Friday, October 31, 2014

From the heart..Thank You

Pride is good, isn't it? When you get something right, you have to be proud, isn't it? Today when I see our local model of care being recognised either by Diabetes UK or the Kings Fund, I don't make any bones about how proud it makes me. No one- and I repeat- no one has seen the long evenings, the extended negotiations, the charm offensive, the time with the family sacrificed to do only with one thing in mind...the model of care needs to change..patients deserve better, much better.
Yes, the NHS is cash strapped, yes, we belong in silos, yes, we all like to believe we are doing a fantastic job and yes, we baulk at the thought that the NHS may not be delivering great care sometimes...but there are many and many folks out there crying out for better care. And I have my own inimitable style..tried to change years of working, years of obstinence, lack of mutual respect between primary and specialst care..and 4 years later? Excuse me for taking a moment to look back..and say " We got there...ladies and gentlemen, we got there".

This blog isn't about explaining the model - there are now enough literature on it- it works on 2 simple principles...Firstly, diabetes care sits in primary care- so support them, help them- on THEIR terms, not ours. Secondly, the changing role of a specialist...moving away from just being a specialist to being also a support, a friend in need, a helping hand and an a realisation that for primary care diabetes is only a fraction of what they support, help...don't criticise, there when needed. Honestly,its not that complicated- never was. No this blog today is about taking off the veneer of arrogance and saying thank you...saying ladies and gentlemen..without you, it simply wouldn't have happened. I have been the public face of it, the spokesperson, the person to showcase it..little else..the credit for this belongs to many others.

Firstly my amazing colleagues..for years my Consultants...then folks who believed in my vision, never unhappy with me taking the spotlight, allowing me to show boat, drive the changes and keeping implicit faith. Darryl, Mike and Iain..its has and is been nothing but a colleagues, my mates, folks I intrinsically trust with anything...gentlemen..thank you.
Then what about our nurses? What can I say...I can't repeat myself enough..they ARE the lynchpins of what we do...amazing women who do a job I can only stand back and admire...ladies, a group hug from all have been just simply who have shown it can be done.
I must acknowledge my primary care colleagues who have received us with open arms- across 83 GP surgeries. everyday has been a learning experience..simply being stunned by the workload...and silently making a note the care being provided. Thank you has and is fun...great to work with you indeed  :-)

At this point, I must say I tire of the managerial bashing I continuously hear. Let me make this crystal clear..without some good managers to work with me, none of this would have happened. Firstly Melissa Way, then Sarah Malcolm..if you want to ever know why we need managers, go and see what they have done for us. Local CCG leads have been great...people always ask how we have done what we have..well..without such forward thinking ones like Jim Hogan, Andy Douglas, Paul Howden et al, would have stayed confined to a powerpoint presentation - for sure

Finally, our patients...I have observed, learnt, taken feedback, accepted the challenges thrown and been my driver to implement what we have done. We haven't solved everything but are always open to being challenged, always open to change and improving things further. The above may indeed read like an Oscar acceptance speech but I don't know of any other forum to thank you so many who have made all this come true.

Ladies and gentlemen, genuinely, from the heart...for once taking off the aura of arrogance, letting the ego rest for a bit...just wanted to say thank you to all. I wouldn't have even dreamt of getting where we are when I started my job in 2008..and wouldn't have without you all. Partha thank you. From the heart. xx

Thursday, October 23, 2014

The Fantastic Four

Sometimes it's worth taking a pause in the hustle bustle of life, politics, work to perhaps stand back and simply say..thank you. This blog certainly aims to do that...thank you to four special ladies with whom I have had or continue to have the utmost privilege of working with. Why am I writing about them? Simply because they are the unsung heroes similar to the thousands within the NHS who are self effacing, humble, absolute super- professionals but never recognised in the fast modern world of self aggrandisation and publicity. I have said this publicly, in forums as well as blogs...I have one specific isn't job planned but I do it. It's publicising the work of the department of Diabetes & Endocrinology of Portsmouth.Love it or hate it, call it the marmite effect, whether it be via blogs, twitter, public campaigns or articles, I do indeed try my best to highlight the stupendous work some of my colleagues do...sometimes it's branded as my ego, to some it's me, it's giving these individuals the rightful place they deserve when they don't have the time or inclination to self publicise like so many do on public forums ( but feign mock horror when someone suggest so!) or social media. Looking after our team is my job too..and yes, it does involve going out and showcasing some amazing work that happens day in and day out.

So lets start with Sharon Allard. I have known her for nearly 12 years now- and recently we went out and celebrated her 25 years of being a part of the diabetes department. Always humble, always the quiet one, she has been a pillar of strength for anyone who has done research within our department. An amazing individual, her patient focus has been second to none and indeed someone who patients love unequivocally...there is something special about Sharon...if you know her,it is impossible to have not been touched by her kindness. An archetype nurse specialist..someone who embodies what nursing should be about..and tongue in cheek? She has been doing the 6 Cs much much before it became a hashtag campaign.

