What does leadership mean for NHS staff?
Leadership in healthcare is a set of behaviours, not a job title. A staff nurse running a bay, a resident doctor coordinating a cardiac arrest, a pharmacist querying an unsafe prescription and a paramedic directing a scene are all leading. The GMC's guidance on leadership and management for all doctors, the NMC Code, the HCPC standards and the GPhC standards all describe leadership duties that apply to every registrant.
Well-led teams tend to communicate better, raise concerns earlier and learn from mistakes. Blame, ignored concerns and poor planning make errors more likely.
The Healthcare Leadership Model
The NHS Leadership Academy's Healthcare Leadership Model describes nine dimensions of leadership behaviour for staff at every level. It is a useful way to reflect on strengths and gaps, and many NHS interview questions map onto it.
| Dimension | What it looks like on a shift |
|---|---|
| Inspiring shared purpose | Keeping the team focused on safe, kind care when pressure is high |
| Leading with care | Noticing who is struggling and making sure breaks happen |
| Evaluating information | Using observations, risk scores and handover to prioritise |
| Connecting our service | Working with site teams, other wards and community services |
| Sharing the vision | Explaining the reasons behind a plan, not just the plan |
| Engaging the team | Asking for views and involving people in decisions |
| Holding to account | Following up on agreed tasks and standards fairly |
| Developing capability | Giving learners supervised opportunities and feedback |
| Influencing for results | Making a clear case to seniors or managers for what is needed |
How do you lead a shift well?
Whether you are nurse in charge, the senior doctor on call or leading a community team for the day, the same principles apply: know your patients and team, plan, keep the overview and escalate early.
- Prepare: Check staffing and skill mix, the sickest patients, planned admissions and discharges, and any equipment or bed problems.
- Brief the team: Hold a short safety huddle. Introduce everyone by name, share key patients and risks, allocate work, agree breaks and say who to ask for help.
- Allocate fairly and safely: Match complex patients to experienced staff, make sure learners are supervised and spread heavy workloads.
- Keep situational awareness: Walk round, ask for updates and keep a picture of who is unwell, what is pending and where the bottlenecks are. Avoid taking a full caseload yourself when it is busy.
- Escalate early: If staffing, beds or acuity become unsafe, escalate through your local policy to the site team or senior clinician, and record it.
- Hand over and debrief: Give a structured handover. After a hard shift, take five minutes to thank people and ask what went well and what could be better.
How do you delegate safely?
Delegation lets teams work efficiently, but only when it is safe. The NMC Code expects nurses, midwives and nursing associates to delegate only within the other person's competence, make sure instructions are understood, make sure the person is supervised and supported, and confirm the outcome meets the standard. The GMC and HCPC set similar expectations. You remain accountable for the decision to delegate; the person who accepts the task is accountable for how they carry it out.
Can you do the obs on bay 3 when you get a minute?
Sam, could you do full observations on the four patients in bay 3 by 2 o'clock, please? Mrs Okafor in bed 12 had a temperature this morning, so tell me straight away if her NEWS2 is 5 or more, or anyone's oxygen is below their target. Come and find me when you've finished so we can go through them.
The strong request names the person, task, deadline, specific concern, threshold for reporting back and follow-up. Check local policy for what each role may do, as some tasks need recognised training and sign-off.
Communicating in teams and in a crisis
Communication failures feature in many serious incidents. Structured tools reduce ambiguity when people are stressed or do not know each other.
| Tool | How it works | When to use it |
|---|---|---|
| SBAR | Situation, Background, Assessment, Recommendation | Escalating a concern or handing over; always state the recommendation |
| Closed-loop communication | Address a named person, they repeat it back, they report when done | Emergencies and any time-critical task |
| Safety huddle | Short team briefing on risks, roles and help | Start of shift and when things change |
| Debrief | Brief structured review of what happened and what to learn | After emergencies or a difficult shift |
Crisis resource management principles, taught on many resuscitation and simulation courses, include calling for help early, taking a clear leadership role, sharing the workload, using all available information, and inviting challenge. A good crisis leader often stands back from hands-on tasks to keep the overview. These skills complement, and do not replace, accredited hands-on training.
