Medical Director Update – Hampshire Thames Valley Q4 2018-19

Dear colleagues, Welcome to the last update of the year. At the Faculty of Medical Leadership and Management (FMLM) conference in 2017, Brigadier Nicky Moffat described leadership as a force multiplier. This is certainly something I agree with. In my personal experience, I have found that improvement is most likely to happen when a coalition of leaders throughout a system come together, with passion, to make it happen. Therefore in this update, we focus on the topic of clinical leadership. As I have stated before, we are privileged to have such a breadth of talented and conscientious clinical leaders in Hampshire Thames Valley (HTV). I am grateful to them, not only for the work they do, but also for being generous with their time and writing about their personal stories in this newsletter. January saw the conclusion of the 2030 programme. My thanks to colleagues from the British Army for hosting this final session at their leadership centre and talking to us about their leadership models. For me, one of the key strengths of the 2030 programme was the ability to bring together and connect primary care leaders from Gloucester, Southampton and Oxford. The geography was

broad enough for a real breadth of experiences to come together, yet small enough to allow people to form a learning community. I’m pleased to see that the WhatsApp group continues to flourish and was stimulated by a recent post about the Topol Review. I am delighted that local health economies are continuing to run their programmes, such as the 2020 programme in Frimley. At the Hampshire Thames Valley level, we continue to run the HTV Leadership Forum which brings together CCG Chairs, Trust Medical Directors, and 2030 participants, and in future the 2020 alumni. Thanks to Mark Kelsey for running a session on digital for HTV leaders and we are developing a HTV Chief Clinical Information Officer Forum. We recently ran a telecon for our chairs and medical directors to discuss the new GP contract. Thanks to Abid Irfan and Nigel Watson for speaking and leading the discussion, and a special mention to James Carter for his superb facilitation. In this newsletter, we have given space to a number of our clinical leaders to talk about their experiences and we have highlighted the work of FMLM and the Thames Valley and Wessex Leadership Academy. The diversity of our local clinical leaders should be a source of pride to us all, but we should be unrelenting in our continuing pursuit of inclusion, and thanks to Sarah Schofield, Kiren Collison and Lalitha Iyer for taking this workstream forwards. At the end of the day, diverse teams make better quality decisions. DR SHAHED AHMAD MEDICAL DIRECTOR HAMPSHIRE THAMES VALLEY, NHS ENGLAND

Leadership Matters

Around 85 clinicians have just completed the first cohort of an exciting and innovative clinical leadership programme: The 2030 Programme.

These clinicians came together from a wide geographical area – from Gloucester in the south west to Slough in the east and right down to Southampton – to develop competencies and connect leaders (current and future) across this large geography to learn some new leadership skills, from national experts and each other. A key benefit of this large geographical spread was that it facilitated the development of networks outside of normal working relationships

The programme consisted of five full day events and two half day learning sets where delegates were able to come together to learn from various specialists in different aspects of the NHS world, share experiences, and develop and hone leadership skills. The days covered a wide range of topics including change management and improvement, examples of other organisations going through change, generative listening skills, a RightCare introduction and information, as well as talks from international leads on primary care and senior military personnel.

Some of the benefits of the programme design included the provision of:

• An opportunity to develop facilitated networks

• A safe space to share concerns and anxieties, both personal and professional

• Support for leaders to help them navigate a complex working environment

• An opportunity to discuss and explore succession planning: what might the role of CCG chairs be going forward and what skills will we need to deliver these roles?

• Strong and independent professional facilitation for leaders

• Access to a personal coach and 360 feedback

• Access to a wide range of national and international leaders and influencers who can help with experience and examples of how they have tackled challenges

This approach enabled delegates to hear what was being developed and used elsewhere, learn from the best in the world and then discuss amongst themselves how these skills and attributes could help locally with the challenges they face.

The participants were deliberately chosen for their mix of experience. They ranged from experienced chairs of CCGs to newly qualified GPs, as well as people just starting out on their leadership career. This mix was an ideal opportunity for all to learn and share experiences and skills, and was well received by the participants.

The 2030 Programme

Dr Marion Lynch Deputy Medical Director NHS England, Hampshire Thames Valley

The participants are continuing to meet in learning sets, and also on the WhatsApp group which proved to be incredibly popular and successful.

The programme has been so successful that discussions have started about running a second cohort starting later this year.

