Dr Jude Marshall; Reflections from a GP

Kate: My name's Kate Arrow. I'm here for our second series of Why apply? Reflections on the Scottish quality and safety fellowship. And I'm delighted to welcome Dr Jude Marshall. So, Jude, what cohort were you of the fellowship?

Jude: I was cohort twelve. So we've not quite finished yet. We finished in September 24.

Kate: Nice. And tell us a wee bit about yourself.

Jude: So, I am from Glasgow, I work as a GP in a practice in Glasgow, and I am also clinical lead for realistic medicine and I've gone on to do jobs as a clinical director as well in one of our HSCPs since the fellowship, I'm a mum, I've got three boys who are young, twelve, nine and seven, and two mad cats, and that's about me.

Kate: How are your cats getting on with each other?

Jude: Not very well. Yeah, not very well. They're at different ends of the house as we speak, having fought with each other for half an hour, as they do every morning in the midst of the school run. So it's great fun, yeah.

Kate: In the background of your teams calls and what brought you to the fellowship?

Jude: So I have to say that I had been aware of the fellowship for a number of years and had never really felt it was the right time for me. I think with my kids being a little bit younger and then with COVID it didn't feel like it was the right time to step away from the things that I was working on to do the scottish quality and safety fellowship or to apply for it. And then I think every year I saw it and I think it was like that cumulative effect. And when I did apply, I just thought, I think this is the right time for me. Things seem to be aligning for me in my work life and also things kids were at school and so it was getting a little bit easier at home. So I thought this might be for me. And to fuel that in myself, I looked at the website and saw some of the names of people who had done it before and started to contact lots of different people who'd done the fellowship. And they're all so giving of their time that they spent time with me on teams calls, just talking about what their experience had been, the benefits for them, how things had changed. And it really just cemented in my brain that this was for me. With every conversation and every team's call, I just became more and more convinced and actually uncovered lots of other people who'd done the fellowship. Through those conversations, people who were leading on things within our board, I was able to then contact them and speak to them. And everybody was very generous, and the things that they said to me just made me even more sure that this was for me.

Kate: Yeah. Cool. So, for people who don't know a lot about the fellowship, can you just summarize the structure of what was.

Jude: Yeah. So. Well, the application process is quite straightforward. You have to do your application form. It usually needs to be in for mid to end of March, depending on where your board is and how your board processes those applications. Then it gets sent into the scottish quality and safety fellowship for them to look at. And if you're successful, you'll be given an interview, which is, I think it was about between half an hour and 45 minutes. Mine was around the end of June. And this is just an opportunity for the people who are hosting the fellowship and some other people who've worked, done the fellowship to ask you some questions about yourself and hear about your journey and just to make sure that you're ready to do the fellowship, I guess. And if you're successful, then the fellowship starts. For us, it started in October, and it starts with a residential, which seems very daunting that you're going from your comfortable work life into a fellowship where you maybe don't know anybody, but it's such a welcoming environment. The people who run the fellowship, the people who support the fellowship, like Sally, are a great support in getting you to meet everybody and get to know each other. And that's really where the learning starts. You start with two residentials before Christmas, or certainly that's what we did then. We did some project surgeries in January, we did another residential in March, and then more project surgeries. For us, it was in April. This year, it's in May. And these are all opportunities for learning. Like, I felt that since I'd left university, other than studying for my fellowship, my membership exams, I hadn't really had the opportunity to do learning or to have time put aside for learning. And for me, that was the biggest kind of draw. And the thing I enjoyed the most was just having this time put aside away from home. So you're fully focused on the learning and just that opportunity to hear from worldwide experts as well as national experts, as well as the people who lead on the fellowship, who have done the fellowship from their experience, and lots of people you wouldn't have the opportunity to speak to or learn from, and you're also learning from each other. So we've got people in our cohort, we had people from Norway and Denmark, Northern Ireland and Scotland. So again, what an amazing opportunity to meet these people, build up your network if you're thinking in that kind of speak, but also make friends, hear about how things work elsewhere. I've certainly been inspired by a lot of the digital solutions that Scandinavia have. And, you know, you look on very with a lot of jealousy about the way that they can gather patient outcomes or patient experiences or communicate with patients through digital solutions. That seems a world away from what we're doing. But it's then helpful when you're having conversations at your board level or your HSep level or even at national level, to be able to say, look, this is done elsewhere. It's not impossible. These are the things that we might want to look at. So as well as having the network hearing about people who work in different countries and how different systems work, you also have a huge new group of friends. And I remember people saying that in advance, oh, you'll make a lot of friends, and thought, oh, gosh, that seems quite daunting. But it's absolutely true. One of your most vital things is your WhatsApp group, which, again, when people told me that, I thought, I don't need another WhatsApp group, but I absolutely do need this WhatsApp group. There's such a support, and I had a difficult time, work wise, during the year that I was doing the fellowship and the support from UK Ed Job and Julia and Sally, as well as the people who were in my cohort and maybe went and spoke to different people about how to handle different situations. We had some communication training from Kathy McDonald, and being able to go to her and ask for her advice about the situation that I was having at that time was just invaluable. And I am so, so grateful for the opportunity to have been part of the fellowship. It was life changing for me. I really enjoyed it. I loved the learning, I loved the network. I love the new group of friends that I've got and the opportunities that we were given as part of the year.

