Leadership and Management Fellow Scheme

My LMFS fellowship involved setting up a new NHS Adult ADHD service in Oxford. This project developed my skills in:

• Navigating Healthcare Systems: I learned the intricacies of the NHS, including funding and stakeholder collaboration, crucial for establishing new services.
• Project Management: I mastered planning, budgeting, resource allocation, and meeting deadlines to ensure the project's success.
• Promoting Awareness and Access: The initiative raised awareness of Adult ADHD, improving the access to diagnosis and treatment for many.

These skills directly benefit my current practice at ADHD Specialist. Understanding the NHS allows me to better serve patients from both private and public healthcare backgrounds.

My experience also highlighted the importance of clinical governance (CQC registration) and leadership. These insights were invaluable in establishing my practice and becoming a CQC Registered Manager.

Leading the development of an NHS Adult ADHD service in Oxford was rewarding. This experience equipped me with skills that have already helped hundreds of patients and families. 

I'm very grateful for the support of the Royal College of Psychiatrists LMFS and Oxford Health NHS Foundation Trust.

I completed the first cohort of LMFS (2019-2020) as an ST6-7 trainee. The scheme was invaluable for me in my development as a leader and a psychiatrist in general. My project involved amplifying the patient voice in ward rounds and improving MDT working in clinical reviews.

However, as the pandemic hit I had to modify my project but also felt empowered to start up a peer support scheme for junior doctors in acute medicine in my spare time. This scheme supported hundreds of trainees working in medicine, intensive care and paediatrics and was eventually adopted and taken over by the Deanery. 

The theories and academic aspects of leadership were interesting but my most valuable lessons came from the experiences leaders shared with us and the power of peer learning. The scheme has helped me think strategically, to transfer clinical skills to leadership scenarios and has emboldened me to take risks. I have a huge amount to learn as a leader but the foundations from LMFS are a great springboard to further opportunities. 

My project focused on upskilling future GP trainees in the management of common mental health issues and raising awareness about mental health referrals. Our aim was to better prepare GP trainees to interact effectively with mental health services. By enhancing GP referrals, we sought to address a significant bottleneck in the patient review process within mental health services.

This initiative unfolded over two phases, separated by a span of ten months. Initially, I conducted a pilot session, followed by a subsequent session that incorporated feedback from the first. Throughout these two phases, we explored a variety of topics within mental health services, including the structure of these services, shared care protocols, the management of common mental illnesses and disorders, and referral pathways.

The outcome was overwhelmingly positive; the presentation was lauded for its clarity, concise delivery, and appropriate level of detail. As a result, GP trainees reported increased confidence, which is expected to enhance communication between primary and secondary services.

Acquiring Knowledge:

I discovered that effective leadership and management hinge on superior communication and coordination. A project must adhere to SMART principles. A Quality Improvement (QI) project is an ongoing endeavour, persisting beyond the achievement of its initial goals.

Investing in evidence-based training for new junior doctors reduces resource wastage. In the long term, the time and resources conserved enhance patient safety and mitigate NHS staff burnout.

Review of Trust Medical Appraisal Policy and implementation of the outcomes of the review

Dr Sachin Gandotra, ST6 General Adult Psychiatry, Tees Esk and Wear Valley NHS Trust

The main aim of the project was to review the existing medical appraisal policy of the Trust and seek consensus from the different group of doctors regarding any changes that needed to occur in light of the new Medical Appraisal Guide (MAG) published by the Academy of Medical Royal Colleges in June 2022. The main aim was to seek consensus from different group of doctors for an informed opinion that would likely drive changes in accordance with the felt need and as prescribed by the GMC requirements. Though this was the main aim, the project also made attempts to draft recommendations on issues relevant to the Trust based on the review to facilitate a possible change in the existing Trust medical appraisal policy. The methodology consisted of reviewing the existing Trust medical appraisal policy and the guidance in the Medical Appraisal guide, drafting questionnaire for gathering the target information from different staff, gathering consensus opinions from focus group discussions for different group of staff which included appraisers who are not managers, consultants who are not appraisers, medical managers who are not appraisers, consultants who are appraisers and SAS doctors who are not appraisers. The focus groups were conducted virtually as well as face to face groups and consensus opinions were then synthesised with information available from the guidelines to draft recommendations. The main recommendations that followed from the review were to promote supportive and developmental nature of the appraisal process by making the process less document intensive and modifying SARD portfolio and appraisal sections, educating staff on not duplicating information, promote verbal reflection, and modifying corporate supporting information section to reduce burden on doctors; maintaining 3 year appraiser turnover; avoiding line manager to be the appraiser of the appraisee; not sending appraisal summary to the line manager and considering how to facilitate communication and input of the line manager to the revalidation decision; clarifying requirements of supporting information for appraisal of particular group of doctors (Trust, IMG, academics, and on zero hour contracts); expand corporate supporting information to include GMC/Trust disciplinary and low level concerns; to promote wellbeing discussion by adding prompt for doctor to comment on their wellbeing and adding a wellbeing statement to the appraisal template and finally to add trainer accreditation statement to the appraisal template to facilitate reporting of trainer accreditation.

