Leadership in GP TrainingInnovation and delivery

Ian McLean

Darren Cocker

Mehal Patel

21/7/10

Postgraduate Deanery for Kent, Surrey and Sussex

This workshop

• Overview and introduction

• What happened at the PCT?

• What happened for the learner?

• What are the results?

Leadership?

• If mentions of the word "leadership" in the BMJ keep increasing at the current exponential rate, then by 2034 every second journal article will include a reference to the term. Will that be enough?

• Escaping the term has been virtually impossible since the publication of Ara Darzi’s final report on reforming the NHS, High Quality Care for All (2008).

• . "What we are going to do with all these leaders in 5-15 years’ time is not clear" (BMJ 2010;340:c914 ) Noble

WANTDISEASE

SQUALOR

IGNORANCEIDLENESS

“We will not be dictating the ‘how’ when it comes to achieving better public health outcomes. But we will be very clear about the ‘what’ – what we want to measure and achieve, such as: increases in life expectancy, decreases in infant mortality and health inequalities, improved immunisation rates, reduced childhood obesity, fewer alcohol related admissions to hospital, and more people taking part in physical activity.” 

• Good leaders exploit teams, not by telling people what to do but by getting the best out of them. To some extent, the NHS has been bullied by successive governments, a process that tends to pass anxiety down the line. Effective health service managers do not transmit anxiety: they contain it, acknowledging its inescapable presence at the heart of healing. That is leadership. No "great men" are required.

How do you become a GP?

12

Medical School

GP

Mentoring

GP

Political/ClinicalMentoring

Management

Mentoring

GP with special interest

Teaching & researchTeaching & research

Clinical

Retiring GP

Mentoring

SessionalGP

Mentoring

SessionalGP

Mentoring

Mentoring

GPR - General Practice Registrar FCS - Flexible Career Scheme

F1 F2

Sub mis Ophtal/ENT

GPRPaed

Palliative care

Derma Medicine

GPR GPR

GP

GP experience

A A AA A AAA

GP training

• 3 years

• Regulated by GMC

• Delivered by Deaneries

• Academically supported by RCGP

• Balance between hospital and GP

• Integrated Training Placements

The Curriculum

• Learning outcomes

• Reflection and recording

• Assessment– WBPA

• CBD• COT• DOPs

• External assessments

Healthy people: Promoting Health and preventing disease

• Understand the concept of health• Understand approaches to behavioural change and their

relevance to health promotion and self-care• Be able to judge the point at which a patient will be

receptive to the concept and the responsibilities of selfcare• Understand the role of the GP and the wider primary

healthcare team in health promotion activities in the community

• Understand the importance of ethical tensions between the needs of the individual and the community, and to act appropriately

• Be able to work as an effective team member over a prolonged period of time and understand the importance of teamwork in primary care.

Community

• Understand the concept of health• Understand approaches to behavioural change and their

relevance to health promotion and self-care• Be able to judge the point at which a patient will be

receptive to the concept and the responsibilities of selfcare• Understand the role of the GP and the wider primary

healthcare team in health promotion activities in the community

• Understand the importance of ethical tensions between the needs of the individual and the community, and to act appropriately

• Be able to work as an effective team member over a prolonged period of time and understand the importance of teamwork in primary care.

Person

• Understand the concept of health• Understand approaches to behavioural change and their

relevance to health promotion and self-care• Be able to judge the point at which a patient will be

receptive to the concept and the responsibilities of selfcare• Understand the role of the GP and the wider primary

healthcare team in health promotion activities in the community

• Understand the importance of ethical tensions between the needs of the individual and the community, and to act appropriately

• Be able to work as an effective team member over a prolonged period of time and understand the importance of teamwork in primary care.

Management in Primary Care

• The need to reconcile the needs of the individual GP and practice with the needs of the wider health economy

• The structure of his or her local healthcare system and its economic limitations

• The importance of involving the public and communities in managing health services, e.g. encouraging patient participation in decisions about the local provision of health care

• The need to reconcile health needs of individual patients with the health needs of the community in which they live, balancing these with available resources

• The local, national and UK health priorities and how they impact on the delivery of health care.

GP training at present delivers doctors that are fit for the consulting room but not equipped to deliver health care to communities and wider society

What did KSS do?

