The Primary Care Fellowship Scheme

THIS EPISODE  is about the General Practice Fellowship Scheme that provides funding to allow GPs and GPNs to pursue interests.  Developed by NHS England and further enhanced  in areas, such as London: The SPIN-new-to-Practice offer:  Munir Adam is joined by a variety of contributors to see how this plays out,  the benefits, the challenges  and even how AHPs, such as Pharmacists in Practice are benefitting  from it.

SPECIAL THANKS to the guest speakers: 
Dr Rachel Roberts, Primary Care Dean for London; 
Mandy Claret, Programme Manager, NCL SPIN/New to Practice Fellowship Scheme & Barnet Training Hub Manager;
Charlotte Cooley, GPN SPIN Programme Director for North London;
Sarah Buthlay, NEL SPIN Programme Manager

And to Adela, Amy, Kaitlyn, Lisa and Tamsin for enriching this further with their contributions.

This episode was developed in collaboration with North-Central London Fellowship Team on behalf of the North-Central London Training Hub. 

USEFUL LINKS:
The NHS Fellowship Scheme, England:  NHS England » General Practice Fellowship programme

HEE: GP fellowships | Health Education England (hee.nhs.uk)

Evaluation of Fellowships (Education for Primary Care Vol. 33; 2022, Issue 6) https://www.tandfonline.com/doi/full/10.1080/14739879.2022.2120832

London SPIN/Fellowship website:  https://www.hee.nhs.uk/about/how-we-work/your-area/london/salaried-portfolio-innovation-spin-scheme-%E2%80%93-new-practice-fellowships

NCL Fellowship webpage:
Spin/New to Practice Fellowships Programme (ncltraininghub.org)

MAIN WEBSITE www.primarycareuk.org

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Transcript

Transcript (Note:  This has NOT been checked for accuracy)

Episode Intro

[0:06] What I was being told by those recently qualified is that they felt they needed additional time to transition into a permanent and really impactful and supported career.  

I found it so helpful having a mentor.
We've discussed everything from work-life balance to clinical situations where I've needed some help and support.
I really enjoyed my time in the fellowship, in particular the peer support that I experienced and the shadowing and meeting various people across my local area.
See how other nurses are working in other practices and other GPs, pharmacists. I would say it's probably the best thing I've done within my nursing career.

[0:51] Hello, it's Munir Adam here and welcome to 2023. And I hope that you had a few nice days of rest during the festive break, perhaps even a couple of weeks.  But if you were working in out of hours serving patients, well, I hope that your dedication was appreciated.

Now, those of you who have heard the introductory episode to this series, and I know that was a while back, may remember I made a promise that I would start each episode by saying who it's relevant for, which actually also means saying who it's not relevant for.  Now, it's a difficult thing for me to do, but you're a busy frontline professional, and I'm gonna stick to my promise.  So, if you're happy doing your role in primary care, and you don't have any interest at the moment to do an extra course, a diploma, or to diversify your role in any way at all, you just wanna carry on doing what you're doing, and you don't have any particular influence or responsibility for developing services or additional opportunities for others either, then it's perfectly safe for you to skip this episode. And so you may wanna go back and listen to one of our other episodes if you haven't already heard all of them. And by the way, if you have, well, you certainly deserve to just put your feet up, relax and feel good about the dedicated person that you are.

[2:05] Okay, I said it. Right, well, if you're still with us, that's great.

Let's talk about the fellowship scheme, because that is what this episode is about.  And this is a scheme that was developed for GPs and practice nurses, but actually in some areas has been expanded or mirrored for other professions as well, such as pharmacists, and we'll be hearing about that a little later.  And so yeah, this is relevant to you if you're somebody who might be able to benefit from the scheme in your area.  But also if you're somebody who's involved with developing pathways and policies, if you have some influence, then this episode might give you some ideas to pursue.  And actually, isn't that what it's all about? Sharing and benefiting from each other's ideas so that we can mutually gain?  I think so. And so do the North Central London Fellowship Team.
And in fact, it's the NCL Fellowship Team that bring you this podcast episode on behalf of NCL Training Hubs.

CONTENTS:

So, what are we going to cover in this episode? Well, we're going to start by hearing an overview presented to us by the Primary Care Dean for London.  After that, we're going to hear some anecdotes from actual and past fellows. After that, we're going to hear a little and discuss how this has been playing out in the NCL area.  And then finally, we'll also be hearing about the pharmacist fellowship scheme.

The episode is a little longer than usual and do feel free to forward to relevant sections using the chapter markers if you wish.

 [3:35] Music.

[3:49] It's no secret that we have a recruitment and retention challenge in primary care in the NHS. And the fellowship scheme is a way of trying to address that challenge, and in particular,  the London offer, which is the SPIN need to practice fellowship, is a very exciting and potentially very useful way of addressing that challenge. But what exactly is it? I think that's best explained by someone who's been leading this in London and involved with it from the start.