Next is Jane Cansfield..another nurse specialist who celebrated her 25 years with us..again someone who I have known for more than 10 years. One thing about Jane? She knows someone who knows someone...master organiser, lynchpin of social events within the centre..everyone within our department loves Jane..without Jane, there never has been any organisation of travelling together to conferences. Her knowledge about retinal screening puts many a specialist to shame..hang on..let me change that..actually, I know very few specialists who know more about retinal changes than her. Jane' s our go-to person..always helping, always accommodating..someone who has and is always there whenever there is a problem.
Testament to how much both these ladies are appreciated? We organised a 25 year a couple, we had a full house turn out including legendary figures of the Portsmouth team from the past such as Ken Shaw and Sue Craddock.

Next up is Jean Munday...and I cannot describe in words what Jean means for our department. Jean breathed the word "retirement in another 5-7 years"..and the sheer look of panic amongst all of us said it all. Without Jean, our endocrine service doesn't exist collapses. A legendary figure in our department..someone who commands respect and admiration from all irrespective of their status or grade, Jean is someone I would encourage any nurse to learn from and try and perhaps achieve even 25% of what she has achieved. It is our pride that she has been shortlisted for Nurse of the Year..whether she wins or not, if we had an award along those lines in our department, Jean would have walked away with it perhaps every year.Her intrinsic knowledge about endocrinology will put most to shame but more than that, her calmness, friendly manner has made her so of luck at the awards, Jean!

Finally, a mention about Gwen Hall. I have known Gwen personally for about an year or more but have known of her for a number of years due to her national profile and work in diabetes education. A strong character, we head hunted her to helm the Portsmouth community team fully aware that she would step down after 1 year or so but boy hasn't that been a recruitment master stroke. She has helped put down the basics for primary care leading on education and support for our local GP surgeries and I suspect the Portsmouth of the future will always thank her for her time, efforts and undisputed passion to improve diabetes care. On behalf of the team and the wider community, thank you Gwen for your time and help to develop diabetes services in Pompey.

All in all, it has been nothing but a privilege and an honour to work with such amazing individuals. There are many such more with whom I work within our department but at this moment of time, these fabulous four and their contribution to making our department stronger and improving patient care must be applauded and recognised. I have always maintained that there perhaps are better departments than Portsmouth but I doubt there are better places to work has always been and continues to be individuals such as the fantastic four who have made it so.

So ladies and gentlemen a moment to pause and say thank you to our Fantastic Four. a moment perhaps for the wider community to also look at where you work and go tomorrow and say thank you to those who are the unsung heroes.
Such individuals exist in every department in the NHS and it is time we have them their just due.Go find them,make them perhaps a cuppa and just say "thank you"

Tuesday, October 7, 2014

Wrong tack?

So shall I dip my toe into this water? Challenge the RCGP and thereby the GPs..or are they a separate entity?  Let me set my stall out at the very outset..don't know about politics but amongst the mates I have grown up with, those who are GPs, I see less of, they arrive late for the football games, look a bit more knackered, so this isn't a debate about who works hardest. Let me be perfectly honest, most GPs, I know work harder than me and unlikely to have as good a work-life or as Mark Cheetham balance.Thats not a condescending sop to balance for what I write below, but as I see it day in, day out.

Nope this isn't about that...this is more about the pathway or tack adapted by the RCGP akaThe Royal College of General Practitioners... it's made me the RCGP more of a collegiate institution or a trade union? I say so without prejudice but mostly from point of view of my own college which has tended to adapt a "hands off" approach to political changes,for good or bad..though in all fairness, their engagement as regards the future hospital has been laudable to say the least.

But the RCGP in recent times has slightly baffled me as quote unquote one of my GP colleagues "it just says more GPs". Which in itself is an interesting position in my book, as the ethos behind that seems to believe that more GPs will solve the problem while on the ground, if given a choice,for right or wrong,I would probably have more practice nurses, more community DSNs...whatever be the case, certainly more primary care staff, not necessarily "just GPs"

It is at this point I can already hear murmurs saying what qualifies me to speak about such an issue? The answer is probably not much but am giving a perception, from the outside if you may, that the position sounds too siloed. Put patients first...absolutely 100% with you....But not by saying lets just have more GPs. Not by saying "give money from hospitals"...believe you me, hospitals aren't running in rosy balance sheets either. I appreciate I offer perhaps a narrow siloed view but diabetes care isn't going to be resolved or improved with more GPs...more primary care staff...absolutely 100%.
As an analogy, you will never find me go out and say we should have more and more diabetes consultants...not certainly when we still haven't evolved enough to work differently and learn to help primary care more, rather than do our clinics in the traditional way,still ducking behind the spectre of information governance and shying way from patient access.More on that chestnut later.

Which brings me to the next point...on one hand, the clamour is for more GPs..on the other hand, posts can't be filled, people are leaving,social media is abuzz with burnouts, GPs themselves encouraging others to leave,tough working life..all this publicly played out...impact? I teach medical students and the proportion of folks considering becoming a GP continues to dwindle. Recently I asked on twitter what makes a GPs job attractive and there were some wonderful stuff,absolutely inspiring..heck...if I had my time again, may have gone for it myself. So why the lack of balance? Yes jobs are busier but to say working conditions haven't improved from say, 20 years ago, isn't right either, is it? You can't attract generation next by being negative...careful you don't end up being the reason why no one wants to do primary  care anymore. Those who work with me know that without being condescending, I am very public and open about my admiration for GPs but a bit of balance is needed.

