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SoWhoCaresAnyway E15 Breaking the Status Quo Through Place-Based Learning · SoWhoCaresAnyway

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Hello and welcome to So Who Cares Anyway, the podcast that shares learning, innovation and ideas from the world of health and social care and beyond.
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My name is Ruth Germain and I'm inviting you to join me each week with my inspirational guests to hear about who cares.
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What they do, their passions, their knowledge and ideas, and importantly, the difference they are making to improve the health and wellbeing of people in our communities.
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I consider each of my guests to be incredible individuals working with people in new ways or with key messages to share.
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People from healthcare, social care, the voluntary sector, community groups, and more.
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To join me each week to find out, so who cares.
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Anyway, to find out more about me, who I am and what I do, please head over to my website, www.reflectiveruthconsultancy.com,
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where you can also catch up with previous episodes and read my blogs.
Hello and welcome to this next episode of So Who Cares.
Anyway, and today it's just gonna be slightly different because today it's just me and I'd like to share my journey.
For those of you that have listened or perhaps know me personally, then.
You probably already know, that I'm a nurse.
It's something that I always want to do from when I was about three, I think maybe four.
I can't remember, ever wanting to be anything else really.
And the reason why I want to be a nurse was because I used to say, because I care.
I want people to be healthy, and I wanted people to be happy.
I don't think I ever really thought about it anymore.
Other than that, this determination that was what and who I wanted to be.
So I went into nursing at 18, quite quiet, quite shy.
Wouldn't say Buda Goose, certainly not on the wards.
It was quite regimented in those days.
Back in, it was 1985 when I first started nursing, and it's very different from how things are now.
But one thing that I noticed from quite early on is that actually we'd done a lot of things, but we didn't always know if they were the things that people wanted to doing for them or needed doing for them, we'd done them because that was what we always did.
Back in those days, it was very task orientated.
So you, when you got on the wards in the morning or the afternoon for your shift, you were either on backs and bottoms, which was about preventing pressure sores.
Or once I've been there, a bit longer than I moved up to be able to do obs, which was about taking temperatures and doing blood pressures, taking people's pulses, that sort of thing.
Or it might even be on the drug round going around giving the medication.
But actually it was still quite limited.
So I'm gonna jump ahead quite away 'cause my journey's quite long and I don't wanna through all of it today.
I'm gonna keep today quite short because there's just a key few messages I wanted to share.
So I'm gonna jump right forwards to when I was working in general practice.
And I'd moved in general practice from being a practice nurse and taken the opportunity to become an advanced nurse practitioner.
And that was mainly because I still felt that a lot of what I was doing was driven by tasks.
People came in for a particular thing, procedure or dressing change or something to happen or to support them with their diabetes or their heart disease and do their annual reviews.
But actually.
I felt that there was more we could do.
So I've moved on to the advanced nurse practitioner role with a view that this wasn't just about improving my expertise clinically.
That was very much of what I wanted to do, but it was also about developing that leadership education and research, and that was something that I really felt was lacking.
Yet when I moved into those advanced practice roles, what I found was people were still drawing on that clinical expertise.
Which was great.
You know, I had some imposter syndrome for a while, so for the first year or so, I was quite happy really focusing on that.
But more and more I started to realize people were still coming to see me.
That actually I wasn't really truly meeting their need, what it was that they wanted, or if I was, I wasn't always to be able to do it in a way that worked for them as an individual.
So there were communities and people out there that perhaps we were brushing over what they needed.
With the services and the support that we were able to provide.
And I just didn't feel like I was able to use that education or that research or that leadership that I'd really hoped to be able to do.
And this really came home to me one day when I was working in the general practice and one of the GPS had taken over being the lead for the advanced practitioners that were there.
There was three of us at the time.
And one of them was retiring, so the other two of us was called up to see this gp and she said to us, it's busy out there.
There's a storm brewing.
That was her analogy.
I want you to get them in and get them out.
And my immediate thoughts were I didn't come into nursing to get anybody in or anybody out of anywhere.
