The Next GenCast
Episode 17. Backstage with: Dame Barbara Hakin
Dame Barbara Hakin’s immense personal contribution to the NHS has spanned four decades – as a clinician, manager and national leader.
During her long career she has worked as a GP for 20 years before taking up her first management role in the NHS, first as a Primary Care Trust Chief Executive in Bradford and then as a Strategic Health Authority Chief Executive in the East Midlands.
She went on to become National Director of Commissioning Operations and Deputy Chief Executive at NHS England, where she helped oversee the establishment of CCGs. Described as Sir David Nicholson’s right-hand woman and a forthright and skilled operator, she has often been depicted as the most influential woman in the NHS during her time there.
In this conversation Barbara provides a fascinating overview of how primary care has evolved over time, as well as advice on leading effectively as the shortest person in most rooms, whether clinical credibility matters, and influencing politicians.
Side note: Given the number of three letter acronyms mentioned, you might find this historical overview and this one useful to look at alongside the conversation. The King's Fund also has some great animations and explainers which might help. Please see a summary of the terms she mentions below too in case it's helpful.
- Her early journey (3 mins)
- Work life balance (6 mins)
- Remaining a doctor and being in management roles (10 mins)
- Her first experiences of NHS management (16 mins)
- Being an influencer (21 mins)
- Having presence and making your voice heard (24 mins)
- Journey to helping to set up NHS England (28 mins)
- Imposter syndrome (33 mins)
- The Health and Social Care Act, and Andrew Lansley (34 mins)
- Advice on working with politicians (38 mins)
- Her favourite health minister (41 mins)
- Her view on integrated care systems and the trajectory of primary care (42.5 mins)
- Future challenges for primary care post-Covid (48 mins)
- Final 3 questions - a leader, a book, and top tips (51 mins)
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Here are some explanations of the terms Dame Hakin uses:
Commissioning: the process by which health and care services are planned, purchased and monitored.
Fundholding: In 1991, the Conservatives introduced the purchaser/provider split. Health authorities began to commission (buy) care, and GP fundholding was introduced. Under GP fundholding, GPs held real budgets with which they purchased primarily non-urgent elective and community care for patients; they had the right to keep any savings and had the freedom to deliver new services. Fundholding was not compulsory and applicants initially had to meet a number of criteria to enter into the scheme. Smaller practices could group together to form fundholding consortia.
PCGs and PCTs: Fundholding and family health authorities were replaced in 1999 with 481 primary care groups (PCGs). In 2000 the government announced that PCGs would become primary care trusts (PCTs). PCTs were managed by a team of executive directors headed by a chief executive.
PEC: Other board members of the PCT included the chair of the professional executive committee (PEC). This was elected from local GPs, community nurses, pharmacists. Broadly speaking, PECs provided a clinical viewpoint on the strategy and operations of the PCT.
SHA: In 2002, groups of health authorities were formed called Strategic Health Authorities (SHAs). These were responsible for developing and improving health services in their local area, ensuring quality, measuring performance, and making sure that national priorities were integrated into local plans.
2012 Health and Social Care Act: In 2012, the 10 SHAs and the 152 Primary Care Trusts which looked after services at a local level, were replaced by NHS England and more than 200 Clinical Commissioning Groups. The proposals were primarily the result of policies of the then Secretary of State for Health, Andrew Lansley
ICS: These Integrated care systems (ICSs) are a key part of the NHS long-term plan, and are intended to bring about major changes in how health and care services are planned, paid for and delivered.
ICSs are partnerships that bring together providers and commissioners of NHS services across a geographical area with local authorities and other local partners, to collectively plan and integrate care to meet the needs of their population. In November 2020, NHS England and NHS Improvement published Integrating care: next steps to building strong and effective integrated care systems across England, which Barbara references towards the end of the podcast.