Undertaking this project was a very useful experience and this was facilitated immensely by the support and clarity offered by the Project Supervisor and facilitated by the LMFS sessions.

• By focussing on the target groups it was possible to experience empathetic leadership attribute as when one is a leader, one tends to ask, “How would I feel in their shoes at this moment?” Following this up by asking questions and listening to responses directly is a great way for leaders to show that they genuinely care for your target group.
• Conducting focus groups was at the heart of the methodology which fostered that themes of Goleman’s Leadership styles: Democratic/forges consensus through participation-What do you think; active listening, not sidelining differences of opinion, rephrasing responses, leading the discussion carefully not jumping to give your own opinions. This helped to generate consensus themes, and change was driven by consensus collaborated with literature evidence.
  • I received some mentoring for conducting the Focus groups and the action learning sets of the LMFS were instrumental in learning coaching styles and explorative thinking. 
  • There were also elements of empowering leadership behaviours such as delegating responsibilities and enabling them to make decisions about complex appraisal situations given background information and this led to formulation of guidance on those situations such as appraisal guidance for special group of doctors.
  • The project did not lose the focus on the main goal but also ensured a firm follow up at senior management levels to present the rationale with evidence to bring about a change.
  • This led to going over and beyond the basic aim of the project to review the Trust appraisal policy to contribute to additional issues relevant to the Trust and led to agreed actions on behalf of the Trust. This was welcomed by the participants.

 

The Royal College of Psychiatrists Leadership and Management Fellowship Scheme 2021/2022 was an excellent experience for me to develop my leadership and management competencies. My project as part of the scheme involved leading the pilot of a service development project; a dedicated aMCI (amnestic Mild Cognitive Impairment) clinic for North Sector patients in Gloucestershire. This was done over a six-month period; run by a medic and assistant psychologist for one session a week. Its’ aim was to ease some of the pressures on the Memory Assessment Service nurses and the medical memory clinics. The pilot also included a pre-screen for existing clinical trials as appropriate. Data from this project is currently being used to inform a business case proposal to develop this as a longer-term service within the whole of Gloucestershire.

A huge challenge of this project was to get funding approved for the pilot development of this new service. Through my learning within the scheme from very senior leaders within the NHS both locally and from around the country, I was able to successfully negotiate funding for it by having regular two weekly meetings with relevant stakeholders reminding them of the potential benefit this service would bring.

 Through the project I was able to empower others and enable team members to feel confident in their own decision making and sharing the same. The project won Severn Deanery Project/QIP of the Year 2022 and we also presented the work at the Royal College of Psychiatrists International Congress in 2023.  We are also writing up the project for publication. The scheme was a unique experience that I am extremely grateful to have had the pleasure to take part in.

Dr Brenda Wasunna-Smith
Consultant Psychiatrist

During my Leadership and Management Fellowship Scheme at Leeds and York Partnership NHS Foundation Trust (LYPFT), I played a pivotal role in the Electronic Document Management (EDM) Project. The purpose was to introduce MediViewer, an EDM system which would allow 24/7 access to patient documents including all historical records.

My contributions primarily focused on ensuring the system was fit for purpose, particularly regarding taxonomy and usability, from a clinician’s perspective.

I actively participated in the Training and Medical Records Work streams, contributing valuable insights from neuropsychology and sensitive information discussions. This involvement was crucial in aligning the system with clinical needs. I participated in mapping current services, serving as a liaison between project managers and healthcare staff to ensure accurate representation and communication.

Attending numerous demos of the system allowed me to address colleagues’ queries. My involvement extended to board meetings, providing me with insights into senior leadership within the Trust.

My engagement with taxonomy was extensive. I worked to ensure all relevant documentation used by staff across the Trust was accessible and logically named. This included leading a workshop with frontline staff to review and refine document taxonomy, a session praised by suppliers for its innovation and potential to significantly improve software usability.

