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Good leadership is consistently cited by networks as crucial to success. Leadership graphicSuitable leaders must be identified or recruited, trained, developed, supported and allowed enough time to perform their role well in addition to any clinical work commitments.

Essential elements are:

  • strong and visible corporate leadership articulating an inspirational vision and narrative about quality of care at all sites.
  • strong and visible local leadership committed to effective, efficient performance in line with the organisation’s strategic goals.
  • good people management and employee engagement skills fostering enthusiastic team working.
  • frequent articulation and sense checking of the vision for the network.
  • agreed level of local autonomy.

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“We know how to solve the problem and it’s good when we’re given the power to get on and do it.”

“It makes such a difference when the executive team come out and see what we’re doing.”

“I’ve trained the sister so she can act as matron when I’m not around, otherwise the matrons can be very thinly spread.”

Staff and patient photo

Sites within a network offer great potential for developing staff, testing innovations and creating excellent patient experience. Strong local leadership is key, particularly to ensuring that all sites operate to the right standards and with the right culture.



  • The leadership of the site should be considered early in the planning process. Don’t assume the existing structure can be stretched.
  • You may not need more people. It may be a question of repositioning and reorganising existing resource, perhaps giving someone the chance of greater responsibility.
  • Experience has shown that the more dispersed the network is, the more diluted the management. Sometimes the answer will be more managers, sometimes it will be a more senior manager.
  • Leaders must be given time to perform their role well in addition to any clinical work.


  • A clear management structure is crucial to proper authority and accountability and to allow prompt escalation. It should be mirrored by clear financial, performance and workforce processes.
  • Clinical services are best led and managed by the senior clinician on site. This ensures they are supported, motivated and able to challenge poor standards.
  • Each site and sub-specialty should have an identified manager and clinical lead.  Appointing a nurse lead and allied health professional leads may also be appropriate.
  • Networks offer greater potential for a dedicated specialty manager and more flexible clinical leadership. Apart from formal line management, it is important that staff know when and how to access advice. Much risk will be mitigated by clear protocols and clinical guidelines.
  • Aim for a mix of local and posts shared with other networked sites – working across more than one site provides more experience and wider shared learning.

    Leadership graphic


  • Leaders should be mindful that a new provider taking over a flagging service can provide continuity of care for patients who would otherwise have to travel elsewhere.
  • Workforce sustainability may be enhanced by developing staff who wish to remain in their local area.
  • The recruitment of local staff with an investment in the area and the service can improve patient experience.
  • Staff should be encouraged to challenge poor practice and to understand how it impacts on patient care. CQC visits can happen any time and social media makes it easy for patients to complain in public. High standards of quality and safety should be business as usual.


  • Leaders are key to ensuring that a new site feels properly integrated into the rest of the network. A risk is the creation of an isolated, unconnected service which may already be going through the trauma of transfer to a new employer and new ways of working.
  • All staff must be encouraged to feel responsible for everything that goes on at a site.


  • Managers are responsible for ensuring that their staff receive communications from the centre and that they understand the role their site plays in the network. If a team brief system is in place, ensure all staff attend meetings regularly and can feed back to the centre.
  • It may be worth swapping newsletters between providers and hosts to keep abreast of each other’s news.


“Good leadership is essential to successful standardisation across
a network.”

“The local management team should be the champions on behalf of the network who educate and train the teams they are responsible for.”

“If you don’t feel you can afford the right level of leadership that might be a reason not to take on a site.”