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Episode 33. Backstage with: Prof Michael West01:02:21After a bit of a break, The Next GenCast is back with some amazing guests for you...And that starts with this episode, which is with our most requested guest since the podcast started- Professor Michael West. Michael West is officially Professor of Work and Organisational Psychology at Lancaster University, but he’s known to many as the guru on compassionate leadership for the NHS. He’s worked tirelessly to develop cultures of high quality and compassionate care in health services over the last 35 years with a strong focus on the wellbeing of staff. Amongst a myriad of achievements, he led the development of the NHS National Staff Survey, and recently co-chaired the two-year independent inquiry on behalf of the UK General Medical Council into the mental health and well-being of doctors. He was appointed a CBE in 2020 for services to compassion and innovation in healthcare. *Highlights:His story (5 mins)How does showing compassion differ from just being nice? (10 mins)Core elements of compassionate leadership (14 mins)What stops us from doing this? (20 mins)Dealing with difficult leaders (29 mins)Happiness at work (35 mins)Moral distress (37 mins)Listening with fascination - top tips (43 mins)Self compassion (48 mins) Quick fire (55 mins) *Resources:His latest book- "Compssionate Leadership: Sustaining Wisdom, Humanity and Presence in Health and Social Care"His book recommendation: Hope in the Dark, by Rebecca SolnitA helpful explainer on compassionate leadership by Michael West, with The Kings Fund *Social media:@WestM61@NextGGP/ @nishmanek *Subscribe to the Next Gen GP monthly bulletin to keep in the loop:bit.ly/NGGPbulletinhttps://nextgenerationgp.co.uk/
Episode 32. Backstage with: Oliver Burkeman.58:56This is our Next GenCast Christmas Special!We've done something different for this one: instead of hearing from a leader, this episode is with the utterly brilliant best-selling author and journalist, Oliver Burkeman. His latest book "Four Thousand Weeks: Time Management for Mortals", was easily my best read of 2022, and might give you lots to think about over the Xmas period.The average person has about 4000 weeks on planet earth, which doesn't sound like much does it? But I promise this isn’t a pessimistic episode about how short life is, or full of cliches about living in the moment- in his book, Oliver Burkeman shares an amazing philosophy to overcome overwhelm when it comes to choosing how to spend the rest of your four thousand weeks. *Highlights:The premise of the book (5 mins)Prioritising (14.5 mins)FOMO (19 mins)Work-life balance (25 mins)Making 'enlarging and diminishing' choices (33 mins)Imposter syndrome (36 mins)Inbox Zero (39 mins)Pay yourself first (46 mins) Procrastinating (47.5 mins) *Resources:Oliver's latest book- Four Thousand WeeksThe Antidote (another brilliant book by him)His viral article on "Winging it" mentioned around 36 mins inAnother great podcast episode he recorded with Stephen BartlettHis website and newsletter *Social media:@oliverburkeman@NextGGP/ @nishmanek *Subscribe to the Next Gen GP monthly bulletin to keep in the loop:bit.ly/NGGPbulletinhttps://nextgenerationgp.co.uk/
Episode 31. Backstage with: Dr Aarti Bansal.39:45This episode is an extra special collaboration with the wonderful team at FairHealth.They are an amazing charity set up by GPs, offering free resources to help anyone in the NHS to develop the knowledge, skills and confidence to work in areas of deprivation. This episode is hosted by Dr Rachel Steen, producer of the brilliant Finding Fair Health podcast. Rachel is a GP in Sheffield, and runs the GP Trailblazer scheme. She's also an invaluable part of the Next Gen GP leadership team, having hosted programmes in her patch in Sheffield and supported our team out there.For this episode, she interviews Dr Aarti Bansal.Aarti’s a GP in Sheffield, and she founded the incredible Greener Practice network in 2017. They are an inspiring network of GPs across the country, who aim to enthuse and engage our primary care community in action towards environmentally sustainable healthcare.*Highlights:Aart'is drive for Greener Practice and sustainability (4 mins)What can we do as health professionals (8 mins)Four pillars of sustainability (10 mins)Prevention (11.5 mins)Social determinants of health (16 mins)Greener Practice (20 mins)Challenges with bringing new people on board (29 mins)Leadership lessons (30.5 mins) Top tips, role model, and a book (35 mins) *Resources:Greener PracticeNancy Kline – Time to Think (book)Active Hope (book) Finding FairHealth Podcast (hosted by Rachel Steen)Next Gen Webinar on Greener practice with Aarti's team- worth a watch if you missed it! *Social media:@rmsteen@NextGGP/ @nishmanek *Subscribe to the Next Gen GP monthly bulletin to keep in the loop:bit.ly/NGGPbulletinhttps://nextgenerationgp.co.uk/
