Diagnosis Salon 1 December 2011 with CapGemini by Dr Matthew Mak, CT1 Emergency Medicine, Kings College Hospital NHS Foundation Trust

The December Diagnosis Salon was generously hosted by Brendan Farmer at Capgemini, taking the medical orientated audience away from our usual surroundings of the Kings Fund and Royal Society of Medicine right into the heart of the city. Brendan was the perfect person to talk us through the process of becoming a Foundation Trust having previously led FT authorisation support across many large university teaching trusts, specialist acute trusts and several mental health trusts. He has also led FT Independent Business Reviews at Trusts at risk of breaching their terms of authorisation.

Our venue was the creative hub of the company, and Brendan explained that the room was usually chair-less, and staff encouraged to draw on the giant whiteboards to facilitate their thought processes. After a brief period of networking, we settled in for the presentation, which from the outset, was engaging and thought provoking. It was interesting to see that less than half of the audience knew whether or not they were employed by a Foundation Trust, and even fewer knew what it meant to be Foundation Trust.

Brendan set out the main differences between Trusts and Foundation Trusts, in that Foundation Trusts are public institutions not subject to direction by the Secretary of State for health, or subject to performance requirements of the Department of Health. We learnt that Foundation Trusts are able to set their own strategies and can invest their money in new patient care facilities or enter into partnerships with commissioners to improve quality of care. We also learnt that regulation of Foundation Trusts falls under Monitor, who also consider applications from NHS Trusts wishing to become FTs.

One of the important things that is considered in the FT authorisation process, and that sets FTs apart from NHS Trusts, is the engagement of the local community. Foundation Trusts must be representative of their local communities, with a governance structure that reflects this.

The majority of the rest of the evening involved an interactive walk through the FT authorisation process and financial and governance risk assessments. Credit has to given to Brendan who managed to explain EBITDA (Earnings before interest, taxes, depreciation and amortisation) and derive a financial risk rating to an audience not normally au fait with finance. The giant whiteboards either side of the projector screen were brought alive with calculations.

I am sure that everyone left the building with a much greater knowledge of what it means to be a Foundation Trust, and a deeper understanding of the authorisation process. Thank you to Brendan for his generosity and dynamic skills in explaining complicated (to me anyway!) maths. Thanks also to Claire Lemer and Emma Stanton for organising another fruitful and enjoyable Diagnosis Salon. Here’s to a great 2012 for Diagnosis!

Internship with KPMG - Health Advisory. By Adam Gwozdz

I was fortunate to have the opportunity to join the Health Advisory Team at KPMG for 4-weeks in August, and extremely grateful for the welcoming and engaging working environment created by the team – thank you Hilary, Sarah, Helena, and Scott. It would have been very easy for KPMG to limit my involvement to shadowing a consultancy team for the duration of my internship. Instead, I was immediately introduced to the team that I would working with and spent my first day in various meetings learning about the project objectives and my role within the team in completing them.

By being given a specific role, I was able to learn a great deal about the project, which involved a review of acute services within the NHS, and how real changes were implemented in the NHS. There were also many lessons to learn about leadership and management that seemed foreign to a medical student like me, but commonplace in the world of medical consultancy, making the workplace environment at KPMG an ideal setting for this. I also had many opportunities to apply these skills by participating in conference calls, workshops, and face-to-face meetings with project leaders, medical professionals, and NHS managers.

My project responsibilities included assembling a literature review of best practice evidence that focused on both clinical and management practices, to ensure that future proposals incorporated the most up to date national and international published evidence and guidelines. Having written review papers in the past, I was already familiar with Medline/Pubmed databases, however, I learned that resources such as the King’s Fund and BMJ Best Practice contained excellent publications on health policy and management, a topic that I found was not well referenced in many scientific databases.

In this particular case, the assembled document was applied to the case for change, and was discussed in detail at various client meetings. I found the exercise extremely helpful in learning how to identify and implement change within a structured organization.

