Pipeline for Upcoming Leaders in Supporting Excellence (PULSE) Network cohort 1 celebrates clinical leadership across London
Our PULSE Network cohort 1 finale event, ‘Leading for Today and Tomorrow’, brought together colleagues from across London for a morning of discussion and reflection on the future of clinical leadership.
The event opened with a keynote from our Regional Medical Director, Dr Chris Streather, who reflected on the significant challenges currently facing the NHS and reinforced the evidence that healthcare systems led by clinicians achieve better outcomes. He spoke about the importance of investing in clinical leadership and highlighted the role initiatives such as the PULSE Network can play in supporting emerging leaders. He also emphasised the responsibility senior leaders have in developing future leaders and creating opportunities for them to contribute to shaping our NHS.
Professor Clare Fuller, National Medical Director, reflected on her own leadership journey and discussed the importance of mentorship, peer support and professional networks in sustaining leaders over time. She highlighted that many of the core capabilities required for leadership are developed through clinical practice, including communication, conflict management and relationship building.
Professor Kevin Fenton, Regional Director for the Office for Health Improvements and Disparities (OHID), delivered a session on leading in complex and uncertain times, exploring the challenges of declining trust, increasing misinformation and widening inequity. He emphasised the importance of evidence-based leadership, authentic community engagement and cross-sector collaboration, and encouraged leaders to actively challenge inequality and structural racism within healthcare systems.
Dr Savita Ghattaora, Associate Medical Director for Clinical Leadership, concluded the event with ‘The PULSE Network and Beyond’, reflecting on the development of PULSE, from the evolution of the PULSE model, to our future ambitions linked to the region’s 5-year medical leadership strategy. Participants and mentors also shared reflections on their experiences of the programme and its impact on their leadership development.
A huge thank you to NHS England colleagues in helping to support the PULSE network thus far. The completion of cohort 1 represents an important milestone for the PULSE Network, demonstrating the impact that co-produced, inclusive and low-cost leadership development initiatives can have in supporting the next generation of clinical leaders across London. We are now building on the success of cohort 1 with the development of an alumni network marking the beginnings of the region’s first medical talent pool, as well as the launch of cohort 2 on 23rd June!
For any further queries, please email: england.pulsenetwork@nhs.net
London 10 Point Plan for improving resident doctors’ working lives update
We would like to extend our appreciation for all the hard work going on in the London trusts, who have been providing us with updated action plans for their 10 Point Plan programmes. It is so rewarding to see the meaningful work taking place to improve doctors’ working lives. The impact this work has on staff wellbeing is highly valued.
- The newest role in relation to the 10 Point Plan is the Non-Executive Director (NED), as part of the triumvirate including the trust board lead and the resident doctor peer lead. As of mid-May, 73% of trusts across the country had NEDs in place. London trusts currently have 86% of their NEDs in place. Trusts should already have a workforce NED, so this could be seen as a widening of their role.
- Resident doctor peer leads are continuing to meet and work together on establishing networks, broadening communication and sharing best practice. They also attend national meetings and webinars as part of their role.
- All London trusts have now confirmed that they are committed to ensuring that resident doctors receive reimbursement for course-related expenses within 4 to 6 weeks of submitting their claims.
- The national team has confirmed that they plan to ensure the board assurance framework is clearly embedded to monitor ongoing progress and drive continuous improvement.
- The London steering group continues to work with the resident doctor peer leads and trust representatives to build on the great work that has already been achieved.
You can find more resources on our Futures page along with the minimum standards annual leave guidance which has been published.
A reminder about our 10 Point Plan Futures page: Improving Resident Doctors Working Lives in London – Futures.
Update from Dr Ruth Brown, Secondary Care Transformation Dean
Delivering better annual leave through the 10 Point Plan
The annual leave project is an important part of the work led by the London Medical Workforce Team to improve resident doctors’ working lives. As part of the wider national 10 Point Plan, this programme focuses on making annual leave arrangements more consistent, transparent and fair. It recognises that the ability to take leave properly is essential for wellbeing, morale and safe, sustainable working. National minimum standards published by NHS England support delivery of point 3 of the 10 Point Plan.