My name is Rupa Joshi and I have been a frontline GP for 17 years, a managing partner for three years and a director of the Wokingham GP Alliance. My leadership journey was sparked by increasing workload and difficulty with staff recruitment and retention. I wanted to create a voice for change and make a difference for myself, my colleagues and for our patients. My vision is to transform our healthcare system locally such that it meets the needs of our patient population both for acute and chronic care. As well as ensuring that the most appropriate clinician sees the patient at the right time, I would also like to see services set up around the patient with allocated funding.

My first involvement in project management was with our paramedic home visiting service in the north cluster of Wokingham, as clinical

lead. The scheme saved 75 sessions of GP time in its first year. We saw 1,138 patients, with 130 hospital admissions expedited (46 with signs of sepsis) and a 23 minute urgent response time. I was also involved in the Time for Care initiative with workflow optimisation, productive general practice quickstart and am locality lead for seven day working. For our chronic care patients, I am currently working on introducing functional lifestyle medicine approaches to our high intensity users and group consultations for patients with chronic pain, fibromyalgia and paediatric asthma.

I was accepted onto the General Practice Improvers Leaders programme, which I completed in January 2018. I gained knowledge in QI and innovation projects which were invaluable to my learning. From here, I was selected for the Primary Care Faculty Development Programme. This involves a more in-depth review of the change model, understanding relationships, strengths and conflict, storytelling and presenting.

I have been a participant in a programme called NHS@2030 to build a network for aspiring clinical leaders who are able to support each other, develop the leadership skills needed to be part of the NHS in 2030. The programme was unusual in that it was participant-led. It was tailored to the mindset of GPs: we like to work fast and show results,

My leadership journey

Dr Rupa Joshi GP, Woodley Centre Surgery Director, GP Wokingham Alliance

we work in unpredictable environments and we make difficult decisions multiple times per day. We are a group of 70 GPs and 15 allied health professionals/managers who are like-minded, supportive and want to make a difference. We understand that change needs to first happen at a local level, and seek to build this up to a system-wide level. The

programme has taught me about the type of leader I wish to be. Leadership is about listening, conversation, connection, understanding and culture. Energy, innovation and empowerment are essential, along with self-awareness and the ability to adapt to the changing landscape of health and social care.

Before moving to the UK to take up his chief executive role at OUHFT, Bruno, who holds a medical degree, a PhD in health economics and an MBA spent 15 years as a partner at McKinsey and Company, and was also the chief executive of the Belgian healthcare system. Here he presents his view on leadership and how this has translated to his own career journey.

Transferring the skills and knowledge from a consulting business to working as a chief executive meant a shift in focus from developing recommendations to delivering on recommendations, and was a key part in his career shift; “As a partner in McKinsey you deal with complex issues and try to find ways to address those, but you’re not responsible or accountable for delivering the results that are required. As a chief executive you are accountable for the success of the whole organisation. So that difference between the intellectual contribution as a management consultant versus being able to do it as a chief executive was the key motivation”. Performing as a manager and leader in complex clinical environments such as a

Foundation Trust has meant Bruno’s initial career and focus on high quality clinical care has given him an excellent foundation; “My PhD’s key thesis was that high quality is associated with more efficient, lower cost care therefore high quality and lower cost go hand in hand.” This is crucial in connecting and engaging with clinicians and he notes “Clinicians want to deliver high quality care, they are often not so interested in the financial consequences. Clinical executives have more of an affinity for that, than if you don’t come from a clinical background”. Making the quality/financial link is therefore crucial: “People without a clinical background often feel more comfortable just looking at the financial numbers [so] it becomes a financially driven organisation….making the link that high quality means you can also do very well financially is an important maxim to work to”. Saying all this, when asked what is key to a chief executive’s performance, the personality

Leadership and my career journey

Dr Bruno Holthof Chief Executive, Oxford University Hospitals NHS Foundation Trust

and leadership style is paramount. “Whilst having a clinical background is important, complex healthcare organisations require a collaborative, consensus-driven approach which requires a lot of bottom-up input and buy-in from clinical teams. This talks to an inclusive and facilitative leadership style rather than a top-down directive style”. Similarities and differences in healthcare systems and learning from these has been a major consideration in Bruno’s career: “Embracing opportunities to learn from different healthcare organisations has been crucial as it enables you to be more creative, [and while] problems have been very similar

(i.e. to improve outcomes for patients, with the most efficient use of resources) the solutions are always different, and this creativity aids both working across the organisation and within the constraints of your own local healthcare system to solve problems.” However, Bruno is quick to point out that the NHS positions itself well when benchmarking his experiences to international partners: “[The NHS] searching out for best practice in the UK and internationally is strong, and adopting these across the health service is a good indicator of system learning and commitment to high quality care and improvement.”

