the lens of CCPL. Applicants were given an opportunity to put forward ideas of live challenges to work on, and worked closely with the Place leaders in that area. 

    The aim is for colleagues to develop holistic leadership skills, form connections, develop a deeper understanding of the skillsets, roles and perspectives of their colleagues and local communities and, in a holistic and supported way, try to make genuine progress on some of the biggest local challenges facing Surrey Heartlands. 

    Alongside this programme the ICS is continuously seeking to create new opportunities for people to connect and come together regularly to problem solve. This occurs through regular drop-in sessions, communities of practice and system-wide quality improvement workshops looking at issues like culture and diversity. 

    “We are having to continually look back and review – who isn’t in the room? Who are we missing? How can we engage them? How are we going to make this work for them? That is an ongoing task.”

    CCPL in action

    Over the last two years the HCPL team has seen people feeling and talking about being more empowered, with colleagues saying there are more opportunities to participate in conversations and then go away and do something differently.

    They are starting to see a change in culture across the organisation and senior doctors are having conversations around the need to have multi-professional input. The team is starting to see a shift towards CCPL being implemented routinely. 

    Leaders are telling the team they feel energised, inspired to leave the room and make change around them. This is distributed leadership in action – when someone feels like they can go away and have the power, and support, to do something differently.