So let's hear from Rachel Roberts, Primary Care Dean for London.

Overview Of Scheme By Primary Care Dean[4:21]

Hello, thank you. I'm Dr Rachel Roberts. I'm a GP and my work is as HEE Primary Care Dean in London.

[4:29] How did SPIN at New to Practice Fellowship come about?

[4:33] So in my role working in GP education over the years and then most recently, what I saw was some really innovative, supportive education for GPs, but also for the other professional groups.

[4:47] But what I was being told by those recently qualified is that they felt they needed additional time to transition into a permanent and really impactful and supported career, and that they  almost felt that they may be falling off a cliff when they finished their training and were suddenly out in the employment marketplace and no longer had the support of their GPVTS training scheme groups.

[5:14] And what does it comprise? 

So it comprises three main elements. So the clinician would be employed on a permanent contract in a primary care provider for between four and seven clinical sessions per week.

[5:30] They would then on top of that have a portfolio element to their career, ideally two sessions a week, but some will be one session a week and a few will be more than two sessions a week in their portfolio and thirdly they'll attend some educationally supported.
Peer groups with the program directors in their integrated care board area which would usually be at least once a month. Awesome and how has it helped? So prior to the scheme and certainly in  terms of GPs we were seeing a reducing number on qualifying going into the permanent workforce, in the immediate years post-qualification and far more going into short-term locum or long-term locum.

[6:14] Jobs which are also extremely valuable but some of the reasons for going into those roles that the clinicians have told us in our annual survey was a little bit of a feeling of overwhelm needing extra support particularly they felt well prepared clinically from their training to be a GP, or similarly for the other professional groups, but they felt less confident in the wider organisational set-up of their area, so the integrated care boards, and also into going into leadership roles and the next stage of their ambitions. So they wanted that additional support.  Clinical workload is a major factor in the feeling of overwhelm and some people were managing that by the type of contract they were taking up, often being more short term.  And of course for those with needs of flexible careers that's a really important factor. But the strong story coming out of the GP Careers Intention Survey was that it is absolutely possible to have flexible careers, to have ambition, to be supported and to have a peer group and, all of those things together actually led 90% of people to want a portfolio career and it made becoming a salary GP or even after a couple of years a partner more and more attractive if those things were in place. And also the Careers Intention Survey strongly showed that the majority of those qualifying in in primary care wanted to work in the area they trained but these were the kind of things they needed,
in order to enter that form of contract.  So from year one in 2018, when I first started this programme in North East London, there were six recruits.


We now have 350 in post across London, and 500 have been helped through this programme.
So some of the findings that have happened through external evaluation are that 90% of those undertaking the programme want to stay in the place they've been recruited as a Spin New to Practice Fellow.

[8:26] Also, the vast majority of portfolio stakeholders that employ have really found that their recruits have dramatically improved the quality of the service they offer, and particularly because it works across sectors between primary and social care, primary and secondary care, primary integrated care. So it is absolutely helping retain into the permanent workforce, giving really positive career satisfaction and it's also pointing out the skills of this group to their employers both in primary care and other sectors.

What problem do you see it to be addressing in particular?

[9:01] So the two main problems I see it to be addressing are firstly the system issues of needing to retain more professionals, whether they be GPs, nurses or pharmacists and others. But secondly, I see it, meeting the needs of those newly qualified professionals to have a really supported.
And impactful career. So for me it's a win-win situation.

And what do you think the future of the programme is?

So what we have found is that the role of those educationally supported groups.  But programme directors are absolutely critical and in many cases have programmes around leadership development, next stages in careers and are extremely popular. So those nurse and GP programme director roles will help expand future placements, continue the impact of those and help develop new portfolio roles as well as new general practice employers. Most importantly, at this point in time in January 2023, we have those 350 GP fellows imposed in London, but we only have 15 nurses.

[10:10] The London group has given voice to the problem that nurses have had in the national fellowship offer, which was newly qualified. And that's now been agreed that in 23, we can trial new to practice fellowships for nurses and we've had projected numbers of increasing from 15 to 100 by Easter 2023. We also know there may be additional funding available to expand beyond that if it's successful so I'd really love to see that greater impact for nurses this coming year in 2023.

[10:44] And also London's been beginning to trial a spin for pharmacists and so I'd love to see this being offered and utilised for pharmacy and even beyond this it's become so
popular that there's a real emphasis in London to offer this for mid-career professionals and we've just in December 2022 had an ability to apply to NHS England nationally under the GP retention funds to roll this out for mid-career fellowships.

