The Lead NCHD initiative is one of a range of initiatives taken at national level to improve NCHD recruitment and retention in the Irish public health system. It has been in place since 2014 and evolved into an important leadership role across the health sector, with over 700 Lead NCHDs appointed over this time frame.

• This initiative is implemented and funded by National Doctors Training and Planning (NDTP), Health Service Executive (HSE). The initiative has been welcomed by the Department of Health, the Irish Medical Council, the Forum of Irish Postgraduate Medical Training Bodies, the Clinical Directors, the Forum Trainee Subcommittee and the Irish Medical Organisation.

It functions to ensure structured communication arrangements between NCHDs and senior management across the health service are established, and to provide leadership training to NCHDs

The current framework began in 2008 with the introduction of the Clinical Director role, created under the new consultant contract, which marked the first formal leadership role for consultants. In 2014, the Lead NCHD role was established at clinical sites across the country, followed in 2016 by the development of a National Lead NCHD role. Consultant leadership has since evolved further, with the creation of the Office of the Chief Clinical Officer in 2018 and, more recently, the appointment of Regional Clinical Directors for the new health regions. NDTP has also developed consultant leadership roles, including the introduction of Regional Directors of Postgraduate Medical Education and Training across all Regional Health Areas.  Given these developments, the Lead NCHD role, now over a decade old, warranted review in the 2025/2026 period to ensure it remains aligned and integrated with the evolving consultant leadership structures within the HSE and the regional operational framework of the HSE. Thus, in 2025/2026, the first Regional and Group Lead NCHDs were appointed.

The role of the Lead NCHD is to

• Provide a formal link at management level between the NCHD cohort, NCHD Committee and the clinical directorate/hospital/mental health service management structure. This enables a structured, continuous two-way flow of engagement and communication between management and NCHDs. Through this NCHDs are provided with an opportunity to participate in discussions and decision-making regarding matters that affect NCHDs, the day-to-day running of hospitals/mental health services, and solutions/improvements to enhance patient care.

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• Support integration of all NCHDs into their clinical site and improve the experience of NCHDs (induction, education, support and direction)

• Develop quality improvement initiatives relevant to the experience of NCHDs on clinical sites, where possible aligned to local or national strategic plans.

• Promote and support their NCHD peers in implementing positive change initiatives, and representing themselves at a management level.

• Attend Lead NCHD workshops.

The Lead NCHD at each clinical site will report to their nominated mentor.  It is recommended that this mentor is a Consultant, the local NDTP lead for post-graduate medical education and training, or the clinical director. It is recommended for the Lead NCHD and their mentor to meet regularly at agreed intervals e.g. fortnightly. These meetings provide an opportunity for the Lead and their mentor to discuss and highlight matters of mutual interest. These may be issues directly affecting NCHDs that require senior input, or issues highlighted by senior management that need to be addressed with NCHDs. The initial meeting may include a number of objective(s) to be achieved, agreement as to how the objectives will be progressed and provide a means of tracking progress towards their achievement which can be reviewed at intervals as agreed. This action plan should be regularly reviewed, and a service improvement or quality Improvement project should be identified early on in the tenure of the Lead.

The Lead NCHD role encompasses the following key elements:

• When interacting with hospital management act on behalf of all NCHDs within the clinical directorate structure.
• Attend regular meetings with their nominated mentor to discuss issues pertinent to NCHDs including NCHD welfare, training provision and access, European Working Time Directive (EWTD) obligations, any executive decisions affecting NCHDs and individual/group grievances.
• Regularly attend the hospital senior management team meetings and participate in discussions and decision making, where invited.
• Where invited, Lead NCHDs should attend (or nominate other NCHD Committee Members) to attend relevant meetings and hospital committees such as:
  • Medical Board/Medical Executive.
  • Clinical Directors.
  • Physicians Sub-Group.
  • Surgical Sub-Group.
  • Organisation of Working Time Act verification group meetings.
  • Bed Management.
  • Infection Prevention and Control.
  • Drugs and Therapeutics.
  • Audit Committee and/or Risk and Quality and Patient Safety.
  • Where appropriate, attend hospital inspections such as healthcare accreditation, college, Medical Council inspections.
  • Chair the NCHD Committee.
  • Establish an avenue of communication with NCHDs working across clinical sites, such as mental health services, primary care and public health.
  • Work in conjunction with NCHDs and the NCHD Committee at all times.
• Meet NCHDs within their hospital or directorate in a regular and structured fashion to inform and be informed of all issues pertinent to NCHDs.
• Liaise with Medical Manpower (MMP) to provide insight of NCHD work-patterns and clinical demand so that MMP may produce EWTD-compliant rotas.
• Liaise with the Senior & Executive Management as required.
• Liaise with relevant medical departments and with individual consultants as required.
• Liaise with health and social care professional representatives and nursing management representatives, on any matters of joint interest, including transfer of elements of NCHD workload, and support for NCHDs on-call.
• Liaise and work closely with Education and Training Leads.
• Liaise with the Regional and/Group Lead NCHD as needed.

Job Description

Be employed as an SHO, Registrar, Specialist Registrar or Senior Registrar, with an NCHD contact and an appropriate clinical commitment in the relevant clinical site for the training year

Each Lead NCHD is required to:

• Contribute to the wider Lead NCHD initiative, through engagement with the National and Regional Lead NCHDs, and attendance at the National Lead NCHD workshops
• Provide feedback as requested by the National Lead NCHD and NDTP,
• Roll out improvement initiatives for NCHDs, and
• Promote continuity of the Lead NCHD role on their site by facilitating a smooth transition and handover to the incoming Lead