萝莉视频

In the second of our series of podcasts exploring ways in which we can help members to thrive in psychiatry, we're looking at the ways in which employers can create an environment for psychiatrists to feel supported and flourish in their careers.

We speak to leaders and psychiatrists at Lancashire and South Cumbria Foundation Trust, where a wide range of supportive measures have been introduced and schemes to help psychiatrists grow into their roles and thrive.

Transcript

Ananta Dave:

Hello everyone! Welcome to this podcast series for the Thrive in Psychiatry campaign by the 萝莉视频. I'm delighted to be joined by colleagues from the Lancashire and South Cumbria Foundation Trust today. 

Before I introduce my colleagues, I'm Ananta Dave and I'm the Presidential Lead for Retention and Wellbeing at the 萝莉视频, and I'm really delighted that we are having a series of conversations with colleagues from across the country, the devolved nations, to look at how we are engaging in good practice around retention, but also to speak to psychiatrists and psychiatrists in training, to look at some of the challenges and the barriers that may be present for retention.

So in this episode, we are looking at what employers or organisations can do in terms of good practice. What are the innovative or creative things that they've done over the years to improve retention, to create an inclusive culture and to make sure that people from various backgrounds can thrive in psychiatry after they've chosen it as their career? 

So without further ado, I'm going to introduce our panel today, and I'll start with Doctor Gareth Thomas, who is the Chief Medical Officer of Lancashire and South Cumbria Foundation Trust.

So, Gareth, if you could just say a bit about yourself before we go on to our colleagues for introductions. 

Gareth Thomas:

Thanks Ananta. And firstly, thank you to yourself and the 萝莉视频 for inviting us to talk on this podcast today. We really hope it's useful for you, but then also that we can share some of our learning experiences, you know, the good and the challenging experiences as well, you know, with yourself and with colleagues as well.

So thanks ever so much. I'm Gareth Thomas and like you say, I'm Chief Medical officer, Deputy Chief Exec. here in Lancs. and South Cumbria. I'm also an Old Age Psychiatrist by background. I've been at this organisation, I've been here for a long time, actually, I started here. I remember coming as a taster session as a medical student and as a foundation doctor, core trainee, higher trainee, consultant, and then through various opportunities and leadership roles, I'm now the Chief Medical Officer and Deputy Chief Exec.

So I think with my own personal journey, it kind of shows if you really do invest in your workforce, then they stay and they really want to deliver the best outcomes for their patients. So I think that's kind of my own kind of story in itself, really. 

And I feel really privileged to be in a position I am, and for the work that we've done.

Ananta Dave:

Thank you. Gareth. I'm sure there's a lot to explore when we come back to you for some of the details. I'm now going to go to Dr Dush Mahadevan. If you could introduce yourself, please.

Dush Mahadevan:

Hi. I'm so I'm Dush Mahadevan, I'm a Child and Adolescent Psychiatrist. I'm the Deputy Chief Medical Officer here in the trust. 

Ananta Dave:

And welcome to you. But also delighted to see a fellow Child and Adolescent Psychiatrist on the podcast. Welcome, Dush. And we then go on to, I think we've got Oli. Please introduce yourself, Oli.

Oli Sparasci:

Hi. Thanks for having me. My name is Oli Sparasci. I'm a consultant Older Adult Psychiatrist like Gareth. And I have been in the trust for, just over a year now as a consultant, and I, did some of my training in the organisation as well. And I'm, I'm really delighted to be here, so thanks for having me.

Ananta Dave:

Excellent. So there's a theme about people having started off in the organisation and then have progressed. And that in itself, I think, is something important to remember. So thank you, Oli, and welcome. 

Then we have Grace. 

Grace Nichols:

Hi. Good morning. My name is Grace and I'm also a Child and Adolescent Psychiatrist, I'm an ST6 trainee at the moment and kind of carrying on with the theme of as kind of staying in the trust.

So I was a foundation doctor in the trust. I did my core training at LSCFT, and I've done the majority of my specialty training in LSCFT as well, and I'm hoping to continue that into consultancy. Thank you for having me this morning. 

Ananta Dave:

Fantastic. And again, welcome to a fellow child and adolescent psychiatrist about to become your ST6, isn't it? 

That's fantastic. Thank you Grace. And also I like the combination of consultants and trainees that we've got here. And Oli, you've although you've, you're now a consultant, you've done your training in the trust. So you can give some of your insights around that experience as well. 

And, Imran, it's a pleasure to see you here. You've been such a champion of psychiatry and psychiatrists, and I've interacted with you over the years. So please tell us a bit about yourself and introduce yourself. 

Imran Chati:

Hi. Thanks, Ananta. My name is Imran Chati. I'm Head of Medical HR here at the trust and Relationship Manager. 

Been with the trust now for around 11 years or so. So, yeah. Absolutely embedded and part of the medical workforce and work with psychiatrists on a day-to-day basis.

So a real passion for supporting our psychiatrists.

Ananta Dave:

Yeah. Thank you Imran. And I'm really glad that you've joined psychiatry colleagues on this podcast. And having seen you in various places and platforms over the years, I know how much you have done, you know, around the work in the trust. So, you know, I'm sure this would not be possible without your input. So really, really delighted that you could join us as well. So thank you. 

So I'm going to start off with you, Gareth, and you've given us a glimpse into your long career in the trust. So really, if you could just expand on your journey in the trust and, you know, sort of in some more detail, but also with the point of view of retention and what are the things that you feel that you've done as an employer in terms of retention, what's worked and what has been innovative about your approach?

So if you could just give us a snapshot of that, please. 

Gareth Thomas:

Thank you. Yeah. Thanks, Ananta. And you know, for me and as an organisation, we've both been really invested in our workforce, particularly our medical workforce, over the past few years, and it's something I'm been really proud to have been able to lead on. And this is something that we've grown.