I have been a GP for 25 years and started working in commissioning back in 1999. At that point I had just started to feel that I had a long time ahead of me and that just being a GP wasn’t going to satisfy my love of change and desire to do different things! I have gradually taken on more complex roles and learnt how to influence and inspire others to develop. I enjoy having a strategic view of our local health economy rather than just seeing the patient in front of me. I get a buzz from seeing ideas coming to fruition and knowing that I have influenced and guided decisions.

I have led on children’s agenda, through to vulnerable adults, been a safeguarding lead GP, worked on the Armed Forces and veterans agenda, I was primary care lead and more recently have been clinical lead in our system for urgent care. Planned care is probably the only big area I have done virtually nothing in over the years!

The Hampshire Thames Valley Medical Leadership Forum has been an opportunity to meet up with clinicians from a much broader area than I had contact with before and we have had a couple of fascinating national speakers which have been really interesting. I am keen be part of the conversations at a bigger area to learn what others are doing, although I am aware I could also be sharing more about what we are up to here in Portsmouth, as I think things are going well here (although we can always do better!).

Leadership and primary care

Dr Elizabeth Fellows Chair and Clinical Executive, NHS Portsmouth Clinical Commissioning Group

Our vision is to create a movement in the Frimley system which results in a culture where more people act in the best interest of the individual, as we equip and support leaders to bring about change across boundaries. 2020 is a leadership development programme launched in 2017 which models collaborative leadership across the Frimley Health and Care system. The programme has become a key enabler in delivering our ICS priorities. In order to act in the best interest of everyone in our system and the communities we serve, we have shifted our focus to ‘place’ and ‘communities’. Interorganisational, non-hierarchical and interprofessional communities are crucial to bring about this change successfully. Some of the Change Challenges 2020 Fellows have developed the following: • Introducing the Red Bag Scheme within

the Frimley system • Redesign the low risk chest pain pathway

for Frimley and Wexham hospital to ensure the right people are being admitted and care is improved

• To deliver frailty education across the Frimley Health and Care ICS so that everyone across the system has a basic understanding of frailty.

• To work with a pilot surgery to improve access to primary care for people with additional communication needs (e.g. non-native English speakers, deaf, mental health issues, learning disabilities) and take the learning from this to expand it out to others.

• Developing a community paediatric BRAAIN website for families with children suffering from ADHD/ASD symptoms.

The 2020 programme brings together leaders for change in our communities; GPs, consultants, therapists, nurses, social workers, managers as well as other public sectors like the police and army. Recently we also invited the private sector to participate in the programme to truly represent our communities. Since the initial cohort of 30 leaders three years ago, nearly 100 leaders have been through our programme. They commit to three residential sessions and three day events over a 12 month period. A spirit of collaborative effort of discovery, curiosity, innovation and commitment to a change challenge has reinvigorated professionals to see the opportunities to change how health and care can contribute to improving health outcomes. The programme is supported by a cross-organisational executive board, system leaders advisory board, the Thames Valley

Leadership in the Frimley Integrated Care System 2019

Dr Peter Bibawy Dr Adrian Hayter Clinical chair Locality lead North East Hampshire & Farnham CCG Windsor, Ascot & Maidenhead Lead Executive Board Member Frimley Leadership & Improvement Academy Frimley Leadership & Improvement Academy

and Wessex NHS Leadership Academy and our delivery partners in CoCreate Consultancy. In May 2018 we launched the Frimley Leadership and Improvement Academy, which provides oversight and development of our programmes. We are also working with other organisations and a key partnership is with Oasis Global, a third sector organisation with roots in Lambeth, developing school academies to empower communities to improve life chances and health outcomes. They are currently supporting us in Slough through an initiative supported by Sport England. Our aspiration is to embed quality improvement in each organisation and translate leadership into real, tangible and local improvements in health and wellbeing.

