This article reflects the conversations in the breakout group on this topic at the Recently Appointed Consultants symposium on Thursday 5 June 2014.


Newly qualified consultants can implement change and develop a service.  Developing a service involves identifying a problem, designing a solution and pitching the idea to the correct managers.

A successful pitch answers the questions: What? Why? How? 


  • Know the subject matter well and give an explicit aim, remit and clear outcomes.
  • Expect the starting point to be an under-appreciation of the problems faced. Remember that managers may have limited medical knowledge, so explain in clear layman’s terms the advantages and disadvantages of service changes.


  • Define the benefits and demonstrate the need for change.
  • Present evidence in the form of patient histories, testimonies (questionnaires) and data from pilot studies. Utilise national guidelines, information on good practice at other hospitals and published evidence.
  • Where appropriate, approach other groups for information and support, e.g. patient groups, carers, referrers, clinical governance groups, the Board QI Department and patient safety groups.
  • Nothing is entirely new – speak to friends/colleagues from other units who may already utilise the service that you wish to introduce. Ask for business plans and audit data from different units to consolidate your reasoning.


  • In the pitch, identify the stakeholders for the project and the barriers.
  • If possible make the idea cost-neutral or cost-saving. Could it utilise ‘spare’ capacity? Take a critical look at the current service and try to identify where potential costs can be saved, e.g. drug budgets. Would centralisation of a given service save money, therefore freeing up funding to redirect to other causes, e.g. a specialist nurse’s salary?
  • Would it be possible to get pharmaceutical funding for a finite pilot?
  • Also remember that quality improvement for patients and professionals is as important as financial considerations.

Be patient.  If your initial pitch fails it may be that pitching the idea higher up the authority gradient may be a good idea. Get support from departmental colleagues, but be prepared to take the idea forward yourself if necessary.  Have belief in your project and your capabilities.

Breakout group leader: Dr Neil McGowan, Honorary Clinical Associate Professor, Consultant Physician and Endocrinologist, Royal Alexandra Hospital, Paisley

Reviewed January 2017, January 2018 & September 2021