Munir Adam:
[11:20] Sounds great, doesn't it? One of the things I didn't mention earlier was that amongst my other roles, I also work as a Programme Director on the Scheme, you know, one of the PDs that was just referred to by Dr Roberts.  And I think it's great to see how the different components come together to enhance the offer.

Let's just clarify quickly then. So there is the national offer that originally came out from NHS England. That is for any newly qualified or qualified within the last 12 months, GP or practice nurse, and it consists of pro rata funding that can be used for that individual to pursue their interest. The London region chose to enhance this by adding in a peer support monthly forum, and by the way fellows are also entitled to a mentor, and developing opportunities for the individual to practice their skills by undertaking work in specialty and other roles.

[12:20] Let's use an example. So somebody might work as a GP in a practice for five sessions.  And then in addition to that, not just do some qualification in, say, rheumatology, but actually do a couple of sessions as outpatient employed often by the trust or seconded to the trust and thereby able to apply their skills and feel more embedded into the system.  This enhanced offer sits alongside the standard fellowship universal offer and also in the London area there's a third type which is the PG-CERT which is a little different and more inclined to those who want to get more involved with managing and improving healthcare services but I won't say anything more about the specifics of the offer because this is being modified all the time to try and make it more and more fit for purpose.

And if you need to know more about the specifics and eligibility, it's better to refer to the the links provided in the episode description.

[13:16] Okay, now we did hear some actual words from fellows at the introduction to this episode. Why don't we hear a little bit more about what fellows, past and present, think about the fellowship scheme?

What The Fellows Say[13:28]

Hi, my name is Tamzin Ellis. I'm a GP based in Islington and I've just finished my two years of the fellowship project. I was lucky enough to be working on a kind of bespoke project that was set up on environmental sustainability and engaging across initially my borough and then across my ICS on environmental sustainability, in particular focusing on inhalers.

[13:50] So my project for the fellowship was to look at long-term conditions and multi-morbidity reviews, looking at a more holistic approach rather than individual conditions, utilising the wider team and using a risk stratification pathway to prioritise patients most in need of care post-COVID.  And making sure that they were seeing the most appropriate clinician and we were using all the clinicians to the best of their ability and reducing GP demand as well.

My project was to deliver the blood pressure at home.  At the beginning I was completely lost. I didn't know who to turn to, who could help me. I was not getting anywhere. And then with the fellowship, I really got to know people and I was able to deliver the project, which I am really happy, because I was able to deliver the BP at home to all South East England PCN and the project is running now.

Since doing the fellowship I have actually taken on leadership roles as in I am now the PCN Nurse Lead and hopefully very soon I'll be in another leadership role within NCL.  I wouldn't be in those roles, I wouldn't even have attempted to apply for those roles pre-fellowship.

[15:08] I think generally being a practice nurse it can be a very lonely job. I felt really part of the team doing the fellowship. I know I have somebody to turn to. Since doing the fellowship I never felt, isolated, I never had this like I'm on this in my own. I felt part of the team and I know I have.  People to turn to for help.

I really enjoyed my time in the fellowship, in particular the peer support that I experienced and the shadowing and meeting various people across my local area.  It meant that when the fellowship ended I still have a supportive network that I can connect with, I've had mentorship as part of it as well. It's been really helpful to have something to go alongside my clinical work and like I said have a group of people who I can turn to. I've made friends for life during the peer support group sessions, finding out about other people's projects, working with other people and supporting other people in.  Their project and also just encouragement as well because it was difficult at points trying to engage stakeholders and things and actually having that support from people who were doing similar things was invaluable.

One positive thing about the fellowship that I've experienced is the benefits of having a mentor. We've discussed everything from work-life balance to clinical situations where I've needed some help and support, to differences between different practices and how they're run and how they're managed. And I've just found her an invaluable source of support.  In being a newly qualified GP and I really look forward to our calls every month.

Fellowship Scheme In The NCL Area[16:48]

Okay, hi, both of you. Well, we know each other really well, of course, but just for the benefit of the listeners, perhaps we should start by introducing ourselves. So Mandy, do you want to
go first? Yeah, sure. Thanks, Munir. So my name is Mandy Claret and I'm the Programme Manager for the North Central London SPIN New to Practice Fellowship and Mentoring Scheme. And I also have
another role as the Programme Manager for one of the local training hubs in the North Central London area. Hello, my name is Charlotte Cooley. I'm the Programme Director for the General Practice Nurse GPN Fellowship Spin Programme for North Central London.

[17:26] And I'm Munir and I actually work as the Programme Director for North East London and have been covering North Central London for a while as well, although pleased to hear now we've got got a permanent replacement for that starting soon as well.

