Dr Karen Kirkham was recently appointed as national clinical advisor for primary care.
With 30 years of experience in the NHS, she also holds multiple other roles, including GP in a Dorset practice, clinical lead for maternity, family and reproductive services for Dorset CCG, and clinical lead for Dorset ICS.
Lea Legraien talks to her about her new role and challenges.
Q What changes are you hoping to make through your new role?
A My starting [point] will be to concentrate on why we need to change.
We know that more people are living longer today. The number of over-75s will increase by more than two million in 10 years’ time.
Along with that, there is a rise in long-term conditions, a burden we need to tackle.
Workforce and financial challenges mean we need to find a different way of working. What I’m hoping to bring to the role is a view on how we can start to join up services in a different way and bring together organisations that have been quite siloed for the last 20 years.
The whole integration agenda is reliant on people working across boundaries that haven’t conventionally merged – [such as] between health and social care – that’s a brand new relationship. [It’s about] joining together primary and secondary care.
I’m trying to think about how we can harness and spread creative and innovative ideas from different parts of the country.
Q What measures are you planning to put into place?
A There are a number of areas we can start to measure. Some of them are undoubtedly about [whether] we shall start to deliver care in a different way that helps prevent admissions to hospital [in cases where you don’t necessarily have to go in].
If you [want to solve] the gap in out-of-hospital care you’ve got to join up primary and community care around a range of conditions and start to put in pro-active management well before people’s [health] deteriorate.
We know that in areas where they’ve started to do things differently [there has been] a [reduction in] the number of emergency admissions.
We can improve outcomes by delivering care in a different way; bringing together primary and secondary care and the voluntary services, [and thinking about] health management and the prevention agenda.
[These changes] mean patients can help take care of themselves in a way that’s less medicalised and that we make the very best use of all the different skills available to get better outcomes. We will create a different form of primary care that will improve resilience in stretched services.
The fourth aim we have [after] care, quality and finances is bringing the joy of work back into the workplace and help clinicians start thinking about a new way to come together to deliver care [and] make their jobs better.
The integrated hubs that bring together health and care professionals in multi-disciplinary teams provide good examples of a different way of working, recognising each other’s skills [and] providing a holistic team approach to care.
There are many examples around the country where this is improving the working lives of staff. This is also seen in new GP teams made up of a more diverse workforce, with GPs working alongside nurses, nurse practitioners, physiotherapists, pharmacists and paramedics.
I’m working with a number of areas across the country and I’ve started to have conversations with the teams on the ground.
This is about me coming in and sharing some of the good work that is happening elsewhere, helping them create their own solutions.
It’s a bottom-up approach, which is really important because [that way] clinicians own change themselves. They are more likely to succeed because they’re invested in their local populations and know their needs.
Q How can we improve maternity services?
A Dorset is working with the national team on developing and improving maternity services.
Dorset has taken part in the national programme [the Maternity Transformation Programme] to improve maternity services and has co-designed a new postnatal and a digital care plan with patients.
[The area] is undertaking a transformation of the local maternity system to improve care and safety in childbirth.
We are looking at what we can improve and working with clinicians but also with the public and patients to help develop a clear maternity system that works across everything from antenatal to postnatal care.
We’re starting to see some innovations come through as result of working with the stakeholders as they have a really clear view on continuity of care and how they want services to change.
Stakeholders – including Maternity Voices, a very active group of local mothers – worked with maternity services to co-design the improved services. They were at the heart of the change.
Q What advice would you give women who want to be leaders in the NHS?
A Getting a leadership position should be based on merit. We need all types of skills in the NHS and that comes down to men and women working together in the leadership team.
[But] we need to see more women in those senior positions. I’d say to anybody who’s coming through and who has experience and knowledge to believe in themselves, take opportunities and make a difference.
Have a really [strong] foundation [and] that authenticity that comes with knowing and leading your services, [that’s] really important.
Q What is the biggest career challenge you have faced?
A Having a family and a career and juggling the volume of work that comes through, particularly when I [take on] different roles. I think having a very clear vision is really important.
Q What are you most proud of in your career?
A I’m really proud of how I’ve worked within my local area, delivering care to patients from cradle to grave, and what I’ve achieved clinically.
I’m very proud of being part of a great team in Dorset because nothing happens without an amazing team behind you.
I’m also very proud to be part of this national team, working with some amazing people who are trying to move the NHS onto the next phase and create something that is better than what we have now.
Q What challenges did you face when Dorset STP became an ICS?
A We’ve probably had the benefit of having more time than others.
In Dorset, we started working on this case for change about four years ago and underwent a clinical services review, which I led with the team.
I think [one of the most] significant challenges was building the relationship between organisations, which has been fundamental to the move to an ICS.
The second challenge was always going to be around workforce. We don’t benefit from [being] a big city where you’ve got lots of people coming in and out, we have to work together to make the whole workforce sustainable.
The third [challenge] has been around finances, to make sure we’re all singing from the same hymn sheet.
