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