It's not been an instant fix, but we've certainly grown with it, you know, and it kind of aligns to our, you know, our vision and strategic priorities the work that we've done. You know, the vision here is to be the best. And we've got a really clear strategy in terms of our quadruple aim, and of course, medical workforce as part of an MDT model is really, really key to delivering our priorities, you know, to improve our patient care overall, and our patient outcomes.

I think what's been good is it's been a real deliberate approach to transform the medical workforce. It's not been reactive, but it's been strategic in what we've done. And I think we've reaped the benefits of that a few years down the line, we really started to see some really good outcomes, I guess key reflections for me, on some of this work, I guess, in preparation for the podcast is what we really wanted to do is create them conditions for doctors to be the best versions of themselves, to bring the whole self to work and for them to thrive.

And that's not just in terms of clinical excellence, of course. That's extremely important, but also recognising the wider work and the wider skills that our doctors at all levels have, whether this be medical leadership, whether this be in research, whether this be in, you know, supporting our clinical pathways or, you know, through medical education. And it's been really key that we actually tap into the huge resource that we've got, the talent amongst our medical pool and really develop them in a really individualised way.

But I think the key things to me that pulled out the golden thread through our work has been that doctors at all levels are leaders, we've you know, the golden thread through about equality, diversity and inclusion. For me, the growth of the workforce and what we've done has been embedded within medical education and continuous improvement in that space, but also taking the stance that everybody's in the developmental role and the learning and growing all the time, regardless of the type, the grade of doctor that you're in or the stage of training, or whether you're a SAS doctor, that that that doesn't really matter.

You continue to grow and learn individually and as a group as well. So we've put into place a few years ago a workforce transformation program, which really looked at two arms. One was to actually grow the medical workforce. And then secondly was to actually use that workforce as efficiently and as effectively as possible. And it's given us the opportunity - what started off as probably a ten-point plan back in 2022 - it's become kind of almost a 30-40 point plan, you know, as it stands today. 

And that continues to grow as well, as we take a more innovative approach towards this. 

So we started, you know, by even, you know, looking back at even, medical schools and the work we did with our medical students at that time.

So we've exponentially increased the number of medical students that join us across a number of different universities now, and, you know, have managed to maintain the quality of that training to really give students a really early flavour that psychiatry is a really excellent career. 

And even if psychiatry is not your chosen career, you'll be supporting and treating patients with mental health conditions.

Therefore, you need to be equipped to be able to do this, whether you're a surgeon or whether you're, you know, a rheumatologist or whatever that might be. 

And so we really want to give people a good experience. And we found that the quality of that training has really supported the retention to go into core training from foundation training for us, really.

So we did notice that we probably didn't have enough trainees, both in terms of numbers, but also those being allocated, as per our weighted population. 

And we did some really good work with NHS 萝莉视频 - Health Education 萝莉视频 at the time - to, you know, expand the numbers of core trainees, expand the numbers of higher trainees, which we did, and it's probably one of the biggest expansions, if not the biggest expansion in 萝莉视频, I think based on numbers for us, on taking the mandate that if we give people a good experience, they will stay with us and that that that's exactly what we did. 

So we've improved the quality of our medical education and training. At core trainee level, at higher trainee level, kept those vacancy rates to almost zero, worked really hard to try and get trainees, even in some of our more complex rural and coastal areas.

Give them a good experience and lo and behold, the trainees want to stay with us to become a consultant. You know, that really, really, really has worked for us. But it's not just about trainees for us. This is about all of our doctors. So we've been really keen to ensure that we've supported our SAS doctors in particular. 

You know, whether it's SAS by choice, whether it's SAS doctors who want to progress to become CESR, and that changes between those as well, you know, to support people in a very individualised way.

A lot of our SAS doctors are international medical graduates, and we wanted to make sure that they have had a really, really positive experience from initially from joining us all the way through to whichever future career journey they would like to take on. So it will be really, really key. And you mentioned Imran's role of Relationship Manager, that has been one of the key innovations around support of our international medical graduates.

Examples of that is through, you know, the MTI program that the College has, you know, been supportive of for many, many years. And we've been very fortunate to have a number of MTI doctors who have either gone into training or they have become SAS doctors with us and have stayed for many, many years. You know, we're really very fortunate. 

But then we've really focused on, how we then support our current consultants because it's a long career. The NHS delivering patient care is more complex than ever in very complex systems that are adapting all the time, particularly post-Covid. So we've been really keen to develop a medical mentorship program that every doctor can access a mentor, we have a program that tailors the mentor to the sort of needs that they have at the time.

So, for example, I mentor some folks that are interested in medical leadership, for example, other folk do it for different reasons. If there are women that want to get into leadership or they are international medical graduates. So we kind of pair people with inspiring mentors through our program. But then we've done a really good piece of work about improving the quality of appraisal, so we can really support our doctors to continually develop, and we have really good assurance around that.

And then Dush has been leading on some great work around job planning, because we really want to recognise through job planning. And it's not just about - not about just having a job plan. It's about having a job plan that reflects the complexities of what a psychiatrist does, what a psychiatrist can offer, aligns to the patient care that needs to be delivered, but also recognising the wellbeing element and also recognising that we need to support people in in an individualised way.

So I think we've started to see all of those come together now, and get some really good outcomes Ananta. And I think we're really, really lucky in the work that we've done.

Ananta Dave:

Thank you. And you've covered so many points. And I hope, you know, people will take some time to actually look at the various things you've mentioned.

I mean, what I've seen is that right from the beginning, right from medical school, firstly, you're focused on retention, actually getting people in, increasing and expanding core training places and, you know, giving them an experience even in their foundation training years or medical school years, which will make them interested in psychiatry. 

You've talked about, you know, I think what is a very important point is that regardless of whether you choose psychiatry as a career, it's really important to have that knowledge of psychiatry, the awareness and make sure that it is, you know, embedded in the medical practice that you will undertake in whatever specialty you go to. 

So right from there to the various things you've talked about, the work with NHS 萝莉视频, the mentorship program, the leadership development, the relationship manager. 