Kate: Yeah, I think that's one of the things that I love about it as well, is that you go in and you've got all these people in different specialties who wouldn't normally meet or speak on a social level, that you might kind of communicate just about a patient or in a stressful situation, and you can really get such a greater understanding of what's involved in their lives and in that specialty just now and learn so much about kind of transferable skills.

Jude: Absolutely great. And I don't think we do enough of that at the moment. In healthcare, I think during COVID we all kind of came together and we were all in it together. But as we've been recovering from COVID I feel like those relationships that we maybe started to build on have maybe fallen away a little bit. And actually, there's a lot at the moment. I think from my point of view, where we are all imagining what other people are doing and we don't understand how they're all working. And it becomes, when systems are under a lot of stress, it becomes really difficult to have an open mind about that. Other people are trying their best and they feel that this is the best way to work things. And I think being part of the fellowship just let you have those conversations with people. So I now am very aware that everybody's trying their best and everybody's a human being. Everybody deserves to be treated with respect and kindness. And not that I didn't do that before, but I think at certain times at the moment, we're all under so much pressure, work wise in your life. So everything seems under a lot of stress that actually knowing how other people work now and being able to ask people in different specialties or different roles through the fellowship network, how would you address this? I mean, I've certainly had lunches out with Christine, asking her about how she would handle certain situations, because it's an opportunity to ask, from your point of view, how do you see this problem? And is there a way that I can approach this within the area that I work in to try and make this a little bit better?

Kate: Yeah, I think you talked about the project clinics, and I think from what, when I've spoken to colleagues who have been recommending the fellowship to sometimes the idea of having to have a project to go to the fellowship with was quite daunting. So did you find that, and what was your experience about the project side of it, doing an improvement project?

Jude: So I think everybody is daunted by this, and I know why, but now having been through the fellowship, I totally get the idea behind it. So it's not to be a massive project. It doesn't need to be changing the way your board works or a massive thing. What you're trying to do is show that you've learned the skills of quality improvement, safety, leadership, change all those different things and trying to demonstrate it within a project. So it's actually a really good way of demonstrating your learning. And I think, don't be daunted by it. I was thinking about projects anyway, and I think many people who are applying for the fellowship do have a project in mind that they want to do, but they worry if it's too big, too small. Have I done too much of this already? Have I not done enough of it already? But what I would say to people is, please don't let that put you off. Everybody gets there in the end. There's great support for it. And again, the project surgeries where you come along and you've got your kind of like the backbones of your project written and you're presenting it to a member of the faculty and also to other people who are within your groups, and you think, oh, gosh, how's this going to go? But it's another opportunity for you to talk about the work that you're doing and have other people's comments and inputs. And actually, I think it was one of the most valuable things that I did. Obviously, I think the way that I think, and I do try and change that and think from other points of view, but having somebody with a totally different head on looking at your project and commenting on it, oh, I learned so much from that. And I wouldn't be daunted again about doing it. I would see it as I can't wait to present at project surgeries because I'm going to have this opportunity to get some input from people who think differently to me, and maybe it'll make my project better.

Kate: Yeah, we get so hung up on not shading our ideas unless we think they're perfect, don't we, in healthcare? So it's quite good practice because I see it with the people who start, and they're quite like the people who are maybe presenting their project initially are quite anxious about it and apologetic for what stage it's at and everything, and then actually, once they've had their questions answered, and then once you get through to the people who have listened to some of the other projects and the confidence is building and you realize how much fun it is actually kind of just throwing ideas out in a safe space and hearing comments about them. And it's actually really enjoyable. But we're not very good at doing that in our professional here because we only get rewarded for having the right answers and being perfect at everything.

Jude: Not having it right first time is not a problem in the fellowship. That's the whole point, is that you're there to learn and you've got all these other people helping you. So that can only help to make your project as good as it can be. And listen, all the pro objects don't work, do they? You've got to learn so many factors.

Kate: Yeah.

Jude: And you learn so much when things don't go well that the next time you're doing it, you'll do it slightly differently. It's just an amazing opportunity.

Kate: Yeah, totally. So were there any surprises during your year or was it what you expected?