For resident doctors, annual leave has often been a source of frustration, with variation in local processes, inconsistent decision making and limited clarity about what should happen when requests cannot be accommodated. The aim is not only to improve processes but also to improve experience, helping ensure resident doctors can take leave in a way that is equitable, timely and compatible with service delivery.
To support communication and engagement, Professor Jo Szram’s video update on the minimum standards is available on LinkedIn. The video outlines the ambition behind the annual leave programme and explains why this work matters for resident doctors across the system.
There is also accompanying Instagram content with aligned messaging to help raise awareness of the project more widely. These materials are designed to support a shared understanding of the standards and how trusts can embed the changes effectively.
For ongoing collaboration and access to programme resources, colleagues can join the NHS Futures workspace. This provides a central place for updates, materials and shared learning as implementation continues across London and more broadly within the resident doctor working lives agenda.
Read the full minimum standards for annual leave for resident doctors.
These standards set out expectations for trusts, including:
- having a published resident doctor annual leave policy
- ensuring timely decisions with clear reasons
- supporting access to full leave entitlement where possible
- enabling resident doctors to take annual leave in line with the principles of equity, fairness and consistency
Taken together, this work represents a practical example of the London Medical Workforce Team’s contribution to the 10 Point Plan. By focusing on a day-to-day issue that directly affects resident doctors, the annual leave project is helping turn national ambition into tangible improvement. It also forms part of a broader commitment to creating more supportive training environments that align with the realities of modern medical training.
Innovate-MD fellowship interview with Dr Richard Bogle, Programme Lead and System Dean for North West London
Dr Richard Bogle is System Dean in North West London and also a Consultant Interventional Cardiologist at St George’s University Hospitals NHS Foundation Trust and Honorary Senior Lecturer at City St George’s, University of London.
A passionate advocate for learning by doing, Dr Bogle has been closely involved in the design and delivery of simulation-based programmes in South London and has supported the establishment of the Innovate-MD fellowships programme to be a strategic platform to embed teamwork, communication and patient safety into early postgraduate training.
Following the first cohort of the Innovate-MD fellowship finalising their projects, we took an opportunity to ask Richard a few questions about the programme:
What do you think makes a fellowship programme truly successful beyond publications and outputs?
For me, the real test of a fellowship programme is not simply whether it produces posters, papers, presentations or project reports, important though those things are. The deeper measure is whether it changes how people see themselves and what they believe they can influence.
A successful fellowship should help doctors and dentists develop agency. It should give them the confidence, skills and networks to identify a problem, understand the system around it, bring people together and deliver change. Some projects will lead to measurable outputs very quickly; others may be more developmental. But if a fellow leaves the programme with a stronger sense of professional identity, a better understanding of systems leadership and the confidence to keep improving healthcare beyond the fellowship year, then the programme has succeeded.
I am also interested in what happens after the formal fellowship ends. The best outcome is not a single completed project, but a group of clinicians who continue to lead, collaborate and support one another across London.
What are you trying to build that other fellowship programmes may have missed?
We are trying to build a fellowship that is more than a collection of individual projects. Many fellowship programmes are excellent at supporting talented individuals, but they can sometimes become quite project-centric: the fellow has a supervisor, completes a defined piece of work and moves on.
With Innovate-MD, we are trying to create a broader developmental community. The projects matter, but they are also vehicles for learning leadership, improvement, collaboration, influence and resilience. We want fellows to understand how healthcare systems really work: how decisions are made, how change happens, why good ideas sometimes fail and how to bring people with you.
We are also deliberately bringing together fellows from very different specialties and professional backgrounds. That is important because many of the challenges facing healthcare do not sit neatly within one specialty or one organisation. Workforce, inequalities, sustainability, education, digital transformation and doctors’ working lives are all system problems. They require people who can work across boundaries.
With 28 fellows doing very different projects, how do you create a sense of shared identity and community?
The diversity of the projects is one of the strengths of the programme, but it does mean that community has to be created deliberately. It will not happen simply because people are all called fellows.
We have tried to build that shared identity through regular programme days, cross-theme discussion, peer learning and a clear sense that every fellow is part of something larger than their own project. The common thread is not the topic of the project, but the purpose behind it: improving healthcare, improving training and developing clinicians who can lead change.
