GP and former chief medical director at Bedfordshire, Luton and Milton Keynes (BLMK) ICB, Dr Sarah Whiteman, speaks to senior reporter Beth Gault about her 30 years of service in primary care
Beth Gault (BG): What first inspired you to become a GP?
Dr Sarah Whiteman (SW): I would describe myself as a polymath – I’ve always been someone who likes breadth rather than depth.
I’ve been a practising GP since 1993. I was sponsored while at medical school by the Royal Air Force and then did a short six-year service commission. The vocational training scheme was good, you got stationed on some air force bases working as a GP on the unit and then did 18 months of hospital posts, six months on each. So, you got exposure to different things, with the emphasis being on the base and on family medicine, which I really liked. Afterwards, I joined a practice in Leighton Buzzard where I became partner.
BG: Since that time, you’ve held numerous leadership roles including most recently chief medical officer at BLMK ICB, and prior to that, medical director and clinical chair at BLMK CCG and medical director for NHS England Hertfordshire and South Midlands area team. Was it always your plan to progress to leadership roles?
SW: Not at all, being in the air force if you’re a doctor, you’re automatically an officer. Then you get promoted promptly so I was then a senior officer and I made squad leader by the time I left. You have to assume additional military type responsibilities in addition to medical. But I didn’t have any ambition to be a leader. I thought when I started general practice I might one day be senior partner, and I liked being a partner and the business side of the practice, but it wasn’t a conscious thing.
BG: You left the role of ICB chief medical officer at the end of April – why did you take that decision?
SW: I was 61 earlier this year and the time was right. For me, becoming the ICB chief medical officer was the absolute pinnacle of my career – I was so proud to get the job and to have been doing it. But my partner and I became grandmothers for the first time on Christmas Day and I want to be able to give my family and myself the time that I feel I need now.
BG: Why was that the pinnacle of your career?
SW: The quality of the competition, but also the role itself – it was a system wide role whereas previously I’d worked for organisations, whether they be regulators or providers or commissioners. I really believe in the integration of health and social care – primary, community, mental and secondary care – that whole spectrum. And it was a role that provides the opportunity to work together more effectively and hopefully more efficiently for the benefit of patients.
BG: There’s been a lot of changes in the structure of the NHS over the past 30 years, have you seen the value in all that change?
SW: None of us really saw CCGs coming, but we made it work. I don’t necessarily think they were a good use of resources, taking all those clinicians out to do managerial stuff, and it was a big challenge when we didn’t have a plan to replace those clinicians in the early days.
But I think now, it would be good to have a period of stability – that’s not without change – but change with a logical progression to it. So, Claire Fuller’s report talking about integrating neighbourhoods is a natural building on PCNs and integration generally, and I think we need more of that picture thinking, so people know what the outcomes are supposed to be.
BG: If you were to do it again, what would you change about the way systems have progressed?
SW: The big change for me would be recognising the importance of other professions. Working in primary care, it would be helpful if there was better integration with nurses, paramedics, and all the things we know now. I would have done that sooner.
I think continuity of care is something we’ve lost a bit as we’ve gone on and that patients really appreciate. It can deliver care that gives assurance, but it takes being organised.
BG: Do you think the establishment of ICBs has or will have a positive impact on the system?
SW: Yes, I do. Mainly around the work of local authorities and the wider determinants of health. Acknowledging and working with public health and using population health data to understand what residents need and therefore plan services.
Obviously, we’re at an early stage of delivering that, but the fact that we’re having those conversations and people are on the same page and you’re tailoring place level to make it more bespoke – that’s going quite well.
Working with local authorities is the mandate ICBs have that CCGs didn’t and so that’s why they are a good next step on from CCGs.
BG: Do you think PCNs were a good change?
SW: I do – I believe in the concept of economies of scale, and I’ve always thought that a shared problem is a problem halved. The ability to work together with other practices for common, shared health goals that have been identified empirically by using evidence and population health statistics is really useful.
BG: What needs to change now?
SW: There are some areas, particularly where there’s high deprivation, with recruitment and retention challenges, like Great Yarmouth, where the current model of general practice as an independent business is no longer viable.
While they have offered very high standards of care to patients in the past, that future needs to include different models of provision and that probably looks like GPs and trusts working together in ways that are yet to be clarified.
BG: If you were to predict the future, what will primary care look like in the next few years?
SW: I think some difficult decisions will have to be made and part of that will include the model of general practice. It’s a great value service, but the workforce issues we’ve seen will likely drive a model of change.
I suspect it will be a largely salaried service, with more people working at the top of their licences, patients having more seamless care, but with some of the services we provide on the NHS now not being offered.