How should you handle conflict and speaking up?
Conflict is normal in busy teams. Handled early and respectfully, it can improve decisions. Ignored, it damages relationships and care. Keep the focus on patient safety as the shared goal.
- Choose the moment: Speak privately and soon, but not in the heat of the moment.
- Describe the behaviour and its effect: Use facts and I statements rather than labels.
- Listen: Ask for their view and the pressures they face.
- Agree a way forward: Find common ground, agree specific actions and check back later.
- Escalate if needed: If behaviour continues, or involves bullying, harassment or safety risk, involve your manager or use your organisation's policies.
You never listen at handover and it's really annoying. Sort it out.
Can I have a quick word about this morning's handover? We were interrupted twice and I missed that bed 8 had a new allergy until I checked the chart. I know mornings are busy for you. Could we finish each bay before taking calls, unless it's urgent?
When you need to challenge a senior colleague, graded assertiveness tools help, such as CUS: I am Concerned, I am Uncomfortable, this is a Safety issue. All regulators require registrants to raise patient safety concerns. Your organisation will have a speaking up policy and Freedom to Speak Up arrangements; since the National Guardian's Office closed in June 2026, organisations hold more of this responsibility locally, so check your own policy for who to contact.
How do you lead change as a clinician?
You do not need a management role to improve care. Many effective changes start small: a new handover sheet, a checklist for a common procedure, or a change to how breaks are covered. The key is to test ideas on a small scale, measure the effect and involve the people affected.
- Define the problem with data: Gather a simple baseline, such as how many patients had delayed observations last week, rather than relying on impressions.
- Involve the team early: Ask the people who do the work what gets in the way. They often know the answer, and they are more likely to support a change they helped design.
- Test small: Use plan, do, study, act (PDSA) cycles: try the change with one bay or one shift, study what happened, then adapt.
- Measure and share: Track a simple measure over time and feed results back to the team.
- Make it stick: Once it works, build it into the routine, update local guidance with the right approval, and hand it over if you rotate.
Expect resistance and treat it as information. People may have practical worries you have not seen. Check that any change to clinical practice goes through your organisation's governance route before it becomes policy.
Case study: a difficult night on call
Ravi is a medical registrar on nights with two foundation doctors. At 1 am, foundation doctor Hannah calls to say she is overwhelmed. At the same time a nurse bleeps about a patient with falling blood pressure, and the emergency department asks for two admissions to be reviewed. Later, a senior nurse tells Ravi that Hannah was abrupt with her.
Ravi prioritises by clinical risk. He sees the patient with low blood pressure first, starts treatment and agrees hourly observations with a clear threshold for calling him. He phones Hannah, asks her to read out her jobs, and sorts them with her into urgent, soon and can wait. He takes one urgent review himself and asks the other foundation doctor, whose ward is quieter, to help for an hour. He informs the on-call consultant about the sick patient and the workload, as local policy requires.
Later he thanks the senior nurse for raising the concern. He then speaks privately with Hannah, describes what was reported and listens. She explains she felt she could not cope and apologises. They agree she will apologise to the nurse and call him earlier next time. Before handover, Ravi thanks both foundation doctors and checks how they are.
Developing your leadership skills
- Reflect on one shift a week against the Healthcare Leadership Model.
- Ask for feedback on your leadership, not just your clinical work.
- Volunteer to lead a huddle, a debrief or a small improvement project.
- Use NHS Leadership Academy resources and any local leadership programmes your employer offers.
- Record reflections for appraisal or revalidation, without identifying patients or colleagues.
Our course Leadership and Team Working in the NHS covers leading a shift, delegation, crisis communication and conflict with worked examples and a full case study. If part of your role is developing others, Teaching Skills for Healthcare Professionals and Clinical Supervision and Giving Feedback build the related skills.