It is also important to create spaces where fellows can speak honestly about uncertainty, difficulty and failure. Real improvement work is rarely linear. Projects stall, stakeholders disagree, data is messy and priorities shift. When fellows realise that others are facing similar challenges, even in very different areas, that creates connection. The programme becomes a community of practice rather than just a timetable of teaching sessions.
What have you learned about leading a group this large that surprised you?
One thing I have learned is that a large group does not necessarily need more control; it needs more clarity. With 28 fellows, multiple themes and a wide range of projects, it would be very easy to over-manage the programme. But highly motivated clinicians do not need to be micromanaged. They need a clear purpose, good structures, access to the right people and enough freedom to shape the work around the realities they encounter.
I have also been struck by how much fellows learn from each other. As programme leads, we often think our job is to provide expertise, teaching and guidance. That is important, but the peer network is just as powerful. A fellow working on sustainability may have a useful insight for someone working on doctors’ working lives; someone leading a digital project may help a colleague thinking about education or health inequalities. The connections across themes are often where the most interesting learning happens.
The other surprise is how much energy there is for this kind of work. Doctors and dentists in training are often described in terms of pressure, burnout and service demands, which are very real. But when given time, permission and support to improve the system, they bring enormous creativity and commitment.
What feedback from fellows has changed how you run the programme?
Fellows have reminded us that structure and flexibility need to sit together. They value the programme days, the teaching and the opportunity to meet as a cohort, but they also need support that is responsive to where their project actually is. A project may need help with stakeholder engagement one month, data the next and implementation or evaluation later on.
Their feedback has also reinforced the importance of practical support. Fellows do not only need high-level leadership theory. They need help with the real mechanics of change: how to frame a problem, how to get the right people in the room, how to use data, how to manage governance, how to communicate with senior stakeholders and how to keep going when progress is slow.
We have also learned that community does not happen by accident. Fellows have told us that the opportunity to connect with others, hear about different projects and share challenges is one of the most valuable parts of the programme. That has made us more intentional about creating time for peer learning and cross-fertilisation between themes.
Ultimately, the programme is evolving with the fellows. That is how it should be. If we are asking them to lead improvement, we need to model the same approach ourselves: listen carefully, adapt and keep improving the programme as we go.
Interview with Rohan Krishnan, Innovate-MD Fellow and CT2 working in London
Introduction to… Dr Rohan Krishnan, CT2 working in East London Foundation Trust (ELFT), as well as part of the first cohort of NHS England Innovate-MD fellows.
“Tenacity and patience helped push this project towards the finishing line.”
Dr Rohan Krishnan is a CT2 working in East London NHS Foundation Trust. He is an international medical graduate who studied in Hungary before moving to the UK in 2022. He is one of the London reps for the Psychiatric Resident Doctors Committee and is involved in multiple projects, including updating the ST4 applications portfolio guidance, working with the College medical training review task and finish group, and reviewing the guidance for resident doctor supervision. He is also part of the College Core Training Advisory Committee. He holds roles within the BMA as an Agenda Committee Member for the Resident Doctors Conference 2026, the North East London representative for the BMA Annual Representatives Meeting 2026, and as a Local Negotiating Committee Representative at ELFT. He is part of the founding cohort of the Innovate-MD Fellowship from NHS England London and is developing a simulation facilitator training package for psychiatry resident doctors.
What was your original vision for your project, and how has that changed over time?
The original vision of the project was to create a local simulation training package for psychiatry resident doctors in East London, to train them to become simulation facilitators. The intention behind the project was to increase the number of facilitators available to medical education departments, enabling more simulation-based courses for resident doctors.
The project has evolved significantly in scope after discussions with trust leadership, who recommended conducting it as a research project to assess the feasibility of creating such a course and its impact on doctors. The intention shifted to generating generalisable results that could be shared across the UK and to exploring how this could be incorporated into the training curriculum for psychiatry resident doctors. So, while the project’s vision has remained the same, the scope has changed, increasing the complexity of its delivery and potential impact if and when it is successful.
What characteristics do you feel helped your project flourish?