Jude: I don't know if there were surprises per se. I think the fact that you've got this friendship group, I couldn't have imagined how that would have been. But having done it, it's brilliant. I think I was probably surprised, although I knew that I was doing the three days of the residentials, I think I didn't quite appreciate how tiring that was because actually having long days of learning, whilst it's great, it is hard. And the only thing I would recommend is that if it was possible for you to have half a day in the next week or so just to go through your learning and almost consolidate it, because I think I probably felt a little bit guilty for having the time out to learn and then rushed straight back into work the next morning. And in hindsight, with the last residential, I did have a day off afterwards to give myself a chance to write down what I'd learned and specific things I wanted to follow up on or things to look at or people to speak to, and I would recommend that. But it's very difficult when you're already taking time away from your work. But even just a half day or an evening, just try and put it aside because there's so much to learn. And the thing is, it all goes in because then you'll be six months later talking to somebody about work that they're doing and you'll think, oh, I remember that session that I did on X, Y and Z. I know somebody who might be able to help, or maybe I can help you with that. So it does go in, but I think for me, I would have just liked a little bit more time to myself to consolidate before going back into family life and straight back into work. So I think I was surprised how probably tiring I found it because I hadn't had that chance to do that for so long.

Kate: And as a GP, how did you balance the residentials and your other work? Have you got advice around how to manage that?

Jude: So I think that this is probably one of the tough things about being a GP and applying for the fellowship. So if you work within a practice, you need to probably negotiate with the partners or if you're salaried with the management and the partners about you having this time away and it's really difficult. I've just said it's really tiring. So it's not like you can make up those three days really easily from being away. I guess the benefits to the practice going back are that you will have done training and quality improvement. You maybe would take on a role like the practice quality lead or the cluster quality lead within your local area, which would allow you to demonstrate all your skills and your learning. But it is difficult because there's no backfill for the time that you're away from your practice, so it probably needs a bit of negotiation. I was in a different situation and I was on a year away from my practice to work in a pilot of a new service in our HSCP. So the HSCP signed off all my forms and allowed me the time away. But this is definitely something as a GP, you would have to consider and make sure you thought about it or discuss with your partners in advance. Listen, it's had a huge, huge benefit for me and I think I am a different clinician, I'm a different person to work around, and I think the way I think about quality improvement now is of huge benefit to the people that are around about me. But it would be a big cost challenge, probably, because if you work for the NHS, say, if you were an acute physician working in the hospital, then the hospital or the board sponsor your time away, so it doesn't come as a financial cost to you. So this is just something to think about.

Kate: Yeah. There are other GPs who've done it who are in practice roles, so I suppose get in touch with the quality improvement people in ness and we could get you in touch with them to find out how they worked around that too.

Jude: I would say if you look at the number of GPs that have done it, it's probably a smaller percentage than you would imagine, because I think of these challenges. There was another GP on the cohort with me, but again, she worked for the HSCP in a community role, but I certainly know of partners who have done the fellowship as partners and so. Yeah, absolutely. Sally or the faculty would be able to give you information about these people and you can speak to them about how they managed.

Kate: Yeah, yeah.

Jude: Great.

Kate: So tell us what's happened? Like, what have you done with all your learning?

Jude: So what difference has it made for me? I remember people saying, oh, it'll change your life. And I thought, really, I don't think my life's that bad that I wanted to be changed, but it has. So I would say personally, for me, I feel more confident in my abilities I think I used to sit in rooms of people in leadership positions and think I can't speak the same way as them. I don't know what they're talking about, but having done the fellowship, I think I've definitely got the chat. I understand what people are talking about and I can contribute to these conversations where before I don't think I would always have contributed. So personally, I think it's made a big difference. It's allowed me to think that I am capable of doing other roles as well. So as well as working as a GP, I do have two leadership positions. So I'm clinical lead for realistic medicine, but also a clinical director now and again before the fellowship, I'm not sure that I would have thought that I could do that, but I'm really enjoying the challenge again, I'm learning all the time. I'm getting an awful lot from that and hopefully contributing well to the HSCP that I work in. So lots has changed and I think I really enjoy my job. I really enjoy the mixture that I've got now. It seems to suit me and kind of motivates me and I love helping other people. So when people are talking to me about the fellowship or if somebody drops in the fellowship, as somebody in the current cohort was standing on the side of a rugby pitch with my kids and she heard me talking about the fellowship and came over and said, are you talking about the scottish quality Safety fellowship? And I was like, yes, do you want me to give you my chat? And she had already got her place on the fellowship, but I was able to give her lots of discussions, so I'm always happy to talk about it and really inspired to watch other people on their journey through the fellowship as well. This year. It's been so lovely keeping in touch with the fellows from our area and hearing how they're getting on and meeting up with them. And as part of previous fellows, you'll be invited back to support the fellowship and talk about it as we are today. And I think that that's something when you've been lucky enough to have the experience of the fellowship that we should do to support other people who are coming along behind us and try and support them with their personal development and give them the opportunities that we've had.

Kate: Yeah. Oh, that's great. Oh, well, thank you so much for sharing your story. We're looking forward to hearing what you do next, Jude.

Jude: Thanks, Kate.