National Association for Patient Participation

Leadership in Action in Northern Ireland

31 January 2019

Dear colleagues,

It may surprise you to know that I specifically asked Grainne if she would allow myself and Niamh to write this week’s blog. I am a busy GP in Kilkeel, so for a GP to ask for extra work seems like an odd thing to do!

The topic I am so passionate to share with you is collective leadership, and the need for GPs across NI to engage with it. I know this will look like a hard sell from the beginning so please allow me to elaborate.

Some of the most challenging things facing general practice today are a result of the behaviours of others towards our profession. We see this daily with unfunded and unreasonable extra work requests and through the denigration of our profession that medical students like Niamh are exposed to, who should instead be inspired by the holistic, patient-centred care we provide.

Collective leadership is about valuing everyone who makes up the Health & Social Care (HSC) workforce as one team and establishing a culture where people are empowered to innovative, improve and flourish, while being valued for the role we play in our health system.  

As part of the HSC Collective Leadership Strategy that was launched back in October 2017, a set of core values are currently being drafted and they will inevitably contain elements about compassion, respect and openness. On their own they look like things that no-one could argue about. What doctor doesn’t want to have compassion as one of their core values? It is only when these values are broken by individuals that cracks appear and ‘bad behaviours’ make our working lives so much more difficult.

Collective leadership is about how we behave together as a group. It is not about sending all GPs on courses in the leadership centre where we learn some new terminology or do team building exercises! It is about recognising that our entire teams – reception staff, nursing and GPs - all have responsibilities to the entire workforce, and ultimately to patients. For example, before Christmas my receptionist and I received a letter from our local cardiologist and as part of her investigations she had requested an echo. We could see that a different hospital had already done an echo recently. What should we do? It wasn’t technically our job to keep them right – but it was.

Working together with our colleagues by simply highlighting this duplicated test, we were exhibiting collective leadership. It was not a case of doing someone else’s work for them but an exercise in mutual benefit. It was best for my patient who wasn’t inconvenienced with a duplicated test and when I request an echo test for a different patient, I can expect the waiting list to be that bit lower as a result of our actions. 

In general practice we have frequently felt separate to the wider HSC body. This is partly due to our unique independent provider status. This status must however not become a barrier to working as a valued member of a wider team, and it must not act as an excuse for excluding GPs from strategic reform and service development. As RCGPNI Advocates, myself and Dr Siobhan McEntee are working hard to ensure the Collective Leadership Strategy does not look just like an exercise for Trust staff alone. 

RCGPNI has been doing some work of our own in the areas of leadership and improving working relationships. Almost one year ago, as part of our work on improving difficulties at the primary/secondary care interface, we ran a positive social media campaign called #DearColleague. I am very grateful to all those who participated, and I still hear from colleagues who feel they have reached out more to their secondary care colleagues and vice versa – in particular, some GPs who are married to hospital consultants!

As a next step in our interface work with all the other medical Royal Colleges in Northern Ireland, we have almost finalised a set of 10 communications and behaviours principles for the medical professions. Like the core values within the Collective Leadership Strategy, our principles outline how we should work together and thus what happens when we don’t follow these. Our next steps will be to build on this co-operation and make these principles part of undergraduate and postgraduate teaching. We hope to initiate conversations with Queen’s University Belfast and the NI Medical & Dental Training Agency over the next few months. 

To offer another perspective on leadership in general practice, I am delighted to introduce Niamh Woods. Niamh is a medical student and has already seen how rewarding and diverse a career in general practice can be. She will undoubtedly be a leader of our profession in the future and we really value her work.

My name is Niamh Woods and I am a fourth-year medical student from Queens with a strong interest in how a culture of Collective Leadership in Northern Ireland can be achieved. 

Working with and chairing the NI Healthcare Leadership Forum (NIHLF) over the past 3 years has really sparked my passion for healthcare leadership. This is a multidisciplinary, student-led group that is driven to make a positive contribution to health and social care. WE arrange conferences to bring together students, HSC staff, patients and sector leaders to share perspectives and debate about service delivery challenges and leadership. In case it is of interest, our next event is taking place on the evening of 26 February named "Changing lenses: chronic pain from different perspectives". The event will start with a patient’s personal story followed by an interactive, multidisciplinary panel debate. It would be great to see a strong GP turnout, and RCGPNI Chair Dr Grainne Doran will be participating as part of the panel. 

Senior HSC leaders have been incredibly supportive of our Forum, contributing to numerous events and helping with promotion of our goals. It is so enthusing and exciting that even at undergraduate level we can play our part in contributing to improving how care is delivered to patients and to society as a whole. The access we have gained through NIHLF has provided us with invaluable vision and understanding of the system to a much greater extent than our degrees ever could. 

This year I became part of a new RCGP Committee; the national Medical Student and Foundation Year RCGP. One of our top priorities is to explore the future of general practice and how we see ourselves working in the future. In NI, much of the transformation agenda is focused on shifting care ‘left’ towards primary care. 

While this seems like a sensible approach considering our projected population demographics, it has forced me to reflect on the challenges and barriers that exist to achieving this. GPs are acutely aware of the needs of their patients and communities and therefore are arguably best placed to advise on the best way to deliver primary care. In order for us to get this right, it is more necessary than ever for GPs to take a leading role in shaping not only how care is delivered in their own practices, but how services are provided across the entire health service. 

Last year, I took a year out of medicine to do a Masters in Public Health. As part of this, I decided to focus my research on Collective Leadership in Northern Ireland. At the outset of the 10-year collective leadership strategy I wanted to use the findings of an online survey to answer the question: Are trainee doctors in NI currently leading improvement? If not, why not?

The findings were fascinating. I was particularly intrigued to discover that regardless of training setting (hospital or general practice), the likelihood of a trainee sharing or implementing improvement ideas was similar. Some GP trainees did explain that they found it simpler to implement improvement in their own practice, compared to hospital settings, but is it as easy for GPs to connect with other practices and improvement projects happening at Trust level in order to bring about larger-scale improvements?

So, the important question remains: How can current and future GPs be enabled to drive forward their vision of what the best care might look like for patients and their communities? With the implementation of the actions from the Collective Leadership Strategy well underway there will hopefully be many opportunities arising for GPs to get involved in improvement.  This is hugely exciting because I think once GPs catch a glimpse of the benefits and difference they can make by being involved in the service shaping process, it will become infectious!

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