Healthcare systems need strong leadership if they are to be sustainable and responsive to the health needs of the future. It has been suggested that involving clinicians in management has potential to improve performance of healthcare organisations. However, there is very little empirical and theoretical literature about how medical managers conceptualise management or undertake management roles. There has also been very little formal evaluation of the capacity of medical managers as well as their needs for future training. Competency frameworks have been described as offering a common language for describing effectiveness in an organisation and possibly helping to achieve a high level of consistency when assessing performance. There has been a recent surge in the number of international projects studying various aspects of leadership and developing leadership frameworks (including in healthcare) which indicates the interest in understanding and better defining leadership.The aims of the study were first to explore and compare the experiences, leadership and management competencies and development needs of doctor managers in Kenya and the United Kingdom, and secondly to explore the use and the applicability of a leadership competency framework specifically developed for doctors. In order to do this, qualitative interviews were done in the first stage of the study with doctors managing healthcare institutions in Kenya and the UK. In the second stage of the study, a survey questionnaire based on the Medical Leadership Competency Framework (MLCF) 2008 was conducted on doctor managers in the Ministry of Health in Kenya and the NHS in the UK. The survey design also allowed for testing of hypotheses that had been constructed before the data was collected. The two sets of data were analysed together to explore the applicability of the MLCF (2008). The template method was used for qualitative data analysis while appropriate statistical methods in SPSS were used for quantitative data analysis.The findings from the survey data validated the findings of the interviews in addition to providing additional information on the applicability of the MLCF (2008). Doctor managers in Kenya and the UK find the job difficult and stressful. Various reasons for and ways of addressing some of the difficulties were proposed. Some key differences between the two countries regarding the issues making management difficult were identified. The participants reported themselves as competent in leadership and management and related tasks in management to their experiences in patient care. The doctors identified their training and development needs. There was a difference between the two countries as to when to start management training for doctors. Study participants were equivocal on the applicability of the MLCF (2008) and results of the data analysis suggest that competency frameworks may not be very good at assessing doctor managers' skills.The findings from this study have provided a better understanding of the experiences, leadership training development needs for doctors in management and validity of some hypotheses. In addition, they have provided a better understanding of limitations of leadership competency frameworks in healthcare and limitations of self evaluation.