[17:38] So Mandy, has the fellowship been a big thing in North Central London? Yes, so the fellowship scheme has been a really well received initiative in North Central London. We did have quite a lot of support for newly qualified GPs and for mid career GPs and for nurses for some time across the patch. But it's always been very dependent on local funding availability, which as we know can be variable. So the fact that we now have a national funding stream, which means that the fellowship is something we can offer to every single newly qualified GP and new or new to practice GPN in the country is a huge improvement on accessibility to the scheme.
Okay. And when we talk about the fellowship, there's different forms, aren't there? You know, we've got the SPIN model, which is specifically in London, perhaps in other areas. And then We have the standard fellowship as it was produced by NHS England, and then also the PG-Cert.
And so what I'd like to ask you is how's the take-up been in terms of those different areas in North Central London?

[18:47] Yep. So in total, we've had about 120 GPs that have taken up the scheme, and so far about 35 of them have completed a fellowship of some kind. As you say, it might be SPIN, it might be Universal, or it might be the PG-Cert.
Although the PG-CERT is for not just fellows, but those in their first five years of qualification.

[19:08] In terms of the nursing, there's been only a handful, so about three that have taken up the scheme, and two of those have completed.
And obviously there's a huge disparity between the GP and the nurses' numbers.
And I know that Charlotte's going to talk about the challenges in regards to the nursing a little bit later. Yeah, when I first heard about the SPIN, I thought, well, why do we have to introduce.
These different things? I mean, if the national model is the fellowship, then that should be it for everybody. But actually, the more I thought about it, and as I started to get involved in this role, I could see those benefits. And I don't know if you guys agree, but sometimes a person, you know, recently qualified GP or GPN might want to take up some sort of course and they'll complete their diploma in whatever. But does it actually aid recruitment and retain them unless they're actually able to apply those skills.

[20:00] I found that the spin is actually a beautiful way of being able to do just that, because you've got two sessions, but there's going to be an element of learning and experience. But because you're embedded into the local system, one would hope that that would make you part of that system and make you feel part of it, and then you won't want to leave.

[20:17] In North Central, would you say that the majority are at the moment on the spin model, or they're mostly on the stand-alones of one session fellowship type of module.

[20:29] I would say in truth at the moment there are many more fellows taking up the universal offer. We are starting to see an increase in the two-session model but obviously the number of.
Two-session portfolio roles that we can offer is dependent on system partners match funding.

[20:51] But it is starting to become much more widely understood and as you say the benefits in terms of recruitment and retention are starting to become a bit more apparent.

[21:04] Certainly from the nursing perspective what I've started to find is that initially nurses might join under the universal offer and then when they realise the depth of the fellowships and what the SPIN aspect can offer they're actually being able to think more about taking up the SPIN element as, they consider their projects and what they want to do. So it's definitely a programme that can involved for the people that are on it and it offers far more I think once they start to understand.
The benefits to them and their career development. Yeah I think that's an important point actually isn't it? You don't have to decide completely at word go and then there you've got the two years and so you might do something in year one and then do something else in year two. It is actually a really good opportunity and I think there's a lot of work to be done on that but definitely
worth thinking about ways of developing it. And I'm sure that stakeholders across the board would welcome that as well, because it's a way of recruiting somebody who's a fresh, newly qualified.
Person who's passed various exams and things to get to where they are now contributing to an additional area of their portfolio interest. But it isn't just about the financial support, is it?
There's more to it than that, isn't there? That's right. So as well as being involved in a portfolio role and I can give you plenty of examples of the sorts of things that people are getting involved in. There's.

[22:26] Also the peer support offer to GPs and to nurses, where they get once a month, an opportunity for peer support, or they might.
Hear from an external speaker about something on an expert matter. Obviously, it's an opportunity for pastoral
support. And really importantly, it's an opportunity for them to network because not only is the fellowship about developing
themselves, but it's about thinking about their potential for the future and making connections now that they might come back to later on. So the peer support is really an important part of that offer.
There's also the opportunity to receive mentoring from a senior GP, also once a month at the start and across the two years of their fellowship, and then perhaps less frequently as they move towards the end. And this is something that is available for not just newly qualified, but actually those that are within the first five years.

[23:29] And this is different to the peer support in that it's more about the individuals setting their priorities of what they want to achieve in their career and how the mentor can guide them, signpost them, connect them.
Whereas the individual that is mentoring them on their portfolio role is more about the specifics of the project portfolio work.
So let's talk about each of those three things, the fellowship itself, whatever their project is, then we've got the peer support and we've got the mentorship as well. So the main part of this being the fellowship, can you give some examples of fellowships in North Central that come to mind?