I also had a role in eLearning development, collaborating with the Head of Digital Change & project leads to create effective eLearning modules.

Overall, my work significantly contributed to the EDM Project, ensuring it met clinical requirements and giving me a fantastic opportunity to put leadership and management concepts into practice.

I worked with the deputy medical director of my trust (Sheffield Health and Social Care) on helping the trust’s successful bid to be affiliated with the faculty and medical leadership and management (FMLM). Specifically, I conducted a gap analysis of how the trust was performing in relation to FMLM leadership commitment to junior doctors. Where there were areas for improvement, I worked closely with the medical education department and other people within the trust to set about a plan for promoting leadership and management development opportunities for trainees in accordance with the faculty’s standards.

Improving service user satisfaction of the therapeutic activities provided in a psychiatry intensive care unit

Introduction

Bio-psycho-social approach helps us understand and treat mental health conditions most effectively. Psychiatry intensive care units are not only the place that care for people with the most severe mental health conditions but also is one of the most restrictive environments.

The Royal College of Psychiatrists sets certain standards for psychiatric intensive care units and is given emphasis on the provision of therapeutic activities. The prominent ones include every patient to have a seven day personalised therapeutic/recreational time table of activities to promote social inclusion, patients receive psychoeducation on topics about activities if daily living, interpersonal communication, relationships, coping with stigma, stress management and anger management.

Aim

We identified the scope to improve the choice, availability and accessibility of activities provided in PICU. Aim is to improve the service user satisfaction of activities provided from 3/5 to 4+ /5 by 6 months.

Methodology

We followed the principles of QI. Did a process mapping, change ideas was collected from the whole team including service users, a driver diagram was created , changes were introduced, and impact was measured through PDSA cycles.

Results and conclusion

(This is an on going study).The measurements show improvements in the primary outcome that is service user satisfaction. There was noted reduction of risk incidents and improvement in staff wellbeing. Though there was attempts to record the number of activities provided this was not successful.

Broadly the activities could be divided in to leisure based and skill based. We identified major changes was brought about by improving the communication about therapeutic activities among the multidisciplinary staff and between the service users and multidisciplinary team. Games that involved physical activities was on demand.

I was part of the 2023-2024 LMFS cohort, alongside taking up a Chief Resident Role within my Trust. Combining my interests in Medical Education and Medical Leadership, my project sought to improve trainee experience and accomplishment in achieving their research competencies.

I began by understanding the current situation from the perspective of trainees, clinical and educational supervisors, and the Trust research lead. I used surveys and focus groups to understand experiences, opportunities, barriers, and challenges around trainee research involvement. I understood that whilst objectively there were numerous research opportunities both trainees and supervisors struggled to access this for basic reasons, like not knowing the language, structures, or processes to engage with research.

I addressed this by identifying and mapping training and resources to the curriculum to help scaffold trainees and inform supervisors about how competencies could be achieved. I linked in with academic clinicians within the trust to create a live database of potential projects and supervisors for trainees to tap into. I problem-solved issues in accessing NIHR resources by clearly identifying the Trust sponsor to trainees. Information about this was disseminated to trainees in emails, at resident doctor committee meetings, and inductions.

Following these interventions, trainees were surveyed again and reported improved confidence in achieving all research competencies. Since completing the LMFS scheme I have continued this QI project. The latest challenge that has emerged for trainees is around having sufficient study leave to undertake recommended training, including the NIHR Associate PI Scheme. I am now working with the Medial Advisory Group, Trust Research Lead, and Resident Doctor Committee to try to agree on allocated time for trainees to achieve their research competencies within clinical placements, as part of a research-active medical culture.

I was a Leadership and Management Fellow with the College from 2022-23. For the year, I was involved in a working group introducing a rehabilitation pathway to our local trust, something required of all trusts by NHS England as part of their vision for community psychiatric practice (the Community Mental Health Framework within the NHS Long Term Plan).

This was a complicated project that highlighted the inherent challenges of introducing a national vision to a local area with its own particular strengths, needs and deficits. The Fellowship Scheme helped to put me in touch with leaders within the trust, to join the meetings where the decisions were being made, and to build a mental map of the trust's and NHS’s management and funding structures.

The ‘realpolitik’ of NHS service development was eye-opening. Working on the project required a foot in both the management and clinical teams involved and helped me to sympathise with their differing perspectives and priorities, how these can create tensions or misunderstandings and how they are resolved in practice.

I’m very thankful to the College and Oxford Health NHS Foundation Trust for supporting me with this opportunity.