Episode 30. Backstage with: Sir Michael Marmot59:37We are back! And this is an extra special episode to kick us off, with none other than Professor Sir Michael Marmot, the guru of health inequalities. Sir Michael Marmot's work has changed how physicians, public health experts and governments think about health inequity. His work has been cited more than 250,000 times, and his influential Review has spread from the Eastern Mediterranean in 2019 to Manchester in 2021. You might have seen Sir Michael’s reports, read his books including The Health Gap, or perhaps you’ve heard him speak. But for this conversation, we wanted to get to know the man behind the title...*Highlights:Key messages of his work (3.5 mins)Growing up (8 mins)His first interest in health inequalities (13 mins)Changing track (17.5 mins)Politics (29 mins)Persuading people (38 mins)Ten years on (46 mins)Hope (51 mins) *ResourcesRCGP modules on health inequalitiesHis book The Health GapOur other episodes realted to health inequalites- with Bola Owolabi and Laura Neilson *Social media:@MichaelMarmot@NextGGP/ @nishmanek *Subscribe to the Next Gen GP monthly bulletin to keep in the loop:bit.ly/NGGPbulletinhttps://nextgenerationgp.co.uk/
Episode RE-RELEASE: with Laura Neilson.54:12Continuing our summer re-release series, this episode is with the amazing Dr Laura Neilson. Laura invariably moves our Next Gen audiences to tears and sparks standing ovations, because of her incredibly powerful story of influencing health inequalities from when she was only a medical student.Laura is the CEO of Hope Citadel Healthcare CIC, and a director of the Focused Care CIC - a unique approach to managing vulnerable patients in areas of deprivation. She founded Hope Citadel whilst she was a medical student living on a council estate in Oldham. She noticed the inequality in healthcare for the poorest, seeing the "inverse care law" in stark reality, and decided that it was possible to make a difference – so she set up a GP practice. Hope Citadel now run 11 GP practices in some of the most hard-pressed areas of Greater Manchester, aiming to provide whole-person healthcare to all.*Highlights:Her early influences (3 mins)'Noticing the gap' (7 mins)Digging deep and finding courage (9 mins)Setting up Hope Citadel (13 mins)Stories that made her stop (19 mins)Going to too many funerals (21 mins)"Focused care" (23.5 mins)Being told she couldn't do it (28 mins)Feeling out of her depth (30.5 mins)Feeling overwhelmed tackling health inequalities (37 mins)The role of doctors in social justice (41.5 mins)Her vision for her patients (43 mins)What can we do? (45 mins)Sustaining her energy (48 mins)Final 3 questions - a leader, a book, and top tips (50 mins)*Resources:Focused careBrene Brown's Dare to Lead book and the podcast on SpotifyHealth Equity in England- the Marmot Review 10 years on*Social media:@NextGGP/@nishmanek*Subscribe to the Next Gen GP monthly bulletin to keep in the loop about future webinars, podcast episodes, and our virtual programmes:bit.ly/NGGPbulletin
Episode RE-RELEASE: with Karyn McCluskey47:05Over the summer period we are re-releasing some some of our most popular conversations....This conversation is with Karyn McCluskey, chief executive of Community Justice Scotland. I heard Karyn on a podcast a few years ago, and never forgot her story.Karyn trained as a nurse in the NHS, but has worked in the police for the last 22 years. She was Director of the Scottish Violence Reduction Unit for the last decade, which proposed a different way of addressing violence in Scotland. They developed injury surveillance, gang intervention and gang exit, and focused on preventing knife carrying and injury. She helps support the Medics Against Violence charity in Scotland, set up in conjunction with the Violence Reduction Unit.So how did Karyn get such startling results in a city once known as the murder capital of western Europe? Listen to Karyn's story, the lessons she's learnt, and the advice she'd give to any leader with a drive to tackle 'wicked' problems- prepare to have your mind blown!*Highlights:Her vision and story (2 mins)Advice on making change (13 mins)Coping with failure (22 mins)Working within political timescales (25 mins)Changing things without evidence (28 mins)Imposter syndrome (32 mins)Resilience and decompressing (39 mins)Mum guilt (40 mins)Final 3 questions- recommended resources, a leader she admires, and top 3 bits of advice (42 mins)*Resources:A recent Telegraph article profiling KarynHer Ted Talk: 'Proceed til Apprehended'The podcast where I first heard Karyn: Reasons to be Cheerful (Episode 50)More about Karyn's work*Social media:@KarynMcCluskey@NextGGP*Subscribe to our monthly bulletin for further webinars, podcast episodes, and programme updates:https://bit.ly/NGGPbulletin