And when I went back downstairs and I'd spent quite a bit of time I always spent quite a bit of time reading the various bulletins and emails and updates and papers that came through because I was interested in what was going on wider, but I always felt like there wasn't actually anything I could do or influence whether that was true or not, but, that was, how I felt and what I felt.
I came down, I read the bulletin, and at the time there was a job advert.
Looking for a nurse to lead, or to support the development of what will commute community education provider networks, which later came on to be called training hubs.
So I thought, right, I'm gonna apply for that job because I need to help to support the changes that we really focus on what people need, and there's so much more and so many different things we could be doing.
But what I'm doing is the same thing in day in, day out, even though I know that it doesn't always work in the best way that it could.
Just as an example, I remember one lady used to come and see me regularly whenever a particular GP was away, because she always went to see him when he was away.
She'd come and see me and I spoke to him and I said, she come see me every time you're away.
And I don't quite know what to write afterwards.
'cause I never quite work out why she comes to see me.
I don't know what to put in her notes.
And he said, well, I think she just comes because she's lonely, Ruth.
And I said, yeah, I think she does.
But.
Actually, we are not the best place for her.
And isn't there something else we could do for our loneliness? And he said, maybe, but I don't know what.
And I thought, yeah, if we could do something different working you in different ways, that would be great.
So I went off and I took on the role.
I was lucky enough to get it to become a primary care workforce development tutor as we were called at the time, and we weren't tutors.
We were there facilitating.
The development of the primary care workforce, creating those cultures of learning, whether that be student nurse placements, which was very much our first focus, bringing student nurses into general practice.
So they thought about that as a new place or a place to work when they qualified and they understood.
Even if they didn't, they started to understand primary care and what that was about.
So if people moved and worked in the hospitals, they understood that wider perspective as well as community.
They understood primary care and we moved on to looking at other pre-registration students.
But beyond that, we looked at, what is a learning culture? What is a lifelong learning culture? How can we draw on the expertise and skills? Of those people that are already there to share their knowledge and learning, and I was fortunate enough then to start working in East Kent, where I worked with a lady called Kim Steelman, who was the lead for the training hub in that area.
And Kim was really quite visionary because she saw beyond the fact that we had a training hub that supported general practices to create those cultures of learning to think about actually how do we develop that within each general practice itself so that they take their own, that ownership and that responsibility for that education and learning.
And I've been in this role by this point for about six or seven years now.
In various places, and it had moved on dramatically.
What we were doing and how we were supporting general practices and what they were doing themselves had moved on dramatically as well.
So there'd been massive changes, but Kim still had this vision in her head about embedding it in practice.
And I went along to one of our, board meetings one day, and Kim spoke about the fact that there was a project on place-based learning.
And that this was about embedding cultures of learning within general practices.
What did that look like? What needed to happen and how did we make it happen? And she was saying, it's a shame because nobody's offered to take on this project.
So I went up to her afterwards and I said, Kim, this sounds amazing.
It sounds like the next step.
I've been thinking for some time that it's great that I'm doing all these things, but actually this needs to come from the people working in general practice themselves, not me.
I'd like to do that project if there's any possibility that I could do.
I don't know that that's possible, but I thought I'd ask and she said, well, yeah, it is possible you have to apply to be a Darcy fellow.
So I hadn't heard of Darcy fellows at the time, but essentially, Lord Darcy had put together a fellowship around systems leadership, systems clinical leadership.
And I didn't not realize even when I applied that actually what I was applying for was to do another PG set and already done one to be the advanced practitioner, and suddenly I found I was applying to do another one, but fortunate that I got that.
Got a place.
So I spent a year as a Darcy fellow, and each Darcy fellow took on a project.
So of course I took on the training hub project, which in some ways meant I was very closely linked.
So it was a bit more difficult to get that outside perspective.
But on the other hand, it was the project that my heart was really with, because I'd already believed for quite some time that general practice was the place where we needed to make the difference.
So much evidence shows that, and that was what I really wanted to do.
And when I was on the Darzi Fellowship, there was a lot of talk about that as well.
