Nikita Kanani – Acting Director of Primary Care for NHS England – interviewed with Roy Lilley at the Kings Fund recently.
Where do you start? What an amazing, full on, vibrant and challenging Health Chat. I watched a recording on Periscope – you can too. Click on this link – it is free!
So it wasn’t just Roy Lilley being provocative at this event. Nikki batted most things back faster than the ball had come to her. Highlights? Number one has to be the thought that Roy will be prescribed Zumba classes if Nikki can just arrange that bit of social prescribing for him. Now get that image out of your head, and get back in the room!
I wasn’t there, so don’t know the audience make up. I’m guessing, as Nikita Kanani is Acting Director of Primary Care at NHS England, as well as being a practising GP in South London, that there were a lot of GPs present. I’m just guessing, as a lot of the times Roy was pushing hard about the GP contract and BMA getting too good a deal and why not use more tech and AI systems – I did pick up some harsh intakes of breath. In France, they have protests. We have tutting and heavy breathing. I prefer it here though…
We had vested interests in the room, yes. But anger is just another name for passion and commitment? There will be another plan (wait for it). And as the protagonists concurred, the agreed newly hatched GP contract is arguably more important than the NHS Long Term Plan. Certainly, if you get the first contact right (and we all agreed it really doesn’t have to be a GP), then the rest of the plan looks more attainable and deliverable. For only 9% of the budget. 93% of first contact is in Primary care. Blooming bargain, mate!
It was wide ranging, this health chat. We started with a tangent into Community Pharmacy. Mainly because her mum and dad still do that, after being refugees from Uganda, escaping from Idi Amin. Could the role be extended? Certainly feels so? If they could prescribe more? Only a handful can and do, I believe? Patients sometimes expect a prescription? And the pharmacist has to tell them to go to the GP surgery, to get the same diagnosis as they have already made, to write a prescription for the pharmacist to dispense? OK, I am being very simplistic here, and there are immense hurdles to overcome (legal and vested interest?). But unless we have this sort of disjointed thought pattern and proposal, will we ever get through the GP access problems?
It seems Nikki was destined for a leadership role from early career. And as Roy says, when you see clinicians who want to be managers too, they are often excellent leaders. The usual, house jobs, surgery and medical- and loved all the disciplines. Loved being part of a coherent, focused and powerful team. An aside here – she misses that in General Practice, as you do tend to feel more exposed with less support? Having said that, I’ve heard junior docs in hospital service complain that they don’t feel part of a team. You hear the nostalgia for the way it was. s this hearsay or ubiquitous? You practitioners will have a better fix on that than I.
It was the leap of faith from having a great Consultant, and being in a hospital where the deputy chief exec used to have ‘drop ins’. She was ranting and complaining to him about patients being in the wrong place, so he said why not come and work with us? Would that still happen? I do hope so…what a great way of getting change happening quickly. And it served to stop her complaining! Nikita suddenly had to make things change. It’s all about stopping just talking about it, and actively taking action. This is probably why Roy ranted once or twice about yet another report being commissioned and published, when two had happened already and were perfectly acceptable as the baseline for an action plan, and action? They made up a job title “Service Modernisation Lead”. Sounded like she then did a crash course in management techniques – LEAN, Prince 2 Project Management, and more. Gantt charts coming out of her ears…
First thing they did? Front Door Flow – and added a Rapid Assessment Team, to make sure the patient was directed to the right care at the right time. That was back in 2005. Her reputation seemed to grow quickly. Hospital Control Team was next. And creating Clinical Decision Units with a Care Coordinator. Yes, all sounds obvious and becoming normal now. It wasn’t then?
The path was so rapid to her current role, Acting Director of Primary Care at NHSE. Although a 6 month post, not substantive, she made sure the job was openly recruited or it wouldn’t have felt correct. I liked that. When you view the recording of the chat, you will see why I might have got things in the wrong order. Nikita’s excitement commitment and speed of thought means you do miss things! She worked in the PCT whilst on her GP training. Frowned upon, but she doesn’t really care if things feel right. DoH with CCGs (2012/13), loved having the budget and accountability. But austerity made the job harder. She described it as the best and worst of jobs.
Let’s get some highlights of the ensuing ‘where are you today’ discussion. I will add in my usual proviso and health check that some of the comments may be my views creeping in. Sorry…
- Looking at in-patients in any hospital. 1/3rd should be in there. 1/3rd should be at home. 1/3rd shouldn’t be there at all. Scary, isn’t it?
- “Why do GPs miss a lot of diagnoses?” (Roy question, out of the blue). “They do a spot a lot”. Fine reply! Early diagnosis of cancer? We come out well on treatment, but badly on early enough diagnostics? Could having the James Kingsland NAPC at Home style, or Sam Etherington’s local do everything garden centre with health centre annexe (I’m simplifying the offering, OK?) – perhaps make swifter diagnostics work better? The diagnostic hub concept? Get it out of hospital and into local walk in that day standardisation?
- Not enough GPs – and maybe there never will be. Maybe there never were? If up to 60% of those who see their GP didn’t really need to see any GP, then what could we do about it? If the biggest impact on people’s well being are the three pillars – have a fulfilling job, have someone to love, and have a safe place to live – what has a GP got to do with that? Maybe it is social prescribing. Maybe it is having the change of attitude in the patients that they want to chat to, see on their phone, have an algorithm exchange first, see any health care expert appropriate to their clinical and emotional need at that time would mean that the GPs could then concentrate on the people who really need their type of intervention. Most patients know already, I think.
There’s no magic bullet, both Nikki and Roy agreed. But she does have a people plan to roll out in 2019 /20. 20 initiatives and projects. That’s a lot.
I am going to watch this space with interest. The audience sounded like they are going to as well. We were all energised by Nikita Kanani as a total force of nature. The journey will be fast and furious. If you weren’t there, have a look at the recording, and see if you want to get on the bus too.
I know that I will.
(if you want to see the health chat recording – click here )
Nikita Kanani MBE is a general practitioner and the former chief clinical officer of the Bexley Clinical Commissioning Group. In 2018 she became the first woman to be director of primary care of the British National Health Service (NHS).