So there are quite a few things. And you mentioned that your work went from a ten-point plan to a 30- or 40-point plan.  So really, as you said, it's expanded. You also touched upon the fact that you are continuously growing and learning.

It's an improvement culture and it's a developmental approach. As a child psychiatrist, I can understand that. You start at the beginning and you have that developmental approach.  

But before I go on to Dush - and I'm really interested in your work on job planning Dush - but before I do that, Gareth, I mean, you've been there for a long time at various stages of your career.

Can you tell me what it is that you wish you had done differently, or something that you wish you had done earlier or not done - the lessons, maybe not even lessons, but insights that you've gained because things don't always work according to the plan that you have, isn't it, they invariably change. You have to adapt. 

So what, what if anything - and you can come back to it at the end, I'm going to call you back at the end to summarise. So if you would rather come back at the end for that, I'm happy with that as well. So, I can give you some time to think about your points. 

Just, one thing I know that the CESR program has now changed to portfolio. It used to be article 14 and then CESR. It's now portfolio. So the terminology changes. But the aim is the same about helping SAS doctors if they wish to, to become consultants by following a particular standardised route yeah? So thank you Gareth, I will come back to you at the end because I want to give the others a chance to talk as well. 

So Dush. So tell us a bit about your role. What do you do in your role and the work that you've undertaken over the years around retention?

Yeah, absolutely. I guess I'd like to start by just giving a personal view of retention and then perhaps a couple of key areas to get into around job planning, as you've mentioned, and then leadership developments as well. 

So as I mentioned, I'm a child psychiatrist and up until a couple of years ago, I was the clinical director of quite a high performing CAMHS in East Lancashire, it's where I'm sat now. And then we heard that our service was going to be transferred by the ICB into the Mental Health trust. So although I’ve worked in Lancashire for a long time, I’ve only been in the trust for just over a year. 

And as you can imagine, we had some trepidation really in terms of this, this transfer. And I wanted to speak to the points around culture that Gareth raised because I think in meeting with the chief executive at that stage and Gareth was in my role then, what was really clear was how open they were to the journey the trust was on, but also their commitment to establishing a culture of multi professional care, but where psychiatrists were really valued and supported as leaders, and I think that was key in terms of retention within our service. 

None of our 200 staff or ten consultants left during that process. And we've been able to kind of embrace the opportunities that that we have in LSCFT.

But it also really resonated with my values when this post became available. So it was like, ‘yeah I want to be part of that’ and see what I can support, in the deputy CMO role. And as you can imagine, this is quite a lot, but definitely can have a conversation about job planning if, and the work that we've done here with Imran and others, if that's useful.

Ananta Dave

Yes. Thank you Dush. I mean, if you could just touch upon it, you know, around job planning, maybe with Imran, yes? That would be helpful to know what it is that you've done. It's, it's quite a tricky thing, isn't it? Many trusts, many organisations struggle with effective job planning, although it might be done as a quick exercise.

So if you're able to share a few insights about how you think that helped. And, Imran, if you want to join in at this stage, it's interactive, so I don't have to stick to a particular order. 

So if you both want to take a few minutes to tell us about your job planning exercise, please. 

Dush Mahadevan:

Absolutely, well. I'll give a summary then I'm sure Imran can come in. So I think engagement is really good with our workforce. And for a number of years now, the trust has been very good in terms of getting job plans agreed and completed. 

And Imran and his team are key to that. So we have a job planning sprint, and a lot of energy goes into making sure that, the workforce and managers are sighted on the importance of getting to a mutually agreed plan.

And our activity splits when it comes to, direct care and supporting professional activities, are where we would want them to be. So they're in line with the 萝莉视频 standards, and where NHS 萝莉视频 might expect us to be as well. And we're pretty consistent across our, you know, we cover a really wide area as you know. And we've got good consistency across our geography. 

But for me, what we're moving into is really more meaningful job planning and thinking about how job planning can support doctors, in particular, in leading in the delivery of high quality care. So we've started to do system - systematic service level planning for the first time in the organisation. And there's been a really good buy in to that from medical managers, but also from operational leads as well.

And that's leading to some really interesting work that we're now starting in linking individual service level and trust objectives. And in fact, we're working with the developers of the e-job planning software to get that alignment on the systems, to really reinforce that. I think, as Gareth said, there is something about acknowledging the complexity of the work that our psychiatrists can do.

So I'm really interested in making sure that we empower leads at a service level who are close enough to patient care, and to the work of the doctors so they can determine what activities is befitting of consultant and SAS doctors and lead on getting to mutually agreed job plans in that space. We've done a lot of work with staff side colleagues, and we launched a new policy, just a couple of months ago as well.

And that, I think, really brings us into line, not just with the NHSE standards in the work that we're doing against those levels of attainment, but also with the BMA consultant charter.  

We're now doing some work with LNC colleagues to, try and formally recognise that our processes are in line with that charter. We await the, doable jobs guidance from the College with interest.

But I certainly think, that we are moving towards establishing doable jobs within our trust. I think there's something about keeping patients at the centre of this. And if we keep patients at the centre of it, then of course, we can be acknowledging the support that doctors need in terms of meeting those needs. And we can really get a good alignment, throughout the trust in this area.

So, you know, it's a work in progress, but I think we're already seeing that we're moving into a better space in the NHSE levels of attainment. And we're getting really good buy in from our workforce, which I think is critical. 

Ananta Dave:

Excellent. Before I go on to Imran, I just wanted to, I was going to ask Dush whether you've collected any feedback from your medical colleagues around the job planning process, and it might be too early on, but you're saying that you're getting good buy in so that's a good start, isn't it, that the engagement levels are good?

And also, just one more clarification question. When you say NHS 萝莉视频, is this the work led by Stella Vig that that you're talking about the job planning process, because one of the pieces of work I think she’s the…she was the, one of the national medical directors at NHS 萝莉视频 who was doing some work around job planning.

But you've already engaged with so many partners. I mean, you as you said, you ensured that BMA was on board, you know, LNCs of course, of course Imran's work, you work with NHS 萝莉视频, the College. So you've already looked at all the major policy leads and drivers for job planning. 

