Clinical leadership plays a crucial role in the effectiveness and sustainability of urgent and emergency care be it in A&E departments or as offered by paramedics out and about across the NHS. However, most clinical leaders in UEC receive insufficient training when transitioning from frontline clinical practice to leadership roles. 

This gap in leadership development not only affects individual performance but also has broader implications for the quality of care, staff morale and the overall efficiency of emergency services. My recent doctoral study with Reading University of an A&E trust in England highlights key factors that influence leadership development in UEC and suggests a new, individual-centric approach to leadership training.

One of the most striking revelations from the research during 2022, is that 33% of clinical leaders in A&E received no formal leadership training beyond mandatory requirements. Many clinicians enter leadership roles without the necessary skills or structured support, often learning on the job through trial and error. The study also identifies three critical, interconnected factors that shape leadership development in A&E.

1. Organisational culture

The way leadership is perceived and supported within NHS trusts significantly impacts how clinical leaders develop. Some trusts provide mentorship and structured leadership programmes, while others leave leaders to navigate their roles independently.

2. Professional identity 

Many clinicians see themselves primarily as healthcare providers rather than leaders, making the transition to leadership roles more challenging. Without clear guidance, some may struggle to balance their clinical responsibilities with managerial duties.

3. Leadership training needs

There is a widespread lack of individual centric or bespoke training programmes that address the specific challenges of UEC leadership. Many existing programmes take a one-size-fits-all approach, failing to consider individual development needs and the unique pressures of emergency care. The study finds motivations behind clinicians stepping into leadership roles are:

• 53% take on leadership as a new challenge – these ‘keen leaders' actively seek leadership opportunities as part of their career progression
• 44% step up because they are asked to – these ‘reluctant leaders' do not initially seek leadership but are encouraged (or pressured) to take on responsibilities
• 50% see leadership as part of personal development – this group consists of both keen and reluctant leaders who recognise the need for leadership skills as part of their career growth.

This diversity in motivation highlights the need for a more personalised approach to leadership training. Some leaders may require extensive preparation and support, while others may thrive with more flexible development opportunities.

This research study challenges the traditional ‘sink or swim' approach to leadership in UEC. Many NHS trusts rely on enthusiastic but inexperienced leaders to manage critical departments, which can lead to burnout, inefficiencies and inconsistent leadership quality. Instead, the study proposes an individual-centric leadership development framework, where training is tailored to personal and organisational needs. This prioritises:

• structured leadership training programmes going beyond generic management courses and focusing on the unique pressures in UEC
• mentorship and coaching to support new leaders as they navigate their roles
• a shift in organisational culture to value and invest in leadership development as a strategic priority
• a clear focus on values and behaviours to articulate the way in which things are expected to be done within a trust. 

By moving away from a system that relies on amateurs, services can cultivate sustainable, effective and compassionate leadership.

This research serves as a timely warning for NHS trusts, who are under pressure to reduce corporate costs, to reflect on the consequences of not investing in leadership development, on both patient outcomes, but also to secure and develop the next generation of clinical leaders. Without proper investment in leadership development, A&Es will continue to struggle with high staff turnover, low morale and inconsistent leadership, which collectively contribute to poor outcomes for patients. Cost reduction should not be done in the traditional manner of reducing leadership development investment, but in rethinking at a system or regional basis, exploring collaborations, working together to support the individual development needs across systems and ensuring clinical leaders receive sufficient training when transitioning from frontline clinical practice to leadership roles.