[24:12] Sure. Yep. So we've been working really hard behind the scenes to put together a brochure of potential opportunities that may be of interest to newly qualifieds. Obviously, some
will have their own interests, and that's absolutely fine. But for some, they like a sort of, rather than starting from a blank piece of paper, they like to have a few ideas thrown at them, and they can run with,
them. So some examples are, there's a project called Dr. Me. And this is about delivering workshops in local primary schools on how to self care for common self limiting conditions. And the idea behind that project is to promote health literacy. Another example is around improving digital use in primary care. So that might be looking at something like the use of SMS services within a practice or a PCN. And another example would be the homelessness health inclusion team, working with them to set up a weekly clinic for homeless patients who they've been seen by the outreach team, but now we want to bridge the gap and bring them back into mainstream primary care.
So you can see that there is a huge breadth in the sorts of things that people could get involved in either at a practice level, so maybe looking at improving the rates of engagement in cervical cancer screening, a PCN level, looking at QOF targets, or across the borough, or indeed across the ICS area.

[25:46] Okay, well it's quite interesting to hear these examples. These are quite different from what I often come across like doing a diploma in a specialty area or perhaps sitting in an outpatient clinic and.
Helping out and developing skills in that way. So yeah, innovative ideas. I think I'll make a note of those.

[26:03] In terms of the mentorship and the peer support, I wanted to ask you as well Charlotte and how that's been going with nursing. I think what we found with the peer support group of the nurses is that we've had a pan London group so their awareness of the bigger system and their place in it has been really apparent.
In the peer support sessions we've been able to talk about the understanding primary care because it works so differently from other areas that nurses may have worked in before.
They really feel that the benefits of the learning that they can bring, some of the insecurities and the worries that they have, there's a big pastoral element to the peer support And I think some of the nicest feedback from the nurses is they feel that it is a safe space for them.
To bring these concerns and to deal with some of the stresses that they have to cope with in general practice. One of the biggest points coming into general practice as a newly qualified
nurse is suddenly working autonomously and then being able to come back to a group and bring some of those fears and concerns. I think in every session we always have two or three areas that by the time people go away, they go back much more happy and confident and they're able to advocate for themselves and their patients better within the practice. I think the peer support has a richness that I didn't realise when I first started it and the confidence in the nurses and what they're now considering for the end of their fellowships is really nice to see them develop.

[27:31] That sounds like a really great deal for the nurses and in the case of GPs as well, in terms of the support they're going to gain the scheme and also a point that was being made earlier about the benefits to patients actually, because skills that they're now able to apply in different settings.

NCL: Outcomes & Challenges[27:48] But at the end of the day, isn't this all very short lived? I mean, we've got a recruitment and retention problem, but isn't it just the case that people are going to complete their fellowship?
It's all great. It's wonderful. A lot of money goes into it, but at the end of it all, aren't people just going to go away and do what they would have done when they qualified anyway?


Not at all. We've had many examples of newly qualified GPs who have completed their fellowship and they've gone on to do all sorts of great leadership work.
For example, one of our fellows participated in a medical education fellowship alongside UCL Medical School, and they are now leading on that Medicine in the Community programme at UCL.

[28:31] One of our fellows who participated in the PG CERT in healthcare practice is now a lead tutor for the course, course. And more recently, one of our fellows has gone on to become a clinical director
for one of the PCNs. So it's only really the start of the journey. It's sort of a platform for their career. And it just gives them the confidence that they can contribute to the system in all sorts of ways that perhaps they didn't realise was possible at this point in their career.
I think that echoes with the nurses as well. Yeah, I mean, I think it's the confidence that I've seen in the nurses as they go through the programme, they're talking about portfolio roles, they're talking about leadership roles, they're talking about things that actually they weren't aware existed and the opportunities to them and how they make it fit around their day-to-day work. Some of the nurses are put into positions because of recruitment problems where suddenly they're managing teams and their confidence to do that because of the fellowship scheme is really apparent.


Okay, so that is quite convincing actually, and that's great to hear. So if it is worth making the effort.

[29:39] There are going to be challenges along the way, aren't there? I think it's really important to to share that as well and as a fellowship PD myself, I'm aware of some of that as well. But what would you guys say about that? It's not always plain sailing, it's not as straightforward. I mean, clearly, NHSE and HE have worked very hard to make this a success.
What are some of the challenges that you come across when you try to do this?
I mean, I think for nurses entering, you know, primary care, it's such a steep learning curve.
And I think trying to make the fellowships work with some of the competing demands that the nurses have to cope with in terms of other academic programmes they may be studying for, but it's really trying to see how the fellowships is a wraparound model for them and it's the support that it gives them to actually succeed in those programmes and what they can do. And I think, trying to make the practices understand how the development of their nurse and the career development that the fellowship gives them and the time and the CPD money, this whole package.
And how they can then embed into the practice so that they're more likely to stay within their practice and feel more confident about leading within that part of the system.

