Leadership beyond title: creating credible routes for SAS doctors
By Dr Naeem Aziz · Published 2026-08-28
Leadership development should connect practical opportunity, organisational support and the authority to improve services.
Leadership is often visible in SAS practice before it appears in a job title. Experienced doctors coordinate complex care, supervise colleagues, teach, review incidents, improve pathways and hold institutional memory. The problem is not whether these activities can contain leadership. It is whether the organisation recognises the work accurately and provides the authority, time and support needed to make it sustainable. A credible leadership route therefore needs more than a course. Development should connect learning with real responsibility: access to meetings where decisions are made, opportunities to lead bounded pieces of work, feedback from credible colleagues, and job-plan recognition where recurring duties consume time. Sponsorship can help capability become visible, but selection for a role should still be based on legitimate criteria and evidence. Organisations also need to examine their own systems. Eligibility rules, succession plans and committee membership should distinguish requirements that are genuinely necessary from restrictions inherited from older templates. Representation should not become tokenism; a doctor invited to contribute needs papers, time, access to information and a route for feedback. For the individual doctor, the useful discipline is to describe the work before claiming the identity. What purpose was advanced? What decision was made? What authority existed? What changed? What evidence shows the contribution? Those questions create a leadership portfolio that can be reviewed without inflating routine competence into grand claims. Leadership development works best when responsibility, authority and accountability move together. The aim is not to erase titles, but to stop titles being used as substitutes for evidence where the real question is capability for a particular piece of work.