Tenacity and patience have been the main characteristics that have helped push this project towards the finishing line since we pivoted to a research project as we progress through the various layers of bureaucracy. Communication has been important, as it has required negotiating with clinical directors, training programme directors and the medical education department to remove existing barriers for resident directors that hinder participation, and to agree on the local funding required to make this project flourish.
What skills do you think are improved by undertaking the challenge of a fellowship?
Problem-solving skills, communication and networking have all vastly improved during the fellowship. I would add that the fellowship and the opportunities it provided helped me understand the need to learn to navigate complex bureaucratic structures within the NHS without losing steam.
What elements and successes have given you the most satisfaction?
Successes that have given me the most satisfaction throughout this fellowship in terms of the project have been in being able to set up the logistics of delivering this course, including negotiating time for resident doctors to be able to participate in this course when delivered, agreeing on frequencies, funding and venues for running the course. Other successes include gaining a personal understanding of the research landscape in the UK and the NHS and learning to navigate it for the first time. The skills I have learnt so far will make it easier when I pursue future projects.
I would be remiss if I did not mention my favourite part of the fellowship: the academic days, when I would meet the other fellows. It was wonderful to see all the work people have been doing, share frustrations and successes, and get ideas on how to move this project and others that I work on forward.
Interview with Joana Teixeira, Innovate-MD Fellow and CT2 working in London
Introduction to… Dr Joana Teixeira, GP ST3 working in East London, as well as being part of the first cohort of NHS England Innovate-MD fellows.
I am Joana Teixeira, a GP Registrar (ST3) in East London with a particular interest in digital health and primary care innovation. Alongside my clinical work at a busy surgery serving one of London’s most diverse urban populations, I am an Honorary Research Officer at the Global Digital Health Unit at Imperial College London, where my research focuses on digital health training for primary care physicians worldwide. I am also an NHS Clinical Entrepreneur (cohort 10), and I hold leadership roles with WONCA’s Working Party on Digital Health and the Royal College General Practitioners Junior International Committee, both of which keep me connected to how digital transformation is unfolding across different health systems.
I care deeply about the gap between national digital health strategy and what actually reaches the frontline, and I am motivated by finding practical, people-centred ways to help close it.
What was your original vision for your project, and how has that changed over time?
My original aim was to evaluate whether Heidi Health, an AI-powered clinical documentation tool, could reduce burnout among primary care clinicians. However, as the project progressed, I realised that the impact extended far beyond wellbeing metrics.
Clinicians consistently described feeling more present during consultations, spending less time on administrative tasks and regaining valuable time outside work. But I also encountered realities that rarely feature in a company’s product vision: uneven adoption rates across practices, varying levels of digital confidence among clinicians and the significant time required to embed any new technology into existing workflows. The gap between how an innovation is imagined and how it actually lands in a busy NHS surgery is substantial and understanding that gap became central to the project.
The work also surfaced broader structural challenges: the complexity of commissioning and procurement pathways for digital tools, the rapidly evolving landscape of clinical safety and information governance requirements, and legitimate questions about data ethics and patient consent. These are not barriers to be dismissed (they exist for good reason) but navigating them thoughtfully is essential for implementing technology responsibly and at scale. The project evolved from measuring a single outcome to understanding what it genuinely takes to embed AI tools into frontline care.
What characteristics do you feel helped your project flourish?
Being both a researcher and an end user of the technology was incredibly valuable. It allowed me to understand the challenges and opportunities from a clinician’s perspective and ensured the evaluation remained grounded in real-world practice, including the moments when things moved more slowly than expected or when adoption looked different across teams.
Strong collaboration was also key. Working closely with practices, Primary Care Network (PCN) leadership and the Heidi Health team created an environment of trust and shared learning. It also meant we could have honest conversations when implementation did not unfold as the company had anticipated.
Equally important was the support of the other Innovate-MD fellows. The academic days created a valuable space to share progress, discuss challenges and receive constructive feedback from colleagues working on very different projects. Those conversations often helped me refine my thinking and approach, and the peer support extended well beyond the formal sessions.
Finally, having a clear and achievable project scope helped maintain momentum and ensured the work remained practical and relevant throughout the fellowship.
What skills do you think are improved by undertaking the challenge of a fellowship?