[30:49] Shall I add to that some of the challenges that we've been having with specifically the GP? So as you know, being part of the fellowship scheme, you have to have secured a permanent role within North Central London.
And sometimes, particularly if you've got a newly qualified GP who is new to the area, they don't always know where the vacancies are.
They don't always know which are the right practice for them, which ones are the bigger practices, the smaller practices, the ones that have got a large multidisciplinary team, the ones that are educationally proactive.

[31:26] And so it can be a huge barrier to them joining the fellowship scheme because without that GP post, they cannot become part of the fellowship. So really it's been the link in with the local system. So specifically in North Central London, the local training hubs to sort of advocate for them and to build up a list of the vacancies that we're aware of, not to get them the job, but to sort of facilitate the introductions if we know of people that are looking. And if they are having particular issues trying to negotiate number of sessions or being released for peer support, things like that, we can certainly support them, you know, and try to empower them to go back and have those conversations. And I think it just sort of gives them a little bit more confidence in going back to the practice and sort of making it known the requirements of the practice in order to secure the recruitment of their GP.
Yeah, so that's really important, isn't it? Because I've come across that as well, where practices aren't always either fully aware of the fellowship scheme or they're not able to support. Is there anything more that anybody in the system can do to try and help or speak practices or share information or what else can we do?

[32:42] Sometimes it's just that the practices have a lack of awareness of what's available. You know, they get millions of emails every day and dealing obviously with patients and staff issues.
And if practices are having difficulty recruiting, I would urge them to speak to their local training hub, because they will be able to put them in touch with people who are looking for work.

And any other challenges that you've come across?

I would say that sometimes we found that the practices are a bit reluctant to release the GPs and the nurses for their peer support. In the respect of the GPs, what we've tried to do is offer three different sessions. So that, for example, if you had three different fellows working within a really big practice, and the practice manager quite rightly was feeling a little bit anxious about letting them all go to peer support at the same time,
they can choose from three separate sessions so that they all get a chance to go, but they're going at a different time to one another. And sometimes that's really helpful in terms of just having a wider network and being able to share learning across the three different groups. So that comes with its own benefits.

[33:58] I think it's echoed in terms of, you know, the practice nurses, the perception that they're going to be taken away from the practice and that there isn't a benefit to that. So in taking that nurse away we accommodate and we draw in multiple different workforce streams and projects that would. Actually develop their nurse through the two-year programme. So they're enriching and they're learning and they're developing themselves all during protected time that the practice would have to support anyway if they weren't on the fellowship. So the fellowships provides this huge network of support for their nurse, which I think people are starting to realize that potential and how they can
then develop their teams within the practice. Listening to all of that, it sounds like getting it right from the beginning in terms of involving the practice and making sure you've got their buy-in is really important, isn't it? And we found that we were able to get better peer support when we made it much more explicit in the initial MOU that practices would have to sign, that attending the the peer support sessions was mandatory.
And I think the same thing in terms of supporting nurses as well.

NCL: Other Considerations[35:04] So it's great to hear about all of this happening for GPs and for GPNs and super to hear about it also happening for other professionals as well like the pharmacist scheme in northeast London.   I know that Sulé had visited some of you in North Central to talk about that as well.
That's right. So we heard about the fellowships that's available for pharmacists in northeast and it sounds like a really fantastic scheme and one that probably doesn't need to stop with pharmacists, it could be for physicians associates and a whole host of other roles.


I think it's a really good opportunity to start to level up the support that's available for all the allied health professionals in primary care because as we know, you know, a supported and valued workforce will be one that will be retained. And I think the other thing to point out is that.

[35:53] We know that there is a huge focus now on MDT working and so it's so important now that we begin to develop leadership skills for all allied health professionals, not just conventional roles of GPs and nurses. Okay, fair enough. I agree with that. But where would the funding come from?

So I think for some of these roles, there is an opportunity to tap into the ours roles funding. So the additional roles reimbursement scheme. The primary care networks will be very familiar with with that phrase ARRS because they're here talking about it all day and some of the listeners might not know about that. So do you just explain what that is?
So the ARS scheme really is just some funding that's been made available for the PCNs to recruit additional roles into the practice to support the workload of the GPs and other staff within the practice. So for example, clinical pharmacists, the physicians associates,
of the personalisation roles as well that people will be familiar with now.

[36:59] Well, certainly that sounds like a really good use of that funding, then I have to say. But then I am a fellowship PD, so I would say that wouldn't I?  But seriously, it makes sense because we've already talked about the benefits, benefits to the community, benefits to the system, benefit to the individual, support for the individual.

[37:18] It sounds like a perfect arrangement. It'll be great to see that being developed in other areas as well and for other professions in working in primary care.

Okay, so some listeners are going to be thinking, this sounds like a great opportunity, but I'm more than 12 months qualified. And at the moment of recording this 12 months is quite a strict criteria, isn't it? So is there nothing that can be done for them? I mean, where do they go? Have they missed the boat?