So within that, I got in touch with a lady called Kim Manley, who I'd worked with previously.
She'd been a critical friend.
She's a professor.
She's been on this podcast.
I can't remember which episode it was.
But yeah, she's been on it as about workforce transformation.
And I said, so will you support me, Kim? 'cause there's quite a bit I need to do in this project and I need to really work out how do we understand what place-based learning is? Of course there was workplace learning, but this was about learning in the place and the primary care networks, which is groups of general practice coming together, we're just beginning to emerge.
So this was 2019.
And she said, yes, of course, I'll support you, Ruth, which he did.
And we'd done some values clarification exercises, which were essentially co-creation, asking people, what do you value about place-based learning? What is the purpose of place-based learning? What is it and how do we make it happen? And there were three core, values.
That people shared around place-based learning that emerged.
The first one was about people-centered learning.
Learning with the people that we care for, and understanding of the people in our communities and understanding what their needs are so that we can support them in the best ways that work for them.
And the other side of people centered learning was being people centered.
To the people that were doing the learning, whether they be pre-registration students such as nurses or trainee nurses or midwives or medics who would just begin to come into general practice at that time from the new medical school that was being developed in Kent, but also that lifelong learning.
So how come people that have been, in general practice or elsewhere.
Develop those cultures of learning and support each other.
What does that look like So that individuals can learn in the best way.
So I'm not sure I ever explained it the best way that I can, but I will share the blog and the article that I wrote with both the Kims I've mentioned, afterwards in the show notes.
The second one was around cultures of learning in teams, which is quite obvious.
You need to have a team culture of learning.
If you want things to move on, if we're gonna do different things, if we're going to question what we do and say, is this what we really need to be doing? Is it the right thing? Is it the best thing? Is there a new way? And there needs to be a culture where people can ask questions.
People can get it wrong.
They can fail, they can try new things out and fail, but actually.
Each time take the learning from that.
And then the last thing was around networks for learning together.
And this was the bit that moves it beyond being, workplace learning to learning in the place, learning broader across the place, across neighborhoods and across systems as well, so that people come together.
So thinking of it in the broader context of.
Developing networks of people that come together to learn those networks might extend into hospital trust.
They might extend into community trust, but beyond that, they might extend into schools.
They might extend into local community.
Groups, whether they be, youth groups or religious groups or various other groups, but into the community so that we really start to build those networks of learning and finding out.
So learning is about finding out discovery and being curious, asking those bigger questions, and really beginning to think out outside the box and beyond status quo and from that, what came about, and this had already been in Kim Stillman's mind as to what she wanted to do, we got managed to get funding For community education facilitators within general practices or the primary care networks at the time, which was really important because this was about still having training hubs.
So that was the cross a place or a system to support general practice with their learning education development needs, but actually giving that ownership.
To the primary care networks so they could support that themselves.
So each primary care network received funding from medical lead, a nursing lead, or a non-medical lead.
So nurse paramedic or somebody else might step into that space and also some admin support around that learning and developing, what that learning might look like and supporting those events to happen.
But I decided that beyond that what I'd do is take that place-based learning values to anything that I'd done.
So I moved on to a role where I was the lead across Ken to Medway to be the advanced practice and prescribing lead.
And the first thing I did was to.
Do a value clarification again around what that was, to really co-create and bring people together.,
But then, I worked with people to say we need to develop networks.
So I was, as I say, I was leading advanced practice and these people all.
Should be working across those four pillars.
And so often, like me, they were saying, yeah, but everyone just wants me to do the clinical bit.
Ruth.
I said, well, let's help you step into that leadership space, develop a network, build networks, meet with other people with similar interests or different interests working in different areas than you.
So not just within your organization, but who else is there out there that's doing things, that's doing you, and different things that you might link with.
And a lot of the time, bit like when I did been in general practice, there was this thing where I felt like I couldn't do something else.
I'd say, well, I don't think I'm allowed to do that.
I said, well, do you need permission to talk to somebody in the hospital or in the community? Do you need to permission