We are passionate about supporting our wider NHS family and modelling responsible leadership beyond boundaries. In January this year, North and Mid Hampshire system launched ‘Hampshire 2020’ and other systems are showing a real interest in the Hampshire and the Isle of Wight area. Bedford, Luton & Milton Keynes ICS are launching their 20/20 in September 2019 and there is further interest from areas such as Cambridge and Derby. If you would like to hear more about our work, or are interested in coming to one of our events please contact Tracy London on 01252 335 719 or email frimley.academy@nhs.net www.frimleyhealthandcare.org.uk/working-here/leadership-and-improvement-academy

“If I want to know what GPs think, surely I can just ask a few GPs? How hard can it be?” If only it were that simple. Firstly, GPs’ views are diverse: “ask ten GPs for an opinion and you’ll get eleven,” and quite rightly so. With the huge variations in demographics, rurality and deprivation, not to mention individual practice models, general practice is complex and multifaceted. Secondly, the current set up has not traditionally lent itself to a strong, single, easily accessible ‘GP voice.’ In Oxfordshire, there are seventy practices, four GP

federations, a local medical committee and a GP-led Clinical Commissioning Group. Each is made up of GPs with different roles and perspectives.

A united voice in primary care

Dr Kiren Collinson GP in West Oxfordshire Chair of the Oxfordshire GP Forum and Chair of Oxfordshire CCG

In the current transforming healthcare system, such heterogeneity can make it challenging to identify a clear route for seeking a primary care view. In addition, the multiple voices, whilst strong individually, run the risk of diluting each other. Hence, the Oxfordshire GP Forum has been born. The Oxfordshire GP Forum is a new single entity, including GPs from the CCG, LMC and Federations. The wider primary care team and others are also invited as appropriate, recognising their key roles and value. The group does not replace the statutory or constitutional roles of its member organisations. Rather, the group provides:

• A single point of access to give system partners clarity about how to seek a GP opinion.

• A clinical primary care view, enriched by several perspectives, on issues that extend beyond the remit of each individual organisation.___________

• A vehicle for closer working between

the different GP groups._________

The group has already produced results by shaping national policy. One example includes a new IT project. The Oxfordshire GP Forum identified potential challenges and pitfalls in the proposed approach that had not yet been uncovered by the national team working on it. These were highlighted by the GP Forum and are now being addressed at a national level, to the benefit of Oxfordshire and beyond.

The NHS Long Term Plan has paved the way for an even greater role of primary care in the future. There has therefore never been a more crucial time for primary care to speak with a strong, well-informed voice, to work closely with and stand shoulder-to-shoulder with other big providers and to help shape this future. The Oxfordshire GP Forum strives to achieve this.

“If I want to know what GPs think, I’ll ask the Oxfordshire GP Forum.”

The Berkshire West system has always been regarded as a highly functioning system and this is facilitated by excellent working relationships with all our key partners. We were very excited when we were picked to be one of the few vanguard systems in the country to go first and lead the way to test and develop new integrated systems of working. This has resulted in our directors being involved in national workstreams, for

example, on new finance models and system architecture, along with showcasing new clinical models of care.

Naturally, at the start of our journey we were keen to learn from other international systems who had a track record of strong clinical leadership and developing accountable care systems. We therefore invited the team from Canterbury Accountable Care System (ACS) in New Zealand for a visit that was

Clinical leadership in Integrated Care Systems – the Berkshire West ICS journey

Dr Abid Irfan Berkshire West CCG Clinical Chair

facilitated by The King’s Fund. They had undertaken a significant transformation of their health economy over a 10 year period. As a result of their integration they were able to support and deliver much more care closer to patient’s homes and communities. This also delivered a much greater sustainable model of care.

One of the key lessons from the visit was that the change had been driven by strong clinical leadership across the system, and that it had to be embedded at the heart of any new governance structures. All partners having one unifying vison of ‘one system and one budget’. The change required a significant amount of investment into the community, and the role of primary care was critical.

As a result of the visit, we quickly set up an ICS clinical leadership and strategy group. This has been critical in not only joining up the clinical leaders from across our system, but providing a direct link into the new ICS executive and leadership groups to ensure everything we do is clinically sound and connected. The membership of the group includes medical and nursing directors from across the system, as well as care group directors from our local acute trust along with chairs of specific clinical boards. We have a rotating chair as with all our new system boards. Our purpose is to not only provide clinical leadership but to have oversight of all our various programme boards (including primary care and mental health) and to ensure that there is alignment between projects and with the population need. We provide assurance to the ICS executive that clinical programmes of the ICS are appropriate. We also function as an entry portal for proposed new clinical projects, acting as a first touch point for review and comment to decide if appropriate for further scoping via the various clinical programme boards.