One of the most valuable lessons was learning how to balance scientific rigour with the realities of busy NHS environments. Implementing and evaluating innovation in healthcare requires flexibility, collaboration and the ability to adapt when things do not go exactly as planned.
It also requires an honest appreciation of the structural landscape: commissioning and procurement of digital tools involves multiple stakeholders and lengthy processes; information governance and clinical safety frameworks are evolving rapidly and can shift mid-implementation; and ethical considerations around AI (including transparency, consent and equity of access) must be built into the design of any evaluation, not added as an afterthought.
The fellowship gave me a much deeper understanding of how decisions about innovation are made and implemented within healthcare systems. That understanding has been invaluable, and it has strengthened my confidence in navigating future leadership and improvement work, particularly as the NHS 10 Year Plan places digital transformation at the heart of how care will be delivered and organised going forward.
What elements and successes have given you the most satisfaction?
The most rewarding aspect has been hearing directly from clinicians about the difference the technology has made to their daily practice: improved focus during consultations, reduced cognitive load and better patient interactions. Those conversations reinforced why this work matters.
It has also been satisfying to know that the findings are helping inform real decisions about future investment and implementation. Seeing research translate into practical change (even if slowly, even if imperfectly…) has been one of the most valuable outcomes of the fellowship. Innovation in the NHS rarely follows a straight line, and learning to find meaning in the small wins alongside the larger ones has been an important personal lesson.
On a broader level, the fellowship confirmed my belief that technology, when implemented thoughtfully and with genuine clinical input, can enhance both clinician wellbeing and patient care. At a time when the NHS 10 Year Plan is setting ambitious targets for digital transformation, having clinicians who understand both the promise and the complexity of that journey feels more important than ever.
Update on industrial action and training progression
The English Deans have issued an updated FAQ to support NHS organisations in managing the potential impact of industrial action on resident doctors’ training and progression. The guidance explains how absence, teaching, induction, Annual Review of Competence Progression (ARCPs), recruitment, exception reporting and possible redeployment should be considered during periods of industrial action. It emphasises the importance of protecting patient safety while maintaining training opportunities wherever possible and ensuring that any impact on progression is reviewed fairly and consistently.
English Deans update on industrial action and training progression
NHS England’s English Deans have published updated frequently asked questions on the impact of industrial action on resident doctors’ training and progression. The guidance supports consistent decision-making across regions and providers, while recognising that local circumstances may vary.
Key messages
- patient safety remains the priority during periods of industrial action
- training opportunities should be maintained wherever possible, including teaching, induction and workplace-based learning
- absence linked to industrial action may contribute to absence thresholds that trigger a review of training progression any impact on progression should be reviewed fairly, consistently and in line with established processes
- redeployment of resident doctors should only be considered where all other options have been exhausted and must be agreed with the Postgraduate Dean or designated deputy
For further information, staff should refer to local guidance and speak to their educational supervisor, clinical supervisor, Foundation School, Director of Medical Education or Postgraduate Dean’s office where they need advice on individual circumstances.
Welcome our new SAS Development Dean for London
Please join us in welcoming Anushka Aubeelack, our new Specialist, Associate Specialist and Specialty doctors Development Dean for London, who will be covering for Marion Norbrook while she is away.
Dr Anushka Aubeelack, a British Mauritian, qualified as a doctor in 2007 after studying medicine at Bart’s and The London School of Medicine and Dentistry, Queen Mary University of London. In the NHS, she is an associate medical director, overseeing care of the deteriorating patient, and a specialist anaesthetist, looking after a comprehensive spectrum of patients from the well to the critically unwell.
She has recently been appointed by NHS England to the post of Associate Dean for SAS development (London). Outside of the NHS, she represents SAS doctors at a national level, working with both the Association of Anaesthetists and the SAS Collective.
Dr Aubeelack is a regular panellist and contributor, speaking on a variety of health issues. She has worked with the BBC, contributed to the Huffington Post, and is vice chair for the charity Compassion in Dying.
Our Specialty and Specialist Doctors Futures page can be found Visit our Specialty and Specialist Doctors Futures page.
Please email the team at england.sasdoctors@nhs.net