So good to hear that. So I've... while you think about whether there is anything further about feedback that you want to say, I'll come to Imran and just to say, now that I've got you, Imran, you know, we can shake up the order a bit. so maybe Grace, after Imran, I'll come to you just for you to talk about your insights and experience. 

So. But before that, Imran, please tell us about job planning. But also you can take this opportunity to then talk about your role as relationship manager, which is really a unique role as far as I understand. 

Imran Chati:

Thanks Ananta. I'll just chip in on job planning initially and follow on from Dush’s excellence of import. I guess it’s just to highlight that it's a journey that we're on at the moment and the engagement is improving year on year for our consultant and SAS workforce as we're going through this journey of job planning. What we think has helped is, is that listening exercise from our medical managers.

So service level planning was a new... was an introduction. We did a soft launch last year, and then took on board some of the feedback from our managers following the job planning around to understand what worked well, what didn't work well, what could be put in place for future job planning rounds that might be more supportive?

And then, that has helped us prepare for the coming job planning rounds for the next year really.

And some small things that can go a long way sometimes. For example, weekly drop-in sessions that Dush put in place where we'd have the deputy CMO there, HR representation and an Ops lead there as well. So any manager or any Ops lead can come into that drop-in session on a weekly basis, ask questions, get some guidance.

They might have had a service level meeting and then need further clarification about certain things that were discussed that they're just not sure about. So there's a bit of a multidisciplinary approach in providing support to our managers who are going through that job planning process. So yeah, it's a it's a journey we're on and hopefully, starts to deliver the outcomes we want in terms of patient care, but also that sort of NHS 萝莉视频, attainment levels that we want to get further up on. 

Ananta Dave:

I just wanted to say it's a really unique thing. I mean, (a) your role in it, but also the, the drop-in sessions and the listening exercise sounds like a very useful and important way of engaging colleagues, isn't it, in the job planning? 

Can I just ask Imran, before you go on to your role more generally? So do you sit within the Medical Directorate or HR, or are you a link between the two? 

Imran Chati: 

So officially I sit in the HR directorate, but I would quite happily say that I'm almost an honorary member of the medical directorate. 

We work extremely closely and the two directorates are very interlinked. So yeah, I probably, yeah, officially sit in the HR directorate, but yeah, I'm definitely very working more closely with our medical directorate colleagues.

Ananta Dave:

I think that link is very important, which is what you’ve highlighted. 

Imran Chati:

Yeah, exactly. And I think so the actual role that's been developed in our trust, the relationship manager role and the decision by our medical leaders at the time to have that sit within HR was quite an important decision actually, because HR will deal with a lot of the systems and process bits relating to doctors joining an organisation.

But actually, the real focus of creating a bond and a relationship with that, with that person who's joining the trust, can sit quite well with that process. And that was a real masterstroke in some ways, in providing an extra resource into the HR directorate to be able to offer that support to our doctors who are joining the trust.

And, and so the role was developed a few years ago essentially to bridge that gap between a doctor joining and going through a process of joining our trust. 

But actually not being able to navigate some of the more pastoral aspects of joining the trust, particularly our overseas doctors, we found, and a couple of examples early on highlighted to us that actually investing some time, energy and resource into providing that pastoral care and support for our doctors who are joining our organisation will make a huge difference in the long run.

And allow them to provide the care for our patients that they are wanting to do, and wanting to focus on. 

So I, it's essentially looking after the people who are looking after our public, and if we do that well enough, our, our medical leaders and our HR leaders kind of recognise that if we do that well enough, then then hopefully the doctors who join our trust, the psychiatrists who join the trust will be able to essentially flourish and thrive and be able to provide the care rather than be constantly worried and stressed and anxious about things that are maybe happening outside of their working life. 

So the remit of the relationship manager role predominantly was sort of, thinking outside the box of, of a doctor joining our trust and the support that they might need, and the non-conventional things that might... they, they might need support with that's not that's not necessarily thought about when, when we were thinking about a HR process of recruitment and onboarding.

People think it's a straightforward process, paperwork, documents, contracts, and then a person starts. But actually, there's a human behind all of that, and there's a whole host of things happening within that, within that human's life that actually will impact on how, they can focus on their work, really. 

So we took the approach of - before a doctor even joins our trust, from the moment they are interviewed and appointed - and especially if they're coming from overseas, making a real connection with them before they arrive into the UK. 

So having some informal contact with them, creating lines of communication, either through social media like WhatsApp, etc.. so we became really accessible, and that could be almost... so it has been on occasion 24-7 access.

So that can be in the evenings. It can be at weekends where they have someone they can reach out to, who they've got a question about, maybe about the visa process, maybe about what to bring over to the UK, maybe about family members. And they can get almost an immediate answer to that. And that thread runs through all the way through to their arrival into the UK.

So we kind of focus on what's going to be provided for them on their arrival accommodation-wise? What are the barriers that that might exist for that individual that we can help with, such as opening bank accounts, finding longer term accommodation? And that might include for someone who's new to the UK, you know, supporting them to go and see those houses go and line up those viewings and appointments that they have to kind of navigate. 

I think we can all agree that, you know, there's, there's probably two or three moments in your life where you're going to be really stressed or feeling vulnerable. You know, moving houses, moving jobs, these kind of experiences. And what we saw was that these colleagues were coming over and experiencing two or three of those things all at the same time, and actually probably sometimes at their most vulnerable that they can be really.

And so taking that human, compassionate approach of saying, we're here for you, you know, on an almost daily basis in those initial weeks, that's what that individual needs, has been extremely supportive, people have really found it helpful, and that that connection continues. It’s not just about supporting them to start up work and settle in the UK. it's about beyond that start date. 

We've become a team and it is a team effort. It's not just myself. There's a you know, that that culture sort of runs through the team of us being approachable for those individuals who have settled in the trust, but actually they come across some issues, some, some, some challenges that they need help with, either in work or in personal life.