We have also had a bespoke development programme over the last year working with The King’s Fund to review all our CCG clinical boards, and we are in the process of moving to system-wide boards where all business will be conducted once. This is really exciting and we know that relationships are always critical to effective partnership working. The programme boards are connected to the ICS strategy group via the chairs and we continue all the time to network and strengthen our relationships. We are really privileged to be working with some fantastic clinical leads who are dedicated to making transformational changes to patient pathways and delivering improved outcomes for all our patients.

Unbeknown to me, my introduction to clinical leadership started on appointment as a consultant with the remit to develop and open a medical high dependency unit. In doing so, some of the fundamental skills of communicating a vision and aligning one’s colleagues were being formed.

Part of my formative development was being introduced to the head of nursing in medicine who soon became the general manager for the directorate. Doctors are naturally curious but are often frustrated by why we are asked to comply with certain NHS ‘edicts’. I was lucky enough to have a general manager and a chief executive who were interested in answering my questions about why we do what we do. Having recognised my curiosity, they asked for my help to transform how we delivered aspects of care. The initial project was developing a daily Board round (old hat now) which saw a significant fall in length of stay. Subsequently I was appointed clinical director

for medicine but within 20 months I was the medical director, nine years after my initial consultant appointment. I attended a King’s Fund MDs course, but the key to my training from an early stage was the informal mentoring from my general manager and latterly by my chief executive.

Being a Trust MD is often seen as the poisoned chalice but the appeal is the challenge and opportunity to influence healthcare on a scale that far exceeds what one can do in normal clinical practice. It is a privilege to be given such responsibility._____

Leadership to me is a state of mind; it is a state of being. It is about who you are as an individual and not really about what role you have. Over the years I have been involved with

multiple leadership programmes. A few years back I was selected as one of the 35 clinicians nationally from about 4,000 applicants to be part of the NHS Fast Track Executive Programme which was developed and run jointly by the Leadership Academy, Harvard

A journey into clinical leadership

Dr Timothy Ho Medical Director and Consultant Chest Physician Frimley Health NHS Foundation Trust

Leadership: a state of being! Prof.(Dr.) Minesh Khashu Consultant Neonatologist & Prof. of Perinatal Health Clinical Director, MCYP Wessex Strategic Clinical Network

and the Institute for Healthcare Improvement (IHI), USA. It was the first time that such a collaborative programme had been put together. It involved specific modules at Harvard on Reimagining Healthcare, USA as well as training at the IHI. International exploratory visits to various healthcare systems were included in the programme and I visited Netherlands to study their system. I also attended IBM as part of a corporate/industry module to better understand systems and processes that may be beneficial for the NHS. The programme was in many ways, a once in a lifetime experience. It reinforced a lot of my pre-held beliefs about leadership and healthcare but also provided some new insights and generated new areas of interest for me within healthcare, leadership and improvement e.g. social movements. I could write books on leadership and someday, hopefully, I will. (Happy to collaborate if this interests you as well). Here, I wish to share some learning and useful tips that may interest you. 1. First and foremost is what I have stated

at the start i.e. that leadership is about a state of mind, a state of being. This is very important for us as leaders and critical as we develop leaders for tomorrow. We need to focus on aptitude

more than just on experience and technical acumen.

2. Vision and passion are key to success as a

leader: ‘Leaders are dealers in hope’

3. People and process are two sides of the same coin. Both are required for change and improvement. More often than not, too much time and energy goes into the process bit and too little on the people. This exponentially decreases the chances of success.

4. Keep it simple. Focus on the 4Cs i.e.

improving culture, capability, communication and capacity.

5. Understand your predominant style of

leadership and ask yourself if that brings out the best in you and others. Make sure you are able to utilise a wide repertoire of styles to suit the needs of individuals, teams and systems.

Leadership, in many ways, is about leading change and improvement. The foundation needs to be built on three pillars: improving public value, legitimacy and supporting operational capacity. Ask yourself what you are doing on all three fronts. You can read the rest of Minesh’s article online here

My passion for medicine was sparked by poor health as a child- I got to see up very close what a difference a doctor could make and decided I would like to do the same.

As an inner city GP working with a young, deprived and very diverse population, and then in a more affluent area with a much older population I saw the stark reality on our health of the conditions in which we are born, grow, live, work and age and the profound health inequalities in our society. Again, I knew I wanted to try and make a difference, and to work to promote the best_

start in life for children and to keep people healthy for as long as possible. I felt a public health approach with its focus on the whole population, on social and environmental determinants of health as well as on prevention and biomedical science was an effective way of doing that.

