Transcript Leadership in GP Training

Leadership in GP Training
Innovation and delivery
Ian McLean
Darren Cocker
Mehal Patel
21/7/10
Postgraduate Deanery for
Kent, Surrey and Sussex
This workshop
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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
WANT
DISEASE
SQUALOR
IGNORANCE
IDLENESS
“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?
Medical
School
Sub mis Palliative Ophtal/
care
ENT
F1 F2
GPR
GP experience
Paed
A
Clinical
GP with
Mentoring
special interest
Derma
Medicine
A
AA
GPR GPR
A
A
A
Mentoring
Mentoring
GP
GP
Teaching
Teaching&&research
research
Political/Clinical
Mentoring
GP
Mentoring
Mentoring
Mentoring
Retiring GP
Sessional
GP
Sessional
GP
Management
GPR - General Practice Registrar
FCS - Flexible Career Scheme
12
GP training
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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
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
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
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.
The programme
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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 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
So what was it like to be a supervisor?.....
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!
Challenges
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Hard work to get started
Resource intensive
Short placement
Problems with identifying keen Gp
registrars
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.
What was it like
for the learner?
Background
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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 projectsnew 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
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
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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’