Book review: The Leadership Hike — to a WISE destination?

Joanne Reeve is a GP, professor of primary care, and leads the @wisegpcouk programme. She is on Twitter:@joannelreeve

A hike of any type may feel unappealing at a time when we are all exhausted. So why read The Leadership Hike: Shaping Primary Care Together by Amar Rughani and Joanna Bircher?

Strengthening primary care leadership is an NHS policy priority. Recent years have seen a profusion of new fellowship opportunities aimed at building capacity for leadership skills across the primary care community — as highlighted on the Royal College of General Practitioners (RCGP) website.1 For those embarking on new fellowships, The Leadership Hike will provide a valuable reference source.

Leadership and Management are core components in the RCGP curriculum. Rughani and Bircher have produced an authoritative and informative reference, in a highly readable format, that provides practical support for trainees and trainers in tackling curriculum objectives on Knowing Yourself, and Leadership and Management.

For those embarking on new fellowships, The Leadership Hike will provide a valuable reference source.

But this book is also a resource for every one of us working in primary care, offering support for the everyday tasks that we all do. The authors are not asking us to take on additional roles. They challenge us not to do more, but to do what we already do differently.

They start by inviting us to first take a fresh look at the context in which we are working (and walking). It is widely recognised that primary care is overstretched, and we know that lack of resource is a barrier to change.2 But Rughani and Bircher invite us to consider why we need to work differently — because the nature of the job has changed.

General practice can no longer be described as a ‘jack of all trades’ model of health care, because we no longer (if indeed we ever did) manage the ‘superficial’ end of health care through knowing ‘a little about a lot’. Professional practice no longer depends on what you know, but how you use what you know to achieve necessary goals and outcomes.3

The general practice team employ skills in managing so-called  ‘wicked problems’ — problems that cannot be defined by (reduced to) a right or wrong answer, measured by simplistic outcomes, but instead require the critical, creative thinking of professional wisdom to find, evaluate, and continuously learn from solutions that are ‘better or worse’ rather than ‘right or wrong’.4

They [the authors] challenge us not to do more, but to do what we already do differently.

Wicked problems are found in the everyday clinical challenges of managing individuals living with problematic polypharmacy, multimorbidity, long COVID, or treatment burden; in the practice challenges of building new models of care — whether the acute changes of a pandemic or the longer term challenges of new networks; and at policy level in defining the goals and priorities for primary care in the future NHS vision.

Rughani and Bircher offer us practical insights in to how we can individually and collectively recognise, develop, and utilise these extended skills of everyday professional practice.

This book therefore supports development of a specific role in general practice (namely leadership), but also to building a new professional vision of general practice. It recognises GPs as community-based consultants in primary care medicine leading the management of the most complex and wicked of problems, drawing on the wisdom of professional practice.

It therefore resonates with the principles and practice of the WISE GP programme and has important contributions to make to wider NHS and RCGP discussions on the future doctor for modern primary care.

We are exhausted. But as a profession we will also deliver. This book offers us someone to walk with at these most challenging of times. And that, ultimately, is its strength. To quote Roger Neighbour in his foreword: ‘It is as nutritious and comforting as hot chocolate — and you deserve it’.



  1. Royal College of General Practitioners. Leadership programmes. (accessed 20 Jan 2021).
  2. National Institute for Health and Care Excellence. How to change practice: understand, identify and overcome barriers to change. 2007. (accessed 20 Jan 2021).
  3. Reeve J. WISE GP: championing the Bananarama principle in general practice. 2019. (accessed 20 Jan 2021).
  4. Rivett G. Our health service presents wicked problems. 2012. (accessed 20 Jan 2021).


Featured photo by Ales Krivec on Unsplash

The BJGP is the world-leading primary care journal. At BJGP Life we add multi-media comment and opinion for the primary care community.

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I am really enjoying this book. It’s the first really accessible book that incorporates concepts of leadership in the context of primary care…highly recommended

DOI – I do know Amar well…but this is still an excellent book!

Thank you so much, Dom! Joanna and I are really delighted that people are enjoying the Hike. Anyone who wants to make a difference for their communities (which is most people in our experience) is a leader within. We hope this journey gives people the confidence to believe that and rise to the opportunity.

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