Leadership has always been an absolutely central function in public health, and particularly now leadership is required across complex systems. With an unsustainable health and social care system it is imperative that we take action to move to a society where being healthy is the norm. Tackling the causes of disease and health inequality by working within local government, and in partnership across systems to influence the wider determinants of health, offers opportunities to reverse the vicious cycle of ill health and help address the increasing need for services. _________________________

What attracted me to public health leadership, and why the work we do is important Dr Sallie Bacon Director of Public Health Hampshire Interim Director of Public Health IOW Adults’ Health and Care, Hampshire County Council

I started my journey as a National Clinical Director (for end of life care) when NHS England was formed in 2013. Things were fairly chaotic. The new Arms’ Length Bodies were busy recruiting staff, establishing structures and sorting out ways of working, at central and regional levels. Most people were still getting to grips with the implications of the Health and Social Care Act. Austerity was biting hard. My role was to interpret the new system, influence, motivate, inspire and coax, not to direct. There was no lever or incentive available. However, what was available was a cadre of hugely committed clinicians who were used to working together and wanted to continue. They formed the basis of our palliative and end of life care clinical network – in many, though not all, parts of the country, they became adopted or supported by their strategic clinical networks. Thames Valley provides an excellent example of the power of local leadership within a supportive network.

Today the landscape remains complex and challenging, but I have learnt to find my way around a bit. My fellow NCDs and I have had different experiences depending on our clinical area. For some, the sun shone from the start and continues shining. For most others, including me, we have had to ‘make our own weather’, find allies wherever they could be found, and build our case carefully and compellingly. There is always a balance to strive for, e.g. in trying to influence from the centre, I must balance between inviting myself and waiting to be invited into others’ space; in listening, to hear both enthusiasts and naysayers so that critical judgement can be exercised; and as part time NCDs, in juggling the demands at national and local level as fairly as possible.

For me, learning to be a leader has been a mixture of experience (predominantly), generous advice from experienced colleagues and personal development through the NHS Leadership Academy’s Directors’ Programme and 1:1 coaching. I would say the single most important ingredient in any achievement I’ve had in transforming palliative and end of life care has been the goodwill and collaborative spirit of other clinicians, non-clinical colleagues and the wide range of stakeholders I’ve worked with – across health, social care and voluntary sector. They have been prepared to keep faith and focus around a common purpose, which we articulated together through the Ambitions for Palliative

Reflections of a National Clinical Director Professor Bee Wee National Clinical Director for End of Life Care, NHS England and NHS Improvement Clinical Lead and Consultant in Palliative Medicine, Sir Michael Sobell House, Oxford University Hospitals NHS Foundation Trust Associate Professor and Fellow of Harris Manchester College, Oxford University

and End of Life Care: A national framework for local action (2015). The phrase ‘call to action’ is often used but it won’t work unless you’ve done the groundwork in building relationships, being authentic, respectful and inclusive, earning trust and proving that you are willing to listen. A bit of serendipity helps too.

Finally, being in a position to spot, encourage and support potential leaders, at all levels and across all disciplines, is part of the privilege of being a clinical leader today, so I have invested in getting trained as a coach during the past year.________________________

Time taken to see the world from a different perspective is rarely wasted. Some years ago I was lucky to do just this in Seattle as part of The King’s Fund study tour. Here are a few lessons I learnt.

LEAN principles can be very useful in understanding how to improve clinical processes e.g. removing waste. There are seven types of ‘waste’ (figure 1). I have found this a useful way to engage clinicians in productive discussions. An example would be a recent transformation saving an estimated 3,080 bed days in just one healthcare system and just one condition (nSTEMI).__________

Doctor’s time is valuable and should not be wasted on administrative tasks. The role of physician associates (PA) in primary care was particularly impressive. The GP is ‘stage-managed’ by the PAs, who ensure the clinical record is up to date, take the history, facilitate the consultation and then re-iterate the doctor’s advice. The doctor alternates between rooms where the patient has been ‘prepared’. Maximising face to face contact with the patient is all important – the doctor is not allowed to type!

Geography is not a barrier. Seattle has one major trauma centre that covers Oregon, Idaho, Washington State and Alaska – about a quarter of the landmass of the USA. A major trauma case in Alaska will fly over Canada to Seattle. The key is logistics and communication. We have much to learn from the UK military about this how they operated an ‘air-bridge’ from Afghanistan to the UK. With adequate planning we can run services safely over much larger areas.

