Job-sharing a senior clinical role: the benefits of a portfolio approach to NHS careers

Dominique Allwood and Francesca Cleugh are two consultants at the Trust who share the role of associate medical director (AMD) for quality improvement (QI). While many all- female job shares are set up to accommodate caring responsibilities outside of work, Dom and Fran have chosen to split their AMD role to allow them to pursue other professional passions and commitments. For International Women’s Day, we asked them what it’s like to be part of a job share, and how they think flexible working could make an impact on the workforce issues highlighted in the NHS Long Term Plan.

How would you describe your current roles?

Fran: I’m a paediatric emergency medicine consultant based at St Mary’s A&E and currently head of specialty for our paediatric emergency medicine team and associate medical director for quality improvement at the Trust alongside Dom.

Dom: I’ve actually got three roles. I am a consultant in public health medicine for the Trust as well as associate medical director for quality improvement, and I also work for the Health Foundation as assistant director of improvement.

How did your job share come about?

Fran:I have been involved with the quality improvement team at the Trust since its inception taking a leading role in the development of our staff education and training programme. I am passionate about creating a culture of continuous improvement and it’s an aspect of my job plan that has always made me proud. The AMD role equates to four ‘PAs’ in a consultant job plan – which is effectively two days. When the role came up, I was really keen but knew I didn’t have the capacity to take on the whole role alongside my clinical job. A job share made it possible and realistic for me to be able to lead the QI team alongside my other commitments and areas of interest. The AMD role is really exciting, but it obviously comes with a level of responsibility and accountability – so it’s been brilliant to be able to share that with someone like Dom who has a really complementary style to mine.

Dom: We’ve been doing the associate medical director role since August last year (2018) and we applied knowing that we wanted to do it as a job share. Although Fran and I knew each other from our work with the QI team, we didn’t know each other very well when we applied. But our vision for the role was aligned, and we both knew we would have struggled to take it on individually while pursuing other interests, so a job share was the perfect, flexible solution for us. That said we still had separate interviews and had to be independently good enough to do the role. Also, while our personalities are quite different, our strengths are really complementary.

How would you describe your strengths?

Dom: Fran is really bubbly and relational and good with people and able to take a big picture view, whereas I’m more into technical stuff – detail and logic.

Fran: I’d agree – our Myers-Briggs * showed we are both extroverts but Dom is definitely a details, stats, need a plan and list person, whereas I’m more intuitive and visual, but these strengths work so well together and by having both of us in one role, the Trust has the benefit of both sets of strengths combined.

Dom: I often hear that when we’re both in one room that colleagues feel they are getting a double benefit, or the power of two. Considering we didn’t know each other very well before doing the job, we are surprisingly in tune with one another – we might be different in our personalities, strengths and preferences but we have underlying shared values. It can be lonely in some of these leadership roles and by having the job share it’s like having a ‘work best friend’. We get to share each other’s’ opinions and thoughts and act as a sounding board – I think this may actually be quite rare.

How does the job share work practically? Are you both involved in everything and do you split the work, or do you have your own distinct areas of responsibility?

Fran: By virtue of our previous experience and expertise, we’ve naturally split the portfolio of work but we cover for each other. I tend to lead on the development of education programmes and creating the infrastructure to support people across the organisation to get involved in improvement work, while Dom has been leading work around evaluation, applying improvement method and rigour across the organisation and the Flow Coaching Academy programme. We see each other most weeks and stay in contact. We very much try and tag-team and not both be at the same things. I might go to one meeting, and Dom would go to another. In a sense the organisation is getting more than the sum of its parts – they are getting more than one person doing two days, but at the same time we are trying to be smart about how we are using our time so we aren’t duplicative. Sometimes we both need to be at an event or meeting because we bring very different skills. But we can definitely both stand in for each other, and we both have intelligence on different aspects of the role.

Dom: This is true – while we play to our strengths and professional interests we still need to be appraised of each other’s’ work and be able to talk to it. We cross over on a Tuesday in the medical director’s office and we also speak regularly on text, email and over the phone. We also try and catch up for a working dinner every couple of months. I’m at Imperial three days a week but I also spend the other part of my week at the Health Foundation so it’s important for us to stay in touch.