Episode RE-RELEASE: with Sarah-Jane Marsh.47:43We're taking a break over the summer, and re-releasing some of our most popular episodes. This one is with Sarah-Jane Marsh, CEO of Birmingham Women's and Children's Hospital. Sarah-Jane joined the NHS via the Graduate Management Scheme. Appointed Chief Operating Officer at Birmingham Children’s Hospital in December 2007, and Chief Executive just over a year later, whilst still only 32, the Trust has been under her leadership for 12 years and was named ‘Provider Trust of the Year’ by the Health Service Journal in 2015.In 2015, Sarah-Jane took on the additional role of Chief Executive of Birmingham Women’s, before going on to integrate the two Trusts to create the first Women’s and Children’s NHS Foundation Trust in Europe in little more than 18 months. In 2016, Sarah-Jane was asked to head-up the NHS England Maternity Transformation Programme.More recently, she was asked by the Government to lead the testing aspect of their Covid-19 'Test and Trace' programme. In this episode, Sarah-Jane talks candidly about her recent experience working for the Government, reflects on how she coped when her resilience hit rock bottom, and shares some of the lessons she's learnt on her leadership journey so far...*Highlights:What it was like being asked to lead for 'Test and Trace' (3 mins)Managing life at home alongside that responsibility (6.5 mins)Lessons learnt from that role (11.5 mins)How her resilience hit rock bottom (13 mins)Her journey to CEO (19 mins)Managing imposter syndrome (23 mins)Her proudest moments (27 mins)What she'd like to achieve over the next 10 years (30 mins)How she balances being a mum (34 mins)How she copes with abuse on Twitter (40 mins)Her final recommended resources, role model, and top tips fo new leaders (42 mins)*Resources:Jess Phillips' first bookOur podcast episode with Sir Bruce Keogh, Sarah-Jane's Chairman at Birmingham Women's and Children's Hospital*Social media:@BWCHBoss@NextGGP*Subscribe to the Next Gen GP monthly bulletin to keep in the loop about future webinars, podcast episodes, and our virtual programmes:bit.ly/NGGPbulletin
Episode 29. Backstage with: Dr Bola Owolabi53:02This is Episode 29, with Dr Bola Owolabi, Director of Health Inequalities at NHS England and NHS Improvement, COVID-19 has shone a harsh light on some of the inequalities that persist in our society, and Bola has been leading the NHS effort to accelerate progress in tackling this over the last few years in her national role.Bola also works as a GP in the Midlands, and has held various leadership roles at local, system and national levels in her career. Having heard her speak at a few meetings and conferences now, I’ve always come away with an impression of someone who is quietly confident, hugely committed to her purpose of reducing health inequalities, and clearly mindful of bringing other people with her along that journey.*Highlights:Her early years and influences (3 mins)Bola's 'why' (7 mins)Managing her imposter syndrome (14 mins)Do leadership qualifications matter? (18 mins)The value of mentoring, and how to find a mentor (22 mins)Being a BAME leader (30 mins)What her role means, and the vision of her team (34 mins)Staying hopeful about tackling inequalities (40 mins)What can we all do to help tackle inequalities? (46 mins)*ResourcesLearn more about Core 20 plus 5RCGP modules on health inequalitiesA blog by Bola on health inequalities in the BMJ, and more blogs she has written for NHSEBook recommendation: Lean In, by Sheryl SandbergLearn more about 'Core 20 plus 5' in this episode she recorded for "Finding fairhealth" with Rachel Steen*Social media:Twitter: @bolaowolabi8@NextGGP/ @nishmanek*Subscribe to the Next Gen GP monthly bulletin to keep in the loop:bit.ly/NGGPbulletinhttps://nextgenerationgp.co.uk/
Episode 28. Backstage with: Hannah Miller53:09Leadership starts with leading yourself, and there is no better person to help us understand ourselves than this week's guest- Hannah Miller. Hannah is one of our most popular speakers at Next Generation GP, and you'll see why! She's an amazing coach, supporting emerging leaders from all sorts of backgrounds using a strengths based approach to development and finding purpose. She's a fantastic speaker, and was chosen to receive the Vistage Rising Star Award for speaking in 2019.She's introduced a lot of Next Gen GPs to a profling tool called StrengthsFinder, developed by Gallup, which offers personalised insights about what you naturally do best. So many Next Gen leaders have been amazed by how accurately it describes them, and how it helps them to understand differences in their teams, what they are really good at, and what opportunities they should decline or pursue as a result. *Highlights:Her career (3 mins)What is StrengthsFinder? (7.5 mins)Why should we focus on strengths rather than weaknesses? (9 mins)Working with doctor leaders (18 mins)Choosing between opportunities (19.5 mins)Coping at rock bottom (24 mins)Starting her own company (30 mins)Managing her own setbacks and vulnerability (35 mins)Where she finds her energy (40 mins)Quick fire: including favourite books, heroes, and top tips for new leaders (45 mins)*ResourcesHannah's website- SidekickA Next Gen webinar with HannahBook: Four Thousand Weeks by Oliver Burkeman or a podcast with him Book: A Fine Balance, Rohinton MistryPodcast: The Diary of a CEO with Steven Bartlett *Social media:Twitter: @hannahloumillerInstagram@NextGGP/ @nishmanek*Subscribe to the Next Gen GP monthly bulletin to keep in the loop:bit.ly/NGGPbulletinhttps://nextgenerationgp.co.uk/