The Virginia Mason Hospital has gone from being virtually bankrupt to being the top performing US hospital in terms of quality and safety. Constancy of medical leadership (Dr

King’s Fund Study Tour Dr Richard A Jones Consultant Cardiologist, Portsmouth Hospital NHS Trust Clinical Director, Portsmouth and South East Integrated care Partnership Clinical Director, Wessex Cardiovascular Network

Gary Kaplan has been the Chief Executive for over 18 years) and a culture of continuous quality improvement was key to this.

The NHS is amazing. U.S. healthcare is very costly and fragmented. The closest thing to the NHS is the Veteran’s Administration which consists of a network of hospitals across the US dedicated to caring for servicemen and their families._________________________

They follow similar procedures and guidelines and the staff share a strong motivation around delivering high quality care rather than a monetary motivation.

Visits to Boeing and Microsoft were also incredibly stimulating and another example of where healthcare can learn so much from other sectors.

We are increasingly benefiting from the advantages of digital technology in many aspects of our everyday lives. When it comes to healthcare, in some cases in the NHS we’ve been slow on the uptake and not always adopted a joined-up approach. The possibilities of utilising technology to improve healthcare are significant – from the basics such as improving record access and inter-operability, to data analytics for population health management and care planning, to wearable technology to empower patients and promote independence, and to artificial intelligence to aid clinical decisions and promote proactive care. However, like any

new technology, careful consideration and planning is required to ensure safe and relevant implementation. My chief clinical information officer (CCIO) role allows me to ensure that this exciting work and innovation is grounded in clinical need, and advised by what is most likely to work ‘on the ground’ for our staff and patients. Much of the role is engagement, creating a link between clinicians in different areas to promote a unified digital agenda.

I feel privileged to be able to influence the effective implementation of projects that span our whole system. The CCIO role is increasingly important as we’re experiencing a ballooning of digital projects, with this being a clear national priority. Clinical input, engagement and expertise is crucial to ensure we avoid our previous ‘IT mistakes’, don’t leave patients or colleagues behind and maximise the potential benefits of technology to improve healthcare.

Technology and innovation Dr Dan Alton GP Partner, Wargrave Surgery, and CCIO Berkshire West CCG

I recently became locality lead for Bracknell and Ascot. It had been my ambition for some time and I was delighted to take on the challenge. However my first year in the job has been quite a learning curve and I’d like to share a few of these nuggets of experience. Firstly, no one leads alone! I felt huge pressure to get everything right. But you can’t do this yourself. You will go mad in the effort. Leadership is about working as a team. I recently attempted to organise an ambitious interactive workshop for my GPs members meeting. It was coming to a standstill until I enlisted the help of our planned care Associate Director. She was a masterclass in rallying the troops and working with the team to turn it into a success. _______________

As locality lead, your time can be consumed in an industry of meetings, all terribly important. However meetings don’t always tell you what you need to know. To really focus on joint working, particularly with those outside your organisation, one to one conversations are important. It helps you understand the pressures and priorities of others in the system and them yours. Then you can start working out how to create a shared goal. That won’t happen in a meeting and it’s time well spent. Finally, I’ve learned just how difficult it is to get the balance right in being a locality lead and a partner in general practice. Immersing yourself in a new leadership role can pull your eye from your practice that also relies on you. I asked my Accountable Officer how he does it, “I compartmentalise”, he said. This is a wise lesson which if you are to survive in both that you need to learn. To do that well is hard, particularly if you want to still carve out a work-life balance. In this I’m definitely still a student but I’m hoping I have a number of years in these roles to perfect it!

Becoming a locality lead Dr Jackie McGlynn GP Principle at Kings Corner Surgery, Sunninghill Locality Lead, Bracknell and Ascot

As the second UHS medical director, I well recall the disappointment (and fear) at reaching for the manual to tell me what I was supposed to do – only to find that no such tome (or course) existed. I quickly discovered that the world of leadership is almost the antithesis of clinical medicine with little resource, no well-trodden career paths and minimal guiding evidence. This challenge fuelled a twenty year passion to improve the status quo.