They feel they can approach our team because they see us as that connection and that sort of informal, initial place to start with when they've got an issue and more often than not, that that helps them, it troubleshoots their issues. 

So that's the kind of approach we've taken. And I have to really take a moment to commend the trust in this as well, really, because it was recognising that this was a space we needed to get into.

And, and the leadership team, you know, made that commitment, to say no, we we want to commit to this. We want to put some time and energy in this. Because actually by doing that, it's going to provide significant results for those doctors who join our trust and help them thrive in the workplace, essentially. And that's what we see.

We get that feedback constantly. And there's reputational consequences. People share that with other colleagues outside of the trust and people, people are therefore then attracted to the trust. But you know, that that's, that's benefits of taking care of your people, essentially. 

Gareth Thomas:

I guess about that, but I think it's been a really key role for us and the work that you do Imran and the work that you your team do is absolutely essential. 

You know, like, you say, sometimes you can look at these things from sort of policy or process perspective, but there's a huge relational component into what we do. You know, healthcare is relational. You know, working with our colleagues is very relational as well. I think you really, you know, took on that role and you have probably undersold yourself as a person within that role as well. 

I know you've helped people set up bank accounts previously when they've lost their key, you know, how do you get you key sorted sort and things, things that you just don't know when you move to a different country and you've been amazing in that space and we're really, really lucky.

And I think when I go out to talk to our doctors, go out and about and I talk to them all the time, those that have had really good experiences in that space remember it as well. This is really important stuff for people like you say, when when folk are moving to the UK to join us, you know moving with family or without family.

It's a new country, new culture, new language, new way of doing things. It's really stressful and you can tell the work that you do helps to reduce that stress. And people remember that. I think it's a significant part of retention is when you actually treat your colleagues really well. And a lot of this is around treating colleagues well.

Dush Mahadevan:

But I think it also enriches our strategic developments. It's a directorate. You know, we talk a lot about multi-disciplinary approaches, but actually having, you know, a slightly different or external perspective Imran from, from you and your team in terms of direction that we might be taking. And of course, you've got your own external networks with chief people offices in the region and nationally, and actually integrating that with our thinking and getting that type of sense check, I think, is really it's really helpful because, you know the history of the organisation and the medical workforce in the organisation it's almost functioning as a kind of a sounding board for us as a directorate.

Imran Chati:

Definitely. And I think we're expanding all the time. So I think we've evolved as a relationship team now. So it's not…although we support our IMGs predominantly, but actually it's about our resident doctors who are rotating into the trust as well. Consultant and SAS workforce, who may not necessarily be IMGs, but actually they're moving from a different part of the UK into Lancashire. And some of those challenges are still there. 

So it's allowed us that space and time and resource in the team to kind of dedicate our efforts to, to supporting colleagues at that, that beginning of the journey with LSCFT really.

Oli Sparasci:

I'd add, that from the perspective of somebody who, you know, was an ST for a period of time in the organisation and then has transitioned into a consultant role and, and has now taken on some leadership roles within the organisation, the support from Imran and, and the team and your team has been one of the most powerful things about joining the organisation.

I'd say even from the very first day of being an ST, it was clear that there was, somebody in a senior position from a HR perspective who really was there to support medics. 

And, and I think that that is a really fantastic thing to have as an organisation. And it really made me feel very valued from the very beginning that I knew this, this organisation is investing in its medical workforce. And that was really clear. 

And then throughout my time as an ST, there were opportunities to link in with you in the team. And again, as an ST, I think sometimes you can feel, a bit detached from some of the, the processes that happen in an organisation that are beyond kind of the core training elements, from a clinical perspective.

But that really wasn't the case here. And being able to link in with you and also to link in at the time with, the chief medical officer, was a really great opportunity. And that was always proactive support. And I think that's one thing that's been really clear is that it's not - it's not about doctors necessarily always having to approach to ask for help.

But actually Imran, and obviously Gareth and your, your team of senior medical leaders being really proactive in reaching out. 

Ananta Dave:

So Oli I don't want you to repeat yourself, but I think you were talking about your experience right from, is it student and training and now a consultant role?

Oli Sparasci:

Yes and not actually a student. I trained down in the southeast of 萝莉视频. But yeah, as a, as a trainee, as a higher trainee particularly and now in a consultant role in the organisation.

And I was just explaining that I was I've been really fortunate to feel the support from the medical, and obviously from Imran in the medical HR side from that relationship manager perspective. 

So, so just to kind of continue my experience when I was a trainee was that alongside proactive support from senior medical managers there was also, a really clear link in terms of a consultant called Dr Claire Oakley, who at that time was leading on ST issues within the organisation.

And Claire was really great at being that point of contact. So that, you know, you could ask any questions that you had. And she was very proactive, in arranging meetings to, to meet up and to be able to discuss, you know, how are things going in the placement? What are good things, what things could be improved, but also to really think from the from the beginning, really, what, what are the what are the steps that we as an organisation can take and that you as a trainee can take to, to make Lancashire and South Cumbria a trust that you want to work for as a consultant and that was really, really great and very helpful. 

I think another thing that was brilliant as a trainee was that, the organisation I think Gareth was, was mentioning this earlier, really encourages doctors at all levels to engage in medical leadership, wherever possible. And that was something that really shone through as an ST. 

I was able to join some committees, I was able to take on a role as, a medical education fellow, which was an internal role, and run an educational project.

I was also able to even something as, as important as investigating an incident. I was able to get involved in that. And, and they were really useful experiences as a trainee, that I think the organisation is very proactive about supporting.

Alongside those, I was also fortunate to be able to have discussions with the AMD at the time, and also the network medical director, because our organisation is, is broken up or divided into networks that are geographically based and I was able to speak to a network medical director about what opportunities there may be, as, as a potential consultant applicant.

And it was great to be able to have those discussions as a trainee and to start to lay the groundwork for potential roles. I think that's particularly important for me because I, I wear many hats, and one of those is a research hat. And I'm at the University of Manchester doing a PhD. So I really wanted to be able to continue that.