Overall, I had a great experience, and I would recommend taking this unique opportunity to learn about medical consultancy, and management and gain transferable skills from an incredibly talented group of people at KPMG, regardless of whether you see your future career within the NHS or not.

MSc in Medical Leadership - Warwick Medical School by Dr L Hayward

If you have ever been interested in undertaking a higher degree in Medical Leadership, but have been concerned about how on earth you might find the time – look no further than the part-time MSc in Medical Leadership by the Institute of Clinical Leadership at Warwick Medical School. It is perfect for those of us trying to establish that all-too-tricky work-life balance.

I am a flexible ST4 psychiatry trainee, working 4 days a week in Bristol , with a husband, and two very small children (2.5 and 1.5years old). I have always wanted to do a Masters or MBA, but had to search at length for a course which was viable both financially and time-wise alongside my family commitments.

That’s where Warwick hit the spot!

The Warwick course, partnered with the internationally renowned Warwick Business School is designed to run for 3-5yrs depending upon how quickly you wish to complete, and consists of two course options: 1) An MSc with Professional Project which consists of 5 core & 2 optional modules plus a project with an 8-10,000 word report, or 2) An MSc with Dissertation which consists of 5 core & 1 optional module plus a dissertation of 15-20,000 words.

The course starts each April, with students usually undertaking the 5 core and 1 or 2 optional modules in the first 2 years. The 5 Core modules have to completed before the optional, of which there are approx 10 to choose from, after which the project/dissertation comes in to play.

Each module is run over approximately 16 weeks, with 4 taught days, split into 2 sets of 2days, with 6-8 weeks in between. In the gap between days 1-2 and 3-4, you are expected to undertake an un-marked practical assignment, generally related to your organisation, and have to feedback your findings to the group orally on day 3 of the module. After day 4, you have 8 weeks in which to submit a 4000 word written assignment. The next module starts just before the assignment for the preceding module is submitted.

The course itself costs £15k, and with plenty of reasonably priced B&B’s close to or at the University
(£35 – 100 per night), additional costs can be kept low.

The fifth core module (Comparative Healthcare systems), potentially involves a foreign trip (for us, Milan), which is self-funded, but, there are options available for those who are unable to go abroad.

I would highly recommend Warwick for several reasons:
1) The lecturing staff are superb and often nationally recognised figures – (eg. Prof Steve Field)
2) It generally requires a maximum of 4 days/nights away from home every 16 weeks (though some commute, and others stay only 1 night), which means it works well if you have other commitments.
3) The cohorts are mixed – primarily consultants & medical/clinical directors, but a handful of Registrars too & the variety of experience offers great networking/learning opportunities.

I am currently in my first year, at the end of module 2, and still managing to juggle my family, work & MSc balls with a smile. Ii clearly isn’t a breeze, no Masters is when you need to find 120-150hrs study per module, but the Warwick MSc is a challenge which is achievable alongside multiple other commitments.

If you’re interested, Further Information on the course structure can be found at: http://www2.warwick.ac.uk/fac/med/study/cpd/subject_index/slm/b91g

Diagnosis Salon 15 September 2011: Medicine and the Media at the Kings Fund by Dr Chrissy Barras

My first Diagnosis Salon and I was not disappointed! Sam Lister, Health Editor of The Times, Alastair McLellan, Editor of HSJ, and Dr Ellie, Resident GP for The Mail on Sunday and Woman magazine spoke about their experience of health journalism followed by Q&A and networking.

Sam Lister was of the opinion that having less space in the paper was actually a bonus as it had raised the standards of the articles that made it in. I was also very reassured when I heard the responsible view he takes of the latest miracle cure or scandal. Rather than sensationalising these to sell more copy he consults the scientists involved to get an accurate account. I think he is right in saying that the MMR controversy could have been greatly minimised if more people in the media had this attitude.