• GP training placements with integrated additional experience ITP

• Would it be possible to do this in a PCT?• Needed to talk to PCT• Needed to get them on board and identify our

Clinical Supervisors. (Senior Managers)• Needed to train CS• Needed to liaise with the GP programme

The Curriculum

• Learning outcomes

• Reflection and recording

• Assessment– WBPA

• CBD• COT• DOPs

• External assessments

What was needed

• Create programme– Create support materials– Map to curriculum– Determine assessment processes

• Identify GP Registrars– Ideally second year (ST2)– Motivated individuals

• Identify and train supervisors

PCT Role

Darren Cocker

Clinical executive NHS ECK

Clinical supervisor

• NHS Eastern and Coastal Kent is a large PCT• Budget approx 1.2billion• Population of 710k• Spread out rural and towns• Large areas of coastal deprivation• Deprivation linking to inequalities and poor

health outcomes• Increasing elderly population

Background

• Recognised that there was common ground between the deanery and pct agenda

• Clinical leadership becoming more important• Wanting to create a potential pipeline of future

clinical leaders• Opportunity to embed the partnership working

between clinicians and managers earlier• Seen as an extension to our already extensive

clinical engagment programme.

Why did we get involved?

• Sourced 3 clinical supervisors from senior figures within the pct

• Created a clinical training programme manager

• Developed a curriculum • Identified several areas that would be

crucial for learning• Attending meetings,learning sets/workshops

and a project.

What did we do?

• Induction • Competency assessment with supervisor• Identify learning needs• Regular meetings with project lead and supervisor• Weekly teaching sessions- flexible and adaptable• Reflection/google group/virtual community• Workshops on leadership/commissioning and

work with public health and management trainees.

The programme

• Live commissioning project• Chance for registrars to understand the wider

community and its implications for patients.• Focuses on 3 main workplace based

competencies within the Gp curriculum.• Harness new skills e.g negotiation,report

writing and presentation.• Develop a better understanding of

commissioning and the clinicians role within it.

The Project

So what was it like to be a supervisor?.....

• Pct has a better understanding of clinicians• The ability to bring the management trainees and

public health trainees together with them creates a richer learning environment.

• Wider conduit to communicate with Gp registrars and trainers about commissioning.

• Develops a better understanding of the pct• Increased cohort of Gps and trainees with a

knowledge of public health and commissioning.• Pipeline of future clinical leaders• Their work!

Benefits

• Hard work to get started

• Resource intensive

• Short placement

• Problems with identifying keen Gp registrars

Challenges

• In the current political climate this pilot is more important than ever.

• Clinicians will take a higher commissioning profile.

• Decreasing resources and 40% management cost reduction. Needs to be factored in.

• Potential expansion to all local registrars!• Hope to develop a link with the NHS institute for

innovation and improvement.

The Future

What was it like for the learner?

Background

• IntegratedTraining Post for 4 months

• 2nd Year of training – GPVTS ST2

• Pilot project

• 3 Trainees- 2 ST2, one ST3

• 3 days in General Practice, 2 PCT

How it Went• Induction programme with educational

supervisors:• GPSTR Self Assessment Tool- competencies

derived from the GP curriculum and NHS Leadership Quality Framework

• Mapping of core competencies against those from GP curriculum

• Learning objectives set on monthly basis• External evaluation by Prof. Annmarie Ruston- 3

interviews- Christ Church university

How it Went

• PCT Induction Programme- One day induction– Vision of PCT– Key challenges– Population demographics, needs and Inequalities

• Assessments- 2 Case based assessments, 2 DOPs(Direct Observed Procedures)

• Weekly tutorial by Senior PCT managers• Attend meetings in the PCT

Projects

• We were given three different projects- new and ongoing to be able to demonstrate and develop competencies

• Myself- liaison worker dual diagnosis project

• Experience: Needs Assessment working in teams- drawing on resources from

different people Project managementLiterature search

Conclusion• Very useful placement- learnt about the

working of the PCT and Commissioning Services

• Leadership skills – understanding the concept of good leadership and key competencies

• Project management• Literature search and needs assessment• Writing a business case• Laid foundation for future professional

development

What are the outcomes

• For the PCT

• For the learner– Projects– Feedback

• For the future– Exploring with other PCTs– Supporting new job role for GPs– And of course, commissioning!

Outcomes

• All respondents were positive about the value and success of the ITP developing the leadership skills of the GPStRs covering the three dimensions;

• Leadership of self; leadership of teams and leadership of organisations within systems.

Outcomes

• Facilitated trainees to understand context for change

• Develop skills to set direction for change• Collect and apply evidence to decision

making• Effective as a means of breaking down

cultural barriers between GP and the PCT and holding potential for improving clinical engagement.

Projects

• Liaison worker Drugs and Alcohol• Maternity project• Housing and Health• Allergy Services• Paediatric Audiology• Community Dermatology• Headache services• Learning Disabilities• Early Arthritis

To sum up...

• ‘I have become of aware of things that I never knew existed. It has really opened my horizons’