I started that as a trainee, and I wanted to make sure I could continue that as a, as a consultant. And, and the organisation were really proactive and flexible, I had some really helpful conversations with Imran, and also with as I say, our network medical director in the east of Lancashire and was able to, to, to kind of work out a job that would suit me, would also obviously suit the organisation and be good for our patients primarily.

And having that flexibility from day one, I think was really powerful in terms of, well, recruitment, but also now through to kind of a retention piece. 

I feel that the organisation's really supported me through that and, and understands that there is necessarily some flexibility needed. And, and, and that's really offered by the organisation. If there are certain events that need to be attended, then the organisation are really great in giving me the time to do those things and vice versa, that flexibility to make sure that the clinical need is met, even on, even on days that may be otherwise for research duty.

So it's been, it's been really helpful. And a really, really great opportunity. 

Ananta Dave:

Yeah. Thank you. Oli, I wanted to ask you, because you've, moved from training to a consultant post in the same trust. What is it that's helped you in the transition? Because that can be a tricky transition for all of us. It's that phase when you finish training and you're about to step into consultant roles, and Grace is in that situation, so what do you think has helped within the organisation to make that transition from training to consultant? 

Oli Sparasci:

Yeah, certainly. Yeah. I mean, I think that's a really interesting point. So one of the things that was really helpful was having contact with Imran, and his team from a very early stage, so that it really felt that all of the - the practicalities, the contractual elements, the, you know, how do I actually make sure this is a job that will work for me in the organisation?

There was no stress involved in that. So I hear from colleagues that even those aspects of starting as a consultant can be really challenging. That wasn't a problem for me at all. There was no worry about that side. I had a contract long before I started. I know that there are people who have never seen an NHS contract.

So, so that's really great. And it really helped to mean that I could focus on the clinical side of things and not worry about the practicalities. 

Alongside that, I was offered the opportunity to act up, and I was offered the opportunity to act into the role that I was taking on as a consultant. And I was able to act up and then move directly into the consultant role.

So I acted up in June-July and then started the consultant role in the August. And that was really helpful. It meant that I could properly get to know the team who I had worked with, to an extent as a trainee. But it allowed me the opportunity to, to get to know them and for them to get to know me as a consultant.

And that was really helpful. And I'd, you know, encourage organisations to, to offer that opportunity wherever possible, because it was great. 

And then as a new consultant, the organisation has a new consultants peer group. So that's not your CPD peer group. But this is a group of new consultants, generally speaking, within a couple of years of CCT or getting CESR, who are, who are keen to meet up on a fairly regular basis - at least every couple of months or so - and occasionally in person, but also on Teams to get that flexibility.

And we meet up and we have presentations from more experienced psychiatrists or members of staff within the organisation. So, for instance, Dush's been to speak to us about his journey as a medical leader, we have a session coming up in a few weeks time, an in-person session where we're going to have some presentations about life as a consultant, basically.

And that's been really helpful. It's been a great opportunity to link in with peers, and, and discuss those challenges. The everyday things about becoming a consultant. I think the other thing is that as somebody who is keen on kind of pursuing, or developing my career, the organisation was really open to the idea of me taking on some leadership roles at a really early stage in my career.

And, one of the conversations that I had with Gareth at the very beginning of taking on those leadership roles was that the organisation sees that as being, obviously a core part of running the trust, but also as being a developmental opportunity. 

And to know that the very most senior doctor in the organisation was telling me that these were, at least in some way, a developmental opportunity, was really reassuring and gave me the confidence to be able to ask questions. Whether that's asking questions directly to Gareth, Imran or Dush or to other medical leaders in the organisation, and not feel that that was a problem, to really feel that these people want me to develop, they want me to become a better psychiatrist and also a better medical leader. And that's really refreshing. It's been such a great culture within the trust.

So, so I think overall there's been so many things that have really helped that transition. 

And, and I just also have to say a shout out to my consultant colleagues in the East Lancashire Older Adult Service. We have a really great group of consultants, and they've really helped me to embed into the service and to really support me in that growth.

And I can't underestimate how valuable that is, having good colleagues. And we're really lucky in LSCFT that we have lots and lots of great colleagues all around the organisation.

Ananta Dave:

Thank you, Oli. I mean, I think there are so many points there for new consultants or those who are about to become consultants to pick up. 

And one, one of the things that I liked, apart from all the other things that you said, is you had an opportunity to be part of an investigation, an incident investigation, serious incident. And it is those kind of opportunities or experiences that are helpful, isn't it, for stepping up into the consultant role? 

So a fascinating journey and thanks for your insights. Before I move on to Grace, which is actually a good way of looking at the experiences of someone who is an ST6 trainee. And then, you know, after listening to what you've said, Oli, I just want to give a further shout out to the work of Imran.

So, Imran, not only have you helped in your relationship manager role across the whole of the, you know, the retention experience, but you've done a particular amount of work - a huge amount of work around supporting international medical graduates. So I know the amount of work the trust has done. I know that, you know, I've, known the work of colleagues like Doctor Rajagopal in your trust, who's done a lot of work along with you.

So a shout out to the work you've done as a trust around international medical graduates and how you've supported them. And again, I think that's that's an important part of your role. 

Before I come to you, Grace, this is also an opportunity for me to talk about the various things that the College offers. The latest one is, as you know, the retention charter that was published a few months ago, and the links are now on the website. 

Now, as part of this podcast series, we have a Thrive in Psychiatry website link on the 萝莉视频 website page, which is all to do about retention and how you can thrive in your chosen profession. 

And there, there are links to resources, blogs written by people about their various experiences, what has helped retention? What have been the challenges and barriers? But there is a link to the retention charter, which has got four domains, as people will know. But the thing that I wanted to ask you all as a trust is to do that self-assessment exercise.

Now we are about to release a set of - a set of tools or guidance which will help you in the self-assessment exercise. But the charter is meant to be a quality improvement tool collaboratively between the College and, in your case, you the trust. 