Dr Ellie was not deterred by comments made by Sam Lister about the Daily Mail and spoke very well on how she balances her journalistic commitments with work as an inner city GP. Honesty and openness appear to be her watch words. She is also careful with what she will write about and like Sam avoids being sensationalist, even if her editor would like her to be. It was amusing to hear that the topic that caused the most controversy for her was when she disparaged a popular ‘very low calorie diet’. A thick skin is needed if you are to survive the kind of comments she received in reply. She also supplied me with my new favourite phrase. A ‘toast dropper’ is a story that is to be avoided as it might put you off your breakfast. Urinary incontinence and mental health both fall into this category!

All 3 of the speakers are very active on twitter; even so I was surprised to hear just how much it influences the articles and editorials Alistar McLellan writes. He follows many doctors on twitter and he has changed his editorial at the last minute because of an interesting suggestion/tweet. It just goes to show that social media has really opened up lines of communication. As a someone who is quite new to twitter I have taken the stance of the spectator so far, I am rethinking this after realising its potential. Alistair also addressed some of the audiences’ concerns about GP commissioning, pointing out that around 10-20% of GPs will be well supported to commission around a third of the NHS budget. The consensus was though that it’s unlikely the public will appreciate this. What will the effect be of the public holding their family GP responsible for being denied that latest cancer treatment? Interesting times ahead.

Over a glass of wine I braved the unknown and spoke to quite a few new people. Great to see several medical students, I also met other medics, consultants from KPMG, a press officer from NHS London and an ex-GP from BDO who is advising on commissioning in my own mental health trust!

Already looking forward to the Christmas event.

Borrowing your watches to tell you the time by Dr Tom Foley, September 2011

Robert Townsend, in his 1970 book, “Up the Organization”, said that “consultants are people who borrow your watch and tell you what time it is.” I have never been very insulted by this view. Sometimes it is not that easy to read your own watch and when you have 1.3 million watches in your organisation, it can be a real challenge.

Diagnosis' recent piece of work with the King’s Fund is a good example. When they asked us to deliver a report on the secondary care doctor’s role in improving productivity in the NHS, we didn’t make it up ourselves, we asked the experts: a group of junior doctors in Newcastle, a group of consultants in London, a group of clinical managers in Manchester, negotiators with the BMA and NHS Employers, the head of Connecting for Health, and others working in the NHS.

We triangulated these views from the real world with the ideas laid out in the academic literature, so that we could assess feasibility as well as effectiveness.

By the end of the exercise, we had identified broad themes, each with practical suggestions and likely challenges. Far from regurgitating our own individually limited knowledge, we found ourselves surprised by many of our findings. Ideas from very different sources came together, generating novel and synergistic possibilities.

The final report, due to be published shortly, is essentially borrowed from the many individuals who participated in the interviews and focus groups, and from the literature that we reviewed, but it provides a new view on the role of doctors in improving NHS productivity.

Internship with Patients Know Best by Towhid Imam, July 2011

I have come to the end of my internship with Patient Knows Best in conjunction with Diagnosis and am happy with the experience I have gained. Dr. Mohammad Al-Ubaydli tasked me with finding out if, given the current climate, the NHS could save money by shifting certain services to the home environment. As this was a broad area, the internship was challenging at times. However, it was interesting because as well as building on the research methods I grew accustomed to at medical school, I also needed to collect information from a variety of people. This included interviews with doctors, health economists and health care organisations, each with a different way of thinking and thus providing different perspectives on home health care. I also used social networking sites such as LinkedIn which proved more valuable than I anticipated. As technology becomes cheaper, more advanced and widely available, it was interested to see how telemedicine could fit into the model.
I must thank Dr. Al-Ubaydli for his guidance on the project and thank Diagnosis for the opportunity. I encourage those interested to apply for Diagnosis internships as they provide a valuable experience for the internee.

Introducing the Imperial MSc in Health Policy

When people ask me my educational background I tend to get embarrassed.  Not because of the class of my degree or the university, but because the link between being a specialist in medieval history and making 21^st century health policy is not immediately obvious.  In over seven years at the Department of Health working on policies such as Payment by Results and the Healthcare for London Review, I have learnt a huge amount about policy-making on the job, but I still have no formal qualification. 