I can only offer tips from history...recruitment in our specialty a few years back was low, with poor job prospects...there is a session at the Annual conference in diabetes UK called the Consultant/SpR session which happens every year. And year after year, as an SpR, I went there and heard people just moan, talk about how life was bad, negative..and a bunch of us sat in the audience and vowed to change that. The SpRs had a 10 minute slot and we decided to showcase the positives in front of everyone...give it a bit of balance and energetic people like Emma Coull, Pratik Choudhury, Marc Atkin went up on stage and said "No" to the negativity..and people started walking way from that session feeling all was not lost, positives were the too. It's our job to inspire generation next, not to push them away. Yes, of course realism, not shying away from the toughness but a bit more balance too, right? It's great to say we will "make" people do more generalists, "make" more fundamental flaw? You can't make anyone do anything they don't want.

The NHS will struggle to exist, not because of political restructuring or any other reason, but simply will collapse if we don't have a robust primary care. The wizards have only a few spells in their magic box....if the gatekeepers stop to exist, the facade of sorcery may well be under threat. A campaign designed in the right spirit hopefully will not end up alienating the rest of the workforce...let alone the next generation. Politics is a part of what we all do...but in that game, hopefully the campaign doesn't t do more damage to the future of primary care. Have a think.

Saturday, October 4, 2014

Up to YOU

One of my colleagues recently mentioned that I had strayed away a bit from diabetes in my blogs...looking back, perhaps she does have a let's get back to it this week- shall we? After all, politics and the NHS along with its challenges will always be there. Let's be honest and keep aside our political leanings for a moment...or if you are overtly optimistic, you may actually believe that the 8000 extra GPs that one party has promised from Narnia will help to provide the 7 day GP service the other party promises. Maybe they are actually working together, right? The elusive hunt for that wardrobe to Narnia is going to go on for a bit- so enough time to get back to that...for this week, let's get back to diabetes, shall we?

The National Diabetes Audit just got published -I am not going through the data - have a read….makes for sobering reading doesn't it? Yes, there are flaws with data, yes-there hasn't been enough data submitted...but cut it any way- if you had diabetes, you would be pretty worried 

Let's take the first one...we are talking about BASICS here. Nothing too complicated, nothing about evidence based medicine, nothing about evil Pharma promoting their drugs….these are basic checks that anyone with diabetes should have- as simple as that- and the national data around it is astoundingly poor. So what shall we say- primary care is poor? Let's take a reality check- shall we? Due to the evangelism of a few who are in committees, below is what primary care has now been asked to do regard diabetes care:

Screening / Diagnosis / Education / Early Intervention / Looking after co-morbidities / Seeing patient in home environment / Intensification /Complication Screening / Counseling / Appropriate referral / Keeping them out of hospital

Extrapolate that across all other disease areas- and the one thing that is crunched is...yes… guessed it….time. How much extra resource has moved to accommodate that sea-shift….very little to be honest. So you would have thought a golden opportunity for all national bodies to get together and look at working together- wouldn't you? Or do specialists take this an opportunity to suggest that they need more specialists....patients should never have been sent to the community? Do GPs say that they need more GPs and it would be fine? I will let you be the judge of that.

Let me be as honest as possible- Diabetes care in this country is in the hands of practice nurses- and if we want to improve care, then we need more educated and supported PNs, NOT GPs, NOT specialists. You don't need specialists to see everyone in hospital but need them to be as educators, guides to making sure the basic check is happening. Not that complicated, is it? It is however when national organizations work in silos, in isolation- all asking for more of their own. The National diabetes Audit has been running for a few years- responses from the national bodies such as ABCD (Association of British Clinical Diabetologists) have been tired, lazy, siloed…I predict a report as to how there is a plan to improve things…how long do you need to actually do so? The NDA hasn't shown much improvement over last few what next? Another report? Where’s the public lobbying, where’s the setting up of educational events looking at addressing this basic issue? Why isn't this primary aim?

So to those who do diabetes as a speciality, let me say so is YOUR responsibility to make it better- not anyone else. If you are waiting for national bodies to do it, you have waited, we have waited, I have waited…it’s not coming ..or if its coming, its not coming fast enough for the people who matter. YOU are the advocate for patients with diabetes, so engage with the Trust, work with colleagues, learn from others, go visit other places, find out what they do- and make the change that’s needed. YOU are the one who can work with patient organizations like Diabetes UK to help drive up basic care in the community, work with the practice nurses, build bridges with GPs, say you are there to help, not to judge. 

In the words of Martin Luther King.." Change does not roll in on the wheels of inevitability, but comes through continuous struggle". It's upto YOU as someone who does diabetes as a job to decide whether you want to lead that..or there is little point in doing audits, is there?