So please have a look at the self-assessment exercise and the charter I think you will be able to use, you know, the stories that you've told me today to map across the various domains, and it can be used as an improvement exercise and also something that you can share more generally with, with colleagues in the profession apart from the podcast.

So do have a link. And I think from what I remember, Peter, there is also a feedback form on the website that Thrive in Psychiatry - there is a feedback form where you can give your feedback about the things that we've done so far, your suggestions, comments, etc. - so please do visit the website and the Thrive in Psychiatry link.

Right, now I'm really keen to hear from you, Grace as a trainee, as a resident doctor, but also after having listened to your colleagues in the trust, really keen to give you some time to talk about your experiences, your insights, and take your time and just tell us a bit about how it's been like in the trust. Thank you very much.

Gareth Thomas:

It's been really interesting listening to everybody speak this morning, and I think I don't want to sound like I'm repeating what everybody has said, but I suppose the thing that's really kind of been the thread through everyone's accounts so far has been about the culture within the trust and particularly resonating with what Imran said about the compassionate way in which everybody in the trust works, the relational way in which everybody works.

And that kind of feeds into how everybody, from my experiences as a trainee, right from foundation medicine up until now, has been that even the most senior of leaders are approachable and you're never going to be met with a closed door. There's always going to be somebody who will be able to listen to you, to hear, to hear what you're saying and to work with you really.

And I think for me, when I was sort of preparing, preparing to speak today,  I was reflecting on my own, my own journey as a doctor. And all but one year of that has, has been, has been in LSCFT. And I think it really speaks to how much value the trust places on both your personal and your professional growth as a doctor and as a person I suppose, and, and how you really feel valued as an individual, how there are so many - for me, especially throughout my core training and my specialty training, there's been so many unique opportunities that have been afforded to myself and my colleagues in terms of professional development.

And I think Oli very briefly mentioned the, the forum that is held on a bi monthly basis for STs across all specialties, and we call it the ST forum. It's chaired by our Deputy Director of Medical Education, and it's really a space for trainees to get together, to network, to troubleshoot any problems that they might be having in their current place of work or in their on-call shifts.

And it's a place where we also have CPD sessions from sort of consultants, and those CPD sessions are voted for by, by the ST cohort. So it's, you know, we're, we're receiving that that education, that information that we have asked for as a, as a group. And then there's also a Ballint style group where we can come together and reflect on any difficult encounters that we've had in, in our jobs or in our clinical practice.

So I think that's a really - it's been for me, a really useful opportunity to network with my colleagues and some of these are colleagues that are now senior trainees that I did my core training with or I knew when I was a foundation doctor. And again, I think that reflects how well the trust is doing at retaining their doctors and making them feel part of the community and making them want to stay, to stay in that community really.

Another opportunity that I've been fortunate to have this year is to do the Leadership and Management Fellowship. So where Oli did the medical education fellowship, I'm doing one that the trust offers in Leadership and Management, and it sort of mirrors, in a way, one of the fellowships that the Royal College offers to specialty trainees where I'm able to shadow senior leaders in their work and to really understand what goes on, kind of at the higher up level and behind the scenes, outside of direct clinical practice.

And to get that experience in - I know I'm quite senior in my training, but still quite junior in my career - it's I think it's been invaluable for me to be able to sit in those meetings, sort of board meetings or with the children in young people's transformation team meetings just to get a real flavour for leadership, which is something that up until sort of ST5-ST6 is something that I've kind of shied away from as a trainee.

So I think that's been a really interesting opportunity. And, you know, just starting out with the quality improvement work and working with Dush in terms of just looking at ideas for projects, but it has been a really interesting opportunity. And I think just leading back on to what Oli mentioned about the support that you receive as a senior trainee, looking towards becoming a consultant in the trust, I can echo that that's the support that I've received as well.

I've been able to have meetings with multiple members of the workforce team, senior leadership teams, just to talk about what opportunities might be out there for me as a consultant. And I think to be able to have those meetings again, just makes you feel really valued on an individual basis - and then sort of from, from another angle the trust has a really good preparation for the consultant interview program that's run once a year. 

Trainees from other trusts are invited to attend it as well. And it's a sort of a short half a day session where there's multiple presentations about what to expect in a consultant interview, how to prepare, what you know, what to do beforehand, what questions might be asked.

And I think what again really speaks to the trust retention rate is that most of the consultants that are presenting these presentations or sessions are names that I knew when I was a trainee that were doing their specialty training within the trust. 

So they've got another workshop coming up in January and then senior trainees that are kind of looking towards CCT-ing in the next few months can also apply for a mock consultant interview.

So I think it just, it just really highlights how much work that the trust put into you as a trainee, how they really, really, really try to help you with your personal and professional growth, want you to do well and want you to stay, to stay in Lancashire. You know, they invested this time and resource into you and they, they want to keep you.

And certainly perhaps I'm the poster child of how that's worked, having done my core training, my specialty training and wanting to be a consultant working in the trust. But again, I'm not the only one. There are multiple names that I see in meetings or local academic programs that have, have been around since I was a foundation medics. It's really, I think it's just really nice and refreshing to see.

Ananta Dave:

You know, thank you, Grace. And I think that endorsement from, you know, people like you who are in training, new consultants, more senior consultants and, you know, colleagues like Imran, that the endorsement across various stages of your careers is actually, you know, quite powerful, isn't it, in terms of the effectiveness that, of the work that the trust is doing around retention?

So really useful. So, Grace, I don't know whether you are involved in any College forums for trainees, the Psychiatric Resident Doctors Committee, or indeed any other forum but part of the exercise today is apart from listening to trusts and organisations like yourselves, about the good work that you do, is also about the collaboration between the provider organisations and the College and how is it that we can work more collaboratively together, but also to see from yourselves whether there are any things that you feel the College could do more of, could do differently, or could collaborate more?

So, I mean, this is not just for you, Grace, it's for any of you actually, if you want to add any points about what the college could do in terms of retention to, you know, aid and to sort of build on the work that you all are doing. So, please share any insights if you all want to in this podcast recording, but also if not to give your feedback on the website.