It is why I believe that the launch of an MSc in Health Policy at Imperial College is hugely important.    Whilst there are more and more qualifications in the health sector to facilitate new roles such as advanced nurse practitioners, there has not been a qualification for the people charged with spending £100 billion of taxpayer’s money and creating an environment for the world’s fourth largest employer to effectively treat the sick.

Imperial’s two-year part time Master’s course is aimed at people who want to develop their health policy-making skills.  Module leads include eminent figures such as former-Chief Medical Officer Sir Liam Donaldson and health economist Professor Pete Smith.  The entire course is under the auspices of Lord Darzi, surgeon turned health policy-maker. 

Teaching is organised into four two-week blocks to give some concentrated study time, whilst also making the course accessible to participants from abroad.  Healthcare systems across the world share the same challenge of unsustainable increases in demand and cost, so it would be good if they could pool knowledge and share some of the solutions too.  If course participants come from a range of countries, it will enhance learning.

I also hope that we will get several clinicians on the course.  Policy is always better informed if the healthcare professions are involved in its design, so why not have more clinicians becoming policy specialists?  Why settle for helping one patient at a time, when you can use your knowledge to develop policies that will benefit millions?  If that appeals to you, and you are interested in becoming part of the first cohort, starting in November 2011, then check-out the course brochure at: http://www3.imperial.ac.uk/globalhealthpolicy/courses/mschealthpolicy

Introducing the Diagnosis Internship Network (DIN)

As a medical student, I frequently found it challenging to organise non-clinical based internships at leading healthcare organisations. This was either due to the fact that I did not know anyone working at particular organisations, or companies would be unsure on how to manage interns or simply due to the fact many felt why does a medical student wants to work in a non-clinical environment.

After constant persistence, I did manage to secure internships in my summer holidays through people I knew or met but I felt there was surely an easier and more organised approach to organising these placements.

I had this idea where I wanted to create a network which medical students could use to gain these internships. The idea had been lingering but I was waiting for the right opportunity and right time. The opportunity did arrive in the form of Emma Stanton and Claire Lemer. Through the Diagnosis Salon’s I was attending, I saw the opportunity to set up the internship network. At the salons I was meeting high profile individuals and I felt by sharing my idea I was getting good feedback and vibes from the movers and shakers in healthcare.

After liaising with Claire and Emma, I wanted to run this internship network through Diagnosis, hence the name Diagnosis Internship Network (DIN).

Both Emma and Claire have been fantastic and inspirational in setting up DIN. DIN coordinates placements for interns undertaking Special Study Components (SSCs), dissertations, master’s projects or summer vacations. Potential interns will browse and complete an application form which will then be screened and filtered by DIN. Shortlisted candidates’ CVs will be sent to potential employers who then select their preferred intern and preferred dates.  Dates tend to be flexible.

We have an excellent array of organisations who have partnered with DIN in order to provide internships for medical students. This year is a pilot project and our priority is to focus on providing quality internships where both the candidate and organisation can gain and learn from one another.

We work closely with our partners to set up meaningful and worthwhile projects for interns. All the organisations we work with do not pay the interns but they cover travel and other expenses. However organisations also work towards making sure that the interns can present their work in the form of a presentation or a paper.

In addition to this, we are evaluating the project through the interns’ perspective. This is being done by sending a pre-placement questionnaire followed by a post-placement questionnaire. We will also be getting feedback from the organisations we work with. Since the launch in October 2010, we have already learnt so much and we are still learning.

Currently I am an academic foundation trainee, and I have strong interest in medical education. I am a strong believer in nurturing, inspiring and laying strong foundations from an early stage of medical training. We hope to achieve this through DIN and mentor today’s medical students who go on to become tomorrow’s clinical leaders.

There are a few things lined up in the pipeline for the next year or two that will allow us to expand DIN and achieve further success. Many thanks to all our partners, medical students who are showing considerable interest and the Diagnosis team working hard to make DIN feasible.

I am very exciting and very much looking forward to this project. 

By Harpreet Sood, Diagnosis Associate and Foundation Doctor, North East London Deanery. 

Contact via pa.diagnosis@gmail.com