Dubbed the ‘Nicholson Challenge ’ by Health

NHS must save £20 billion by 2015, or four per cent per year. Monitor, the independent Foun-dation Trust (FT) regulator, has more recently indi-cated that this is more likely to be six per cent per year. However, hospital productivity is falling and primary care trusts are failing to meet savings targets. David Cameron has said: ‘It’s not that we can’t afford to modernize; it’s that we can’t afford not to modernize’.1 Despite preoccupation with the reform agenda, the most pressing issue facing the NHS is the need to increase value: maintaining and improving the quality of care whilst saving money. To achieve this, engagement of clinicians is essential. We therefore cannot afford not to involve the junior doctor community. This article examines why junior doctors are essential for the NHS to achieve efficiency savings, why they are currently disengaged from the process and potential initiat-ives to address this. Why engage junior doctors in NHS leadership? Medical engagement is where doctors actively and positively contribute towards enhancing the per-formance of the organization in which they work. NHS hospitals with enhancedmedical engagement perform better2 and those with more structured medical leadership initiatives have improved rates of hospital acquired infection, staff productivity and financial performance.3 Disengagement of doctors can have disastrous consequences as highlighted at Maidstone an