Fran In my clinical role, 80% of my job is direct clinical work in A&E and 20% is for personal development, leadership, service change, audit, governance, supporting trainees – a whole collection of things. Usually Tuesdays are my QI day, when Dom and I meet with the QI team and make sure we have at some time to catch up. Our relationship has developed massively in the last nine or so months – we have a really good, strong working relationship.

"When you can align the organisation’s and employees’ needs this is the sweet spot, and I think flexible working is one solution to that."

How would you describe your role in relation to the quality improvement team?

Fran: We provide clinical leadership and mentorship to the improvement team and have clinical accountability for the investment the organisation puts into the QI programme at the Trust. We have two programme managers we work very closely with who lead the team and most of the other team members report to them. We’ve done a lot of work together shaping the structure and objectives of the QI team and we are in close conversation with the programme managers and others from the team throughout the week to support them to deliver our vision of creating a culture of continuous improvement.

Dom: Ultimately, in medical leadership roles like ours you have to be able to influence without doing it through a direct reporting structure. We have a great improvement team who report into the programme managers, but nominally Fran and I have responsibility for the whole quality improvement programme as we provide leadership for it. Colleagues generally know which of us to speak to about what based on our portfolios, but we try to behave like we are interchangeable too.  If one of us is away – we can manage it – and we spend a lot of time keeping each other up to date as we need to be on top of what each other is doing

How do you manage conflict?

Fran: There’s not been any big conflict and I think we are pretty aligned in terms of the vision for the team. We do have different styles and approaches but I actually think we are both really good listeners and the wider team is a really safe space to be open and challenge. The QI team environment is quite different to the clinical environment and it’s fun to be disruptive sometimes. I think Dom and I are both disrupters in our own right, and like to challenge the status quo. The health system as we know it needs massive innovation to keep it sustainable and free - and we need to challenge the way we do things now. Working together in this role gives us the opportunity to have these kinds of conversations, and have our own paradigms challenged

Dom: I can’t imagine many people I could work with where it feels so equal. I have so much respect for Fran and she is so lovely about all the things she thinks I can do. There’s been points where we’ve had a difference of opinion – although these have been rare – but generally we’ve talked it out and seen it from each other’s perspectives. I think if we did have conflict we’d manage it really well. It’s a risk to do a job share if you don’t come as a package in the first instance, as you have to work out how you’ll mitigate conflict.

With the workforce challenges the NHS is experiencing, how do you think greater flexibility at work could aid retention?

Dom: There’s a fine balance between delivering the needs of the organisation and employees feeling fulfilled and motivated, wanting to be here and putting in discretionary effort. When you can align the organisation’s and employees’ needs this is the sweet spot, and I think flexible working is one solution to that . There could be a whole bunch of people who might have otherwise left the organisation in order to pursue another role or other hobbies or passions, or caring responsibilities and feel their current work set-up doesn’t support that. Having flexibility helps to retain people with skills interest and organisational knowledge. I can see the risks for the organisation if everyone wants to work flexibly though when you need to staff rotas, but that doesn’t mean we shouldn’t be open to it and think more proactively about it. In a time where the Long-Term Plan has just come out and we’re short of 100,000 people in the NHS, we simply can’t afford to let people go because they don’t feel the job fits in with their life. We’ve also got a huge problem with burn out and presenteeism. I see flexible working as a way to really address some of that.

Fran: I work in children’s services where there are lots of less than full-time workers for various reasons. While service needs are important, a happy and motivated team has been shown to improve the quality of care. It’s vital to give people space to develop and pursue their passions which often brings with it new perspectives and improvements to services. As an organisation there are opportunities for us to explore in enabling people to pursue flexible careers that promote resilience, retention, wellbeing and joy in work – a feeling of mastery, motivation, meaning and membership in what we are doing. For some people that is all about focusing on one aspect of work, for other people it’s having a more varied and portfolio based working week. The infrastructure can make it quite challenging sometimes so people end up taking on additional responsibilities on top of their day jobs or doing work above and beyond their contracted hours. I believe we should definitely be looking towards outcomes and outputs, rather than clocking time. When people have time, it’s crucial to support them to do really good things for their professional development and the services they deliver. 

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*Myers-Briggs is a personality assessment often conducted in the workplace to better understand how colleagues relate to each other