Immediately after UHS, I helped to establish the first NHS Leadership Centre and then, via a wonderful job in the Wessex Deanery, I joined South Central SHA as medical director and director of leadership. Angered by seeing the Leadership Centre closed down, I thought I could better protect leadership development from a board position. Then, following the demise of the British Association of Medical Managers (and strategic health authorities) the Academy of Medical Royal Colleges concluded that a Faculty of Medical Leadership and Management (FMLM) should be established. I was offered the enormous privilege of leading it. Seven years on, with over 2,000 members, we have just become an independent charity – hopefully an endorsement of our sustainability and our achievements to date.

FMLM’s prime objective is to improve the quality of patient care through better medical leadership - research evidence shows a positive association between leadership and clinical outcome, even mortality and between enhanced clinical quality and more doctors in the board room. Research around leadership development is shakier and FMLM was somewhat unpopular when we said so in an early evidence review. Before signing up for

the latest commercial course, it is worth noting the Center for Creative Leadership’s 70:20:10 rule - 70% of leadership learning is ‘on the job’ from experience and mistakes; only 10% comes from the classroom. Emulating medicine’s proud record in clinical standards, FMLM publishing the first UK standards of medical leadership, in 2015, ironically on the same day the Morecambe Bay Review called for the same. Members responded positively to having a tool to benchmark themselves and over 130 fellowships at three levels have now been awarded against the standards.

Disseminating evidence is crucial and, in partnership with BMJ, we have launched the journal BMJ Leader and our seventh international conference attracted over 800 delegates last November.

Medical leadership has for too long enjoyed poor status and been bedevilled by silly allusions to the dark side which ignore the evidence. Hitherto, it has not helped itself by failing to submit to scrutiny and standards which FMLM has now addressed. Disseminating and growing the evidence is progressing and over 2,000 members attest to growing recognition within the profession. Finally, the interests of our more junior colleagues (>1,000 members) gives added hope for the future.____________________

Leading leadership Peter Lees Chief Executive and Medical Director, Faculty of Medical Leadership and Management

It is clear that effective clinical leadership is not an option but a necessity, as there is a growing evidence base that supports a strong relationship between the engagement of clinicians in the leadership task and a range of healthcare quality and outcomes (West M et al (2015) Leadership and leadership development in healthcare). The evidence base: https://www.fmlm.ac.uk/resources/leadership-and-leadership-development-in-health-care-the-evidence-base

The NHS Leadership Academy is proud to support the development of clinical leaders in many ways:

• National programmes The NHS Leadership Academy supports and facilitates a range of programmes that develop current and future clinical leaders – such as the Edward Jenner programme and the Rosalind Franklin programme, please see https://www.leadershipacademy.nhs.uk/programmes along with other targeted

programmes such as the Clinical Executive Fast Track Scheme.

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• Locally and regionally facilitated programmes The local leadership academies run bespoke programmes such as the 2020/2030 programmes and programmes for specific groups such as directors of nursing, clinical directors (in primary and secondary care) and general practice nurses. Please see your local academy website for more information https://www.leadershipacademy.nhs.uk

• GP/Consultant exchange scheme The local academy works in partnership with local GPs to facilitate opportunities for quality improvement activities. Please contact us for further information.

• Resources There are also some excellent resources such as the Learning to Lead Toolkit, developed for medical educators to facilitate the leadership skills in trainees. For the toolkit please see http://bit.ly/2S4wsnU

• The Knowledge Hub is a repository of information and evidence on all aspects of leadership. Please click the following link to access it https://blogs.bodleian.ox.ac.uk/tvw-knowledge-hub/home/

• The Primary care CPD zone is available for

all clinical staff https://www.oxfordhealth.nhs.uk/library/cpd-zone/

NHS Leadership Academy Support Maggie Woods, Deputy Director Leadership and OD – Thames Valley and Wessex Leadership Academy Interim Deputy Director – Kent Surrey and Sussex Leadership Academy Associate GP Dean, Health Education England, Thames Valley

• Coaching and mentoring Your local leadership academy provides funded access to coaching and mentoring. For more information and to register please see http://www.tvwleadershipacademy.nhs.uk/coaching-and-mentoring

• Graduate Management Training Scheme The GMTS is run by the NHS Leadership Academy and provides opportunities for individuals wishing to focus on management as a career

• Fellowships The academy supports a range of fellowship schemes. Please contact us for further information.

• The local leadership academies also

support and collaborate with other providers such as the Next Generation GP schemes http://nextgenerationgp.wixsite.com/2017

Individual organisations and primary care training hubs also facilitate some excellent leadership development support, contact your local lead for more information.