Right. So the first thing to mention is that although the guidance is quite strict about the 12 months qualified criteria, if the newly qualified GP or nurse has had a significant amount of time out of practice, so they've had a period of sickness or maternity leave,
adoption leave, something like that, then the system can flex a little bit to try and accommodate them starting the fellowship a little bit later. If they are well and truly over the 12 months and they've got no extenuating circumstances, then unfortunately the newly.

[38:17] Qualified fellowship will not be open to them. But there are some mid career fellowships starting to come on board. There is mentoring that's available to, at the moment first five, but I believe that's going to be expanded as well. And there's also the opportunity to take part in the PG certificate in health care practice. And that's also available to first five. So not quite the same offer, but there are some things that are still available and things are coming on board all the time.

[38:49] And yeah, I mean, particularly for those nurses, there are local schemes that will offer support and learning opportunities, but particularly around CPD offer and some of the mentoring and coaching offers that are currently made available to people within primary care.
There is also support through the primary care nurse leads within North Central London in terms of career development and there are local variations in terms of the clinical supervision and learning support that nurses can have locally. The borough nurse leads are very well connected and quite often can tailor support and find programmes to support nurses that may not be eligible.

[39:28] Okay, great. So if someone's listening and thinking, I really like the sound of that, and they are eligible, and they do want to join, and they are, you know, within the qualifying period, etc. What do they do next? Who do they contact? Sure. So in most areas, I imagine that,
the fellowship and mentoring schemes are being managed by the local training hubs.

In North Central London, the fellowship scheme is being managed by a central North Central London Training Hub team. Probably the easiest thing to do would be to go to the website which is www.ncltraininghub.org, and there is lots and lots of information on there including about fellowships and mentoring.
And whether you're a GP or whether you're a nurse there are different bits of information and to tell you everything that you need to know.
Brilliant. Okay, well, thanks both.

Munir Adam: Pharmacist scheme.

[40:26] So there you have it as far as GPs and practice nurses are concerned. But what if you're from one of the other professions such as pharmacy, for example?
Pharmacist Fellowship[40:35] Now the fellowship scheme in its current form doesn't apply to you as far as the national office concerned, but it is encouraging to see that some other areas.
Are beginning to develop this for other professions. And I have now for you a summary of the fellowship scheme as applied to pharmacists in North East London. And perhaps this might serve as a stimulus for similar schemes to develop in other areas for pharmacists and other professionals working in primary care.

[41:04] Hi, my name is Sarah Buthlay. I'm the North East London SPIN new to practice project manager. The SPIN Fellowship Programme was initially set up for newly qualified GPs and GPNs, but, it's actually generated quite a lot of interest among other primary care providers. This particular SPIN Clinical Pharmacist Fellowship pilot came about via the North East London Health and Care Partnership, which submitted a funding request to Health Education England in order to try and develop a pharmacist-specific portfolio career model across primary care networks.

[41:37] Throughout Northeast London, primary care networks are planning to recruit quite a number of pharmacists over the next few years. And recent experience has shown that recruiting into primary care particularly has identified problems in geographical areas, where recruitment is a challenge, as well as significant turnover in quite a lot of practices.  So the aim of this pilot is to try and combat some of those types of issues by supporting future recruitment, retention and career development of early years pharmacists covering bands 6 to 8A across the whole of North East London and obviously focusing particularly in these areas that have struggled to recruit or retain pharmacists predominantly in PCNs and practices.
The model basically is looking at pharmacists being substantively employed in a core role and then undertaking an additional two funded sessions per week in an alternative setting which could be an acute trust, a community and mental trust, or a community pharmacy.

[42:40] As well as the two alternative spin sessions, the pharmacists also have access to dedicated monthly peer support sessions, and these are facilitated by our dedicated clinical lead pharmacist, Sahad Naz.  We think these sessions are vital in supporting the individual's developmental needs. needs. There are forums for sharing ideas, issues, concerns and successes and are a mandatory part of the fellowship.

[43:10] We're basically looking at testing and developing an employment model which enables pharmacists to work across two sectors. And this pilot offers a lot of fluidity and flexibility. Because it's trying to align priority areas identified from local population health data analysis, whilst also developing individual pharmacists' knowledge and expertise.

[43:36] The thing I think is really beneficial is that it's not a prescriptive situation where we're simply pushing individuals into certain areas. We're looking holistically. So what are the needs of the PCN or the practice? What are the targets? And what will the benefits be? And the whole ethos of this spin model is about collaborative partnerships, networks, integrated systems, and breaking down some of the barriers that I've just mentioned. So the current situation in northeast London is that we set up a steering group early in 2022 with representatives from across the whole sector and then began the pilot by requesting expressions of interest, firstly for a clinical lead pharmacist and then identifying potential host providers, so those organizations who are willing to provide alternative placements for pharmacists.