Frequently asked questions
What are the most important leadership skills in the NHS?
Clear communication, safe delegation, situational awareness, prioritising by clinical risk, managing conflict early, and supporting the team's wellbeing are central. Behind them sit compassion and psychological safety, so people feel able to ask questions and raise concerns. The NHS Healthcare Leadership Model groups these into nine dimensions that apply at every level.
What are the nine dimensions of the Healthcare Leadership Model?
They are inspiring shared purpose, leading with care, evaluating information, connecting our service, sharing the vision, engaging the team, holding to account, developing capability, and influencing for results. The NHS Leadership Academy designed the model for all staff, and it is useful for self-assessment and for preparing examples for interviews.
How do I lead a shift as a newly promoted nurse in charge?
Prepare by checking staffing, acuity and planned movements. Run a short safety huddle, allocate fairly and make sure learners are supervised. Keep the overview by walking round rather than taking a full caseload, escalate staffing or safety problems early through local policy, and debrief at the end. Ask an experienced colleague to be your sounding board.
Am I accountable if I delegate a task that goes wrong?
You are accountable for the decision to delegate, including checking the person is competent, giving clear instructions and arranging supervision. The person who accepts the task is accountable for carrying it out properly. If you delegated appropriately and followed policy, responsibility for how the task was done rests with them. Check the NMC, GMC or HCPC guidance for your profession.
What is compassionate leadership?
Compassionate leadership means attending to people, understanding the challenges they face, empathising and taking practical action to help. Described by Michael West and colleagues, it is linked with better staff wellbeing and safer care, and is widely promoted across NHS leadership development. It does not mean avoiding difficult conversations or standards.
How can I show leadership without a management role?
Lead a huddle or debrief, coordinate an emergency, support a learner, challenge unsafe practice using SBAR or CUS, or run a small improvement project with PDSA cycles. Record what you did and what changed. These examples are valued in appraisals, revalidation and interviews for senior posts.
Who can I speak to if I am worried about raising a concern?
Start with your line manager or a senior clinician if you can. Your organisation's speaking up policy will name Freedom to Speak Up contacts and other routes. You can also contact your trade union, professional body or defence organisation for advice. If the concern is about patient safety, regulators expect you to raise it.
Related courses
Leadership and Team Working in the NHS
This course explains what leadership means for every healthcare professional, not only managers, and teaches practical skills for leading a shift or…
Teaching Skills for Healthcare Professionals
This practical course teaches you how to plan and deliver effective teaching in clinical settings, from a formal session to five minutes at the…
Clinical Supervision and Giving Feedback
This course explains the different kinds of supervision used in UK healthcare, how to set up a supervisory relationship that works, and how to give…
Sources and further reading
- Leadership and management for all doctors. General Medical Council.
- The Code: Professional standards of practice and behaviour. Nursing and Midwifery Council.
- Delegation and accountability: supplementary information to the NMC Code. Nursing and Midwifery Council.
- Standards of conduct, performance and ethics. Health and Care Professions Council.
- Healthcare Leadership Model. NHS Leadership Academy.
- The future of Freedom to Speak Up. NHS England.
- Compassionate leadership resources. The King's Fund.
Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.
More guides
Teaching Skills for Doctors and Nurses: Practical Methods That Work
Practical teaching skills for doctors and nurses: learning outcomes, the one-minute preceptor, SNAPPS, Peyton's four steps, and bedside and group teaching.
Giving Feedback in Clinical Supervision: Pendleton and Other Models
Pendleton's feedback model explained with a worked example, plus SET-GO, Ask Tell Ask and R2C2, and how to give feedback well in clinical supervision.
Time Management and Prioritisation for Busy Healthcare Workers
Time management and prioritisation for healthcare workers: how to prioritise by clinical risk, organise a task list, handle interruptions and escalate safely.