Intended for healthcare professionals

Careers

Stepping into management: the GP and PCN director

BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n2568 (Published 25 October 2021) Cite this as: BMJ 2021;375:n2568
  1. Francesca Robinson
  1. London, UK

The Brent GP talks to Francesca Robinson about the rewards of working with colleagues to improve population health

Achieving change in the NHS can be challenging, especially when people are reluctant to leave their comfort zones, says GP Nigel de Kare-Silver. But the rewards of having a role in influencing care at a population level are gained over time as services improve for patients.

De Kare-Silver, who is the clinical director of a primary care network (PCN) in Brent, London, is most proud of a covid-19 vaccination programme that he was involved in setting up with three other PCNs last year.

By using unconventional vaccine centres such as a temple, a mosque, a church, and pop-up clinics in buses outside supermarkets, it became one of the top 10 programmes in the country.

De Kare-Silver, who is also a partner and trainer at the Gladstone Medical Centre in north London, was first drawn into a clinical management role in the mid-1990s when he was asked to join his local medical committee. The idea of being able to tackle local problems appealed, as he felt he had good relationships with local GPs and could advocate on behalf of general practice.

He went on to chair the GP commissioning group when it was set up in his area. Over the next three years he was influential in improving patient flow and enabling earlier interventions for patients.

“I didn’t see myself as a pioneer, I felt I was just doing ordinary boring stuff trying to help our area to catch up. But at a conference one day I realised we had leapfrogged into quite an influential position on clinical commissioning,” he says.

By 2017, PCNs were being formed. De Kare-Silver liked the idea of providing care at a population level and moved into his current role as a PCN clinical director. He says the job is challenging—general practice is under huge strain and his local area of Brent has a diverse population which suffers from some of the worst health inequalities. This makes it hard to achieve key performance indicators on which income streams are awarded, which in turn makes it more difficult to support patients in the community. “One of the biggest hurdles is to pull NHS management teams away from their spreadsheets and persuade them to take these challenges into account,” de Kare-Silver says. “Working as a PCN within a CCG population of two million means individually we have little influence. Working collectively to represent the entire borough of Brent has at times, however, put us in a strong position.”

Throughout his management career de Kare-Silver has continued to see patients. “If I didn’t do the clinical work my role in management would suffer,” he says. “The intensity of the workload in general practice can be draining and to get a break in a different field is stimulating.”

De Kare-Silver says he doesn’t feel he has any special skills to be a manager. “Anyone who is enthusiastic about improving care and wants to achieve change can take on a management role and will work to achieve the priorities they have identified in their own way.”

At times the work is frustrating: “If I’ve been in a meeting and got nowhere I’ll ask myself what I didn’t say that could have persuaded people to do what is needed. It’s my role to shift hearts and minds. When this happens it’s important to continue the discussion and debate.

“You don’t see the changes until you look back. There is never a big bang—things evolve over time. It can be a slow burn.”

Nominated by Vidya Patel, GP, Brent

“The support that Nigel de Kare-Silver has given our PCN during covid-19 has been fantastic. He is a practising GP, a GP trainer, and a clinical director—that’s a heavy workload, which he manages really well.”

  • Vidya Patel is a GP in Brent, London

Footnotes

  • To nominate someone who has been a role model during your medical career, send their name, job title, and the reason for your nomination to tmoberly@bmj.com.