Geriatricians as leaders and managers to improve care

This blog was originally published on the British Geriatrics Society website

Last year I became the first trainee in geriatrics selected onto the National Medical Director’s Clinical Fellow Scheme, and spent 12 months on ‘out of program experience’ completing this fellowship.

As this year’s recruitment process just ended, I’ve been reflecting on what made me apply, and how it has affected my subsequent practice.

My cohort of fellows was a group of doctors in training who, whilst loved working in the NHS, recognised the need for change and wanted to help make improvements. We were put to work on projects within key healthcare organisations (such as NHS England, the royal colleges and the GMC). Much as a whinge in the mess/ward/pub can be therapeutic, this was about being given a chance to use skills acquired in a clinical environment in a different way, to influence change.

Fittingly for a scheme based on ‘leadership’, large portions of its success were down to our own efforts as a group. We arranged seminars with key NHS figures, ran our own scheme’s recruitment process and organised national events, such as conferences; I was pushed outside of my comfort zone (an experience familiar to many of us from our clinical careers). I even joined Twitter, surprised by how much professional interaction and knowledge was inaccessible to those not using social media in this way.

Amidst the group activities were the projects themselves – I was based at Health Education England, the central body responsible for training the NHS workforce, including postgraduate doctors. Refreshingly, the job wasn’t just about improving the training for one specialty, or even doctors in general, but started from the premise of ‘How do we improve care for this group of patients?’. This approach fitted well with our profession’s holistic view of healthcare for frail older people. For example, geriatric nursing is renowned for being the ‘Cinderella’ of the profession in terms of status and recruitment, despite the considerably high level of skill that it entails to provide the high quality nursing care that will make a huge difference to the recovery of vulnerable elderly patients. Attracting, training and retaining high calibre candidates are therefore crucial, and I was involved with several key projects in this regard, which was a novel way to work towards improving care for older patients.

Working in an environment dominated by non-clinicians, I was pleasantly surprised, and even humbled, by the insights that project managers, accountants, chief executives and the like bring to the challenging environment in which we work, providing perspectives that have widened my understanding of my own clinical role. Of course, clinicians and non-clinicians may have conflicting approaches; this can be constructive if handled respectfully by those involved, but too often there have been uncomfortable moments where as doctors we have let ourselves down, railing against non-clinicians and even medical colleagues in other specialties indiscriminately, unwittingly portraying our profession as naïve and self-important. Our clinical responsibilities give us invaluable perspectives; the best clinician-managers I have seen pool this knowledge with the approaches of non-clinicians to optimise their ability to effect change, and never under-appreciate the immense difficulties currently faced by everyone else in the NHS.

The real challenge was always going to be moving back into clinical practice. Had I moved over to ‘the dark side’? Could I still cope with general medicine nightshifts? Reassuringly, it’s been okay – in some ways a broader perspective working off the wards has better equipped me to deal with the vicissitudes of registrar on-calls.

Geriatricians have the knowledge, skills and holistic perspective required to get involved in the running of the NHS, and better organisation of care for elderly patients is vital to improve outcomes. So consider pushing yourself further and apply for the National Medical Director’s Clinical Fellow Scheme.