10 Work with managers and clinical colleagues

Ask the person who can make the relevant decision

Career development often involves several supportive people but no clear owner. A mentor offers encouragement, a consultant says the doctor is capable and a manager suggests collecting more evidence. Months can pass because no one has identified the actual decision.

Start by naming that decision. Is it access to a session, time for improvement work, clarification of clinical scope, a job-plan review or a formal application? Then identify who can authorise it and who can advise. A meeting with the right people is more useful than several general conversations with people who cannot act.

Use T10 to prepare a brief agenda. State the decision sought, the facts supporting the request and the questions that remain. Attach only material that helps the discussion. Keep the material focused so that the issue can be resolved or referred to the person able to decide it.

Different roles in the conversation

A suitably experienced clinical colleague can help describe the work, review practice and provide corroboration within their knowledge. This may be a consultant, Specialist, Associate Specialist or another appropriately qualified colleague. Use the specific eligibility requirements where a formal assessor or referee role prescribes them. A line manager can address work arrangements and development within their authority. A clinical director may consider the service implications and wider workforce need. Medical workforce staff can explain the process and contractual documents.

A SAS tutor or educational lead may help identify opportunities and learning support. An advocate may help the doctor make their concerns heard. A mentor can help clarify direction. An appraiser can connect reflection and development planning. These contributions overlap, but none should be assumed to confer a grade outside the formal process.

Ask participants to be explicit about their role. “I can support this educationally, but the manager must decide the cover arrangement” is a useful statement. It allows the next action to be directed correctly.

Where the same person holds several roles, separate the functions in the discussion. Clinical feedback, resource approval and a formal assessment may carry different responsibilities even when one individual contributes to more than one.

Preparing a specific request

“I would like support with career progression” is understandable but easy to answer vaguely. A more specific request is: “I would like to agree access to the specified activity, with named clinical support and a review of the evidence after an agreed period. My current duties prevent attendance at the available session. I am asking for a decision on cover or an alternative opportunity.”

The revised request makes the decision visible. The manager can examine the operational issue, the clinical colleague can comment on the activity and the doctor can understand what is needed next.

Bring a short scope profile and the relevant development objective. If you are seeking recognition of established work, say that explicitly. Do not allow the meeting to be framed as a request for new experience when the immediate question concerns actual responsibilities already carried.

Where a policy is relevant, identify it and the provision you want clarified. Use the source to focus the discussion, not as a substitute for explaining the facts.

Receiving feedback without losing the question

Feedback may be welcome, uncomfortable or unclear. Listen for the specific claim. “Needs more confidence” could refer to communication, uncertainty in decisions or simply the observer's impression. Ask for an example and what change would demonstrate improvement.

If the feedback identifies a genuine need, agree how it can be addressed. If it concerns evidence, ask what information is missing. If it reflects limited observation, discuss how a relevant review can occur. These responses are more productive than either accepting every vague statement or rejecting all criticism.

You can also ask what evidence supports a positive conclusion. A helpful colleague may say that you are ready, but a formal application still needs an account that others can assess. Specific supportive feedback is more useful than an unqualified endorsement.

The aim is not to negotiate away a standard. It is to understand what the standard means in the activity and how the available evidence relates to it.

Explore objections carefully

An objection may concern safety, capability, capacity, service design, funding or process. Do not assume that all objections mean the same thing. Ask what would need to change for the request to be reconsidered.

If the issue is capacity, consider whether another arrangement meets the same objective. If the issue is capability, seek a specific account and a supported plan. If the issue is the formal route, ask for the current document and decision authority. Where a regrading policy applies, its provisions should guide the response rather than a generic statement about vacancies.

Sometimes the answer remains no. Record the reason and the next appropriate option. A credible plan does not require every meeting to end favourably. It requires the outcome to be understandable and usable.

Avoid solving an organisational objection by immediately volunteering unlimited unpaid work. That can conceal the resource problem and create an unsustainable expectation. A feasible alternative should retain appropriate support and recognition.

Make the meeting record useful

A good record is concise and factual. It states what was requested, what was agreed, what remains unresolved and who will act. Separate a decision from a suggestion and from an item awaiting advice.

For example: “The clinical scope will be reviewed by the supporting clinician and doctor. The manager will confirm whether the proposed session can be accommodated. No decision has yet been made about the resource request. The group will reconvene after those two actions.” This is more useful than “positive discussion about progression”.

Invite correction where the record does not reflect participants' understanding. Keep the agreed version and update it when the position changes. The record supports continuity, particularly if personnel change, rather than functioning only as evidence for a dispute.

Where there is disagreement, describe it precisely. “The participants differed on whether the current job plan reflects the activity described in T02” is clearer than “manager unsupportive”. It points towards the information needed to resolve the issue.

Support when the conversation stalls

If repeated discussions produce no decision, identify the unresolved question and the person with authority to answer it. A SAS advocate, tutor, professional representative or appropriate senior colleague may help you frame the next conversation. The relevant support depends on the issue and local arrangements.

Do not assume that every delay is deliberate obstruction, but do not allow indefinite delay to become invisible. Ask for a realistic date for the next action and record when it is missed. A calm factual account is often more useful than escalating the tone before the decision process is understood.

Where you believe a formal process has not been followed, obtain advice about the applicable route and any deadline. An informal discussion should not cause you to miss a time-limited right. Chapter 18 explains how to separate developmental feedback from a procedural concern.

A career meeting that reaches a usable decision

A one-page proposal can focus the discussion: identify the activity, its purpose, the conflicting duty and the support needed. Ask explicitly whether the proposed opportunity can be accommodated or, if not, what alternative is feasible.

In the example, the manager supports the learning purpose but cannot yet release the proposed session. A colleague suggests an alternative. The meeting records that cover approval remains pending, the manager owns that decision and a date for an answer has been agreed. The proposed opportunity has not yet been authorised.

A separate concern about prioritising competing information becomes a defined learning objective with feedback, without disguising the outstanding resource decision. T10 records both actions so neither is lost.

Useful responses to an unclear answer

If you hear “You need to show more leadership”, ask which behaviour or contribution is missing and what evidence would help. If you hear “There is no capacity”, ask which resource is unavailable and whether an alternative is feasible. If you hear “Everyone has to do this course”, ask whether it is a formal requirement, a local programme expectation or one suggested way to meet the learning need.

These questions can be asked respectfully and directly. They invite an explanation without accepting an unsupported rule. Record the answer accurately, including uncertainty. Where the issue concerns policy, obtain the source before making a consequential decision.

If discussion becomes personal or unproductive, return to the decision sought and the facts needed. You can arrange a further meeting with appropriate support rather than attempt to resolve everything in the moment. Formal concerns about treatment or process need the relevant advice and route; the career meeting record should remain a factual account of what was requested and decided.

What the service needs to arrange

Respond to the actual question, identify decision ownership and provide specific feedback. Avoid sending the doctor between people who each assume another person is responsible. If a decision requires wider input, state who will obtain it and when.

Support should be honest. A clear statement that an opportunity cannot currently be provided, with a reason and review point, is more useful than repeated encouragement without action. Where a formal application remains available despite non-support, the relevant policy should be explained accurately.