[44:29] And then obviously PCNs and practices who had pharmacists they wanted to put forward for the programme. We then started having initial conversations with everyone to understand more about ambitions and targets before the process of matching individuals with suitable opportunities commenced. The actual onboarding process started around October, November 2022, and we've now got eight pharmacists in place with another two who are due to commence their fellowships in April 23. The pathways that are being followed are quite varied and they include paediatrics, acute medicine, respiratory and cardiovascular.

[45:09] I'd say that there are a huge number of benefits for both the individual pharmacist and the profession as a whole, as well as the wider healthcare system. Things like improved recruitment and retention, career progression, and obviously patients benefiting from the specialist knowledge that their local pharmacist will have, as well as sort of good working relationships
with other healthcare providers. But I think equally important is to stress that this isn't just about clinical knowledge. It's about developing a shared culture. It's about managing stakeholder relationships and equally important developing new qualified pharmacists confidence in their chosen area. As the pilot evolves over the next six to eight months, it will be tailored to maximise benefits for everyone involved and will hopefully demonstrate the importance of portfolio career models throughout primary and secondary care settings.


There's so much more to say. But what I would say is get in touch with me, Sahad Nas, the clinical lead, or Rallya Aton Atadeh, who's the Chief Pharmacist and Director of Medicines and Pharmacy for North East London ICB. We'd be happy to share our knowledge and experience to date,
and assist you with any questions that you might have. Thanks very much.

Final Words & Next Steps[46:28]
And there you have it. I hope that we've been able to give you an overview of the fellowship scheme as it stands nationally, and also that we've been able to give a flavor of how it can be applied in a particular area, in a specific part of London.
And the idea is not to try to say that this is the only way to do it, or that this is necessarily the best way, but just to give a flavor of how it might be put to good use. If you happen to be somebody who might be able to benefit from the scheme, then please do have a look at the link, and normally it's your local training hub that will be able to point you in the right direction. On the other hand you might feel inspired by what you've heard and might want to apply some of those changes in your area and if you have the ability to develop those opportunities that's fantastic. Why not expand this further? I mean what started off as a very specifically for the newly qualified GPs and nurses has been expanded to include mid-career opportunities, a pharmacy fellowship scheme and perhaps in other regions other opportunities exist as well.

[47:30] Now those of you who have heard other episodes on the series will know that I tend to have a bit of healthy skepticism. And I gotta say, I honestly don't claim that this scheme is going to solve our recruitment retention problems on its own. Those are big challenges and much more needs to be done to address those. But I do think that the fellowship scheme is a big step in the right direction.
And I did say before, and I will say it again, that in my own view, the SPIN offer is definitely an enhanced way of improving recruitment and retention.  And allowing fellows to feel embedded in the system, while at the same time addressing the system's needs as well.
And this is better than just the fellowship offer on its own. And so, if the fellowship opportunity is available to you, you might be asking yourself the question, should I go for this or not?
Well, why don't we finish this episode by listening to what fellows themselves would advise.

[48:27] One thing I would say to anybody thinking of starting a fellowship is to definitely go for it. It's so nice feeling part of a group.

[48:37] Again, after you've recently qualified and you lose the VTS kind of support and camaraderie of that and interaction with your peers, It can be quite lonely and the fellowship is a really great way to feel part of a group.

If you have the opportunity, please do the fellowship.  You know, there might be a moment when you're giving your time into it, but you will definitely get the reward.

I have been a practice nurse in my surgery for three years, and we have another practice nurse which has been here three years.
And I described her what I came from, and she said to me, to me, I wish I had done it.

I'd say the key thing to think about when you're doing a fellowship project is the time and that things can be quite overwhelming at the beginning when you're trying to learn about the system and how things work.

We're learning how to be a newly qualified GP, but that's why it was really good to do two years of it and really hone in on how I could work on my work-life balance and time management skills.  And I'd really recommend it to anybody who's thinking about fellowship.

I would say 100% go for it. I feel like the fellowship has given me this newfound enthusiasm about nursing.

[49:46] That's it for today. We hope that you're finding this podcast informative and educational, and that it helps us develop as a primary care community.
So ask yourself, what's the one thing I can do differently after having heard this episode? And if I can't benefit directly, then is there somebody I know who may be able to?

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Disclaimer[51:12] This podcast was developed to inform, educate, support and unite the primary care workforce. However, all information and advice contained therein is time, location and context dependent, and is general advice.
No guarantees are provided with respect to the accuracy of the content.

[51:30] The host, contributors and the organisations they represent do not accept liability for any actions, consequences or effects that result directly or indirectly from the material.

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