Leadership in GP Training Innovation and delivery

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Leadership in GP TrainingInnovation and delivery

• Ian McLean
• Darren Cocker
• Mehal Patel
• 21/7/10

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This workshop

• Overview and introduction
• What happened at the PCT?
• What happened for the learner?
• What are the results?

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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 Darzis 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
  2010340c914 ) Noble

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WANT
DISEASE
SQUALOR
IGNORANCE
IDLENESS
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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. 
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• 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.

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How do you become a GP?
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Sub mis
Ophtal/ ENT
Palliative care
F1
F2
GPR
GPR
GPR
Medical
School
GP experience
Paed
Derma
Medicine
A
A
A
A
A
A
A
A
Mentoring
Clinical
Mentoring
GP
GP with
GP
Mentoring
special interest
Teaching research
Teaching research
Political/Clinical
Mentoring
Mentoring
Mentoring
Sessional GP
Sessional GP
GP
Retiring GP
Mentoring
Management
GPR - General Practice Registrar
FCS - Flexible Career Scheme

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GP training

• 3 years
• Regulated by GMC
• Delivered by Deaneries
• Academically supported by RCGP
• Balance between hospital and GP
• Integrated Training Placements

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The Curriculum

• Learning outcomes
• Reflection and recording
• Assessment
• WBPA
• CBD
• COT
• DOPs
• External assessments

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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.

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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.

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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.

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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.

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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
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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

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The Curriculum

• Learning outcomes
• Reflection and recording
• Assessment
• WBPA
• CBD
• COT
• DOPs
• External assessments

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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

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PCT Role

• Darren Cocker
• Clinical executive NHS ECK
• Clinical supervisor

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Background

• 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

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Why did we get involved?

• 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.

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What did we do?

• 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.

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The programme

• 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.

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The Project

• 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.

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

• 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!

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Challenges

• Hard work to get started
• Resource intensive
• Short placement
• Problems with identifying keen Gp registrars

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The Future

• 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.

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What was it like for the learner?
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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

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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

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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

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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 management
• Literature search

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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

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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!

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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.

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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.

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Projects

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

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To sum up...

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