A Doctors Point of View

January 8, 2014

By guest contributors Alexander Finlayson & Edward Maile.

The NHS workforce is one of the largest workforces in the world. Furthermore it is a workforce brimming with ability and potential beyond the delivery of service. As such it must contain a huge capacity for solving the institutional challenges. Like all large systems it can occasionally feel constraining to work for and this potential can at times be prevented from simmering to the surface.

The NHS, like most global health services faces a huge financial challenge. There are only five feasible responses to this challenge; to close it down, to run it into the ground, to cut services, to increase funding or to drive transformative efficiency saving.

We like many others, believe that a large part of the solution lies in unlocking the untapped potential of health workers at the coalface to drive transformative change. In so doing we can solve the dual problem of staff disenfranchisement and the need for excellent ideas which are well implemented to maintain the values of the NHS.

We wanted to create a point of access for all health workers and not create an elite cadre of separate ‘leaders’. Too often initiatives have focused on a select few pre-designated leaders and their purpose restricted. Furthermore terms like Transformative change sound like inaccessible and remote government jargon.

Google is well known for it model of empowering staff to innovate. Staff do their work (service delivery) in 80% of the time and are allowed to innovate relatively freely in the other 20%. 

As health workers in training we are all too familiar with the experience of coming in on a Monday morning, putting our bags under a spare table somewhere and then firefighting until Friday evening when you start your on call. During our infrequent lunch breaks we moot the frustrations of the systematic problems we see every day. The thought of a doctor in training, who is not part of a designated leadership scheme, having time set aside for project work, service change or strategy is not the day to day reality. There are problems of permissions, cover and finance.

The 2023 Challenge is an attempt, and only one of many other initiatives throughout the UK, toward enabling coal-face health workers to play their role in making sure that the NHS deserves pride of place at our next Olympic Opening Ceremony or at least until 2023!

In its first iteration the 2023 Challenge offered financial support and access to network of implementation support for the projects of doctors in training and medical students across Oxford Deanery (LETB) and Oxford University Medical School. Instead of putting constraints around the scope of ideas and therefore risk excluding people who are thinking outside the box, The 2023 Challenge welcomed ideas with application anywhere across healthcare; in service delivery, education or research. 

Setting up this project has hopefully been a small microcosm of doctors in training working collaboratively with decision makers in the NHS to drive change. As demonstrated by the purpose of this project, doctors in training don’t have access to finance, project management, decision makers nor allocated time for this type of work. This was also the case for setting up the 2023 Challenge whereby the trainees did not have any time allocated to make it happen.  We are therefore indebted to the unwitting support and hard work of HETV and the Executives of Trust’s across the Oxford LETB. 

2023 challenge was for those people, and there are many, on wards, in the community, in clinic or in theatre frustratedly watching inefficient systems and have been brewing a brilliant ideas to fix them. Perhaps it’s an app to transform the community treatment of COPD, seed funding for a new training scheme like Harvard’s Global Primary Care, a simple and disruptive quality improvement project like Atul Gawande’s surgical checklist, or a scheme which brings new positivity and meaning to being a doctor in the NHS.

This is not Palo Alto, there are no NHS hoodies and we have yet to see a pinball machine but we are keen to see ensure that some of the brightest 17 years old still chose healthcare as an attractive career and that this is based on a realistic understanding of the experience of training.

But I want my junior to be able to do my discharge summaries, I don’t need them to have new ideas I hear some consultants cry. Indeed they must. But perhaps given the chance we might not still be using paper ones……………………….

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