And Grace, I think your account of what helps not only in training, but as a new, about to become a new consultant, I think will be very helpful to all resident doctors listening in, and anyone who is actually in the early stages of their consultant career listening in. 

And indeed, what I was thinking when I was listening to all of you is, I mean, there are so many people out there listening who hopefully will take heart from the fact that (a) there are organisations which have this very clear strategic vision and aim for supporting retention, but also, I'm sure we'll then hear from other organisations which are hopefully doing, you know, similar good work and you all can come together. 

So on that note, I just want to say at the College, as part of our work around retention, we will be setting up for the next six-seven months at least while I'm still in post as the presidential lead, we are going to be setting up a retention tracker forum where people, organisations and all devolved nations you know who are doing good work around retention can come together, share their experiences, but also engage with the retention charter, assess themselves and see where they are at.

So please do look out for these initiatives by the College and also share anything that you feel the College can do. Now I, I mean I apart from going to Gareth for a general summing up and maybe reflections on, you know, any learning or insights, etc., I don't have any more questions, but if there are any last comments that people want to make, please feel free.

Otherwise I'm going to go to Gareth. 

Gareth Thomas:

I guess to say, I'm really proud when I hear colleagues talk, you know, all different stages around the experiences they've had, I'm really proud of that because when we started to think about this and I started to think about this probably in about 2018, 2019 time when I was director of medical education, it feels that the time taken to develop, you know, our doctors is starting to bear fruit now.

And that's fantastic. This thing does take time in a, in a in a world, in the NHS where everything is quite reactive and within year it shows the importance of developing a longer term vision and a strategy. And regardless of who's in the different roles, it continues as a culture. I mean, it's not it's not easy. We've seeing really good outcomes, but it's not easy with the financial pressures we've got, the clinical operational pressures with sort of coastal and rural areas, it's really difficult for trainees to get to, and really difficult for consultants to move to, but the opportunities are there. At the same time, you know, we, we are working through that. Quite excited for for the next stage actually. 

I just feel like it's been in place some time but really excited by the future for us to be honest. 

Ananta Dave:

Yeah, no thank you. So you know, there are two points that I wanted to make that you touched upon. One is you've all said about the high retention rates or the good retention rates. Now, I'm not sure we've reached a stage yet of calculating or measuring retention rates very accurately or effectively, but it would be good to know what it is in your organisation compared to others.

I mean, I, I know that this is not a sophisticated science yet, but just some indications would be really good to hear about that because I think your work will be bearing fruit. 

And the other thing that you've said, Gareth, is about linking this good retention rate to good patient outcomes, good quality of care. And I'm sure you know, you'll be able to make the link between those departments or services which have good retention and continuity of care and how that translates to good outcomes.

And I think ultimately to, you know, staff wellbeing as well, because a big part of the moral injury and stress and burnout is about not being able to do the right thing by patients or not being able to do what we want to do or what we know is right. So it would be fascinating to hear more about that, Gareth.

Any, any points about what, you know, looking back, hindsight, 20-20, is there anything you would have wanted to do earlier or done differently? 

Gareth Thomas:

Yeah, I mean I think we started – the, the workforce transformation is actually grounded in the medical education plan that we came up with about 2018, 2019 time. I kind of wish we would have looked at the workforce strategy at the same time, because I think - I'm excited now when you see the numbers of substantive consultants that were recruited, and it's grounded in all the work that we've done so far, how medics are valued in this organisation. I kind of wish we had set the strategic vision on this, perhaps around that same sort of time. So we'd be probably three, four more years down the line.

Because I can kind of see where we'll be at in three or four years if we carry on as we are, you know, we'll continue to, you know, year-on-year improve our consultant psychiatrists, you know, recruitment, you know, retention will stay really, really good. We'll, you know, attain - we've attained teaching status, but we'll have university status, you know, have really much more sophisticated job planning.

You know, appraisal will continue to grow, you know, developing all of our doctors at all different stages and of course that culminates in improved patient outcomes, which ultimately we – that’s, that's the business that we're in, you know, and I kind of wish we were a few years down the line, I also appreciate I'm quite impatient.

So I really want this to be those couple of years down the line as well for me as well. But anything we can do to work with the College, to support the College on how we collect data, how we use data is really important. I guess one of my biggest take homes, though, is how I mentioned at the beginning about the strategic angle of it, and that board oversight.

I think that's been really key for us overall. You know, having the strategy and showing, you know, we're the measure of accountability in this space as well. The resource allocation, despite challenging times has been really, really key. And our board reporting has been really key to make sure our medical workforce as part of our MDT is front and centre in everybody's thinking.

And I do think there's a responsibility for folk in my role and Dush's role and equivalent roles to be ensuring that this is at board level. So I do think there is, there is power in that, really. Overall, I'm just really proud of what we're doing. But we you can like I said before, it feels like you’re spinning plates.

You can never take your foot off this. This is really important stuff. And, you know, you must absolutely continue. It must be - it has to be grounded in values around leadership, around equality, diversity and inclusion. Treating everybody as an individual and then having the patient at the heart of all of that is really, really key for me. 

Ananta Dave:

Thank you. I mean, it's been a fascinating time listening to all of you talking about the work in the trust and that coordination and alignment between what you all have said and some common threads emerging, but that, I think that run through right from what happens at frontline operational level to the ownership and accountability at board, having that strategic vision and looking at it not only as a part of medical education, but workforce patient outcomes.

So fascinating. I mean, there are so many take home messages in this. Thank you all. It's been very insightful and, a very interesting hour. I think the conversation could have continued, but I'm going to end it now. So firstly, a huge thank you to all of you, and please do visit the website. Secondly, to everyone who will be seeing the podcast and listening to it in the future.

Please do leave your feedback, engage with it and let us know what else we can do in the future, what kind of topics we should be covering and leave us your general feedback about the Thrive in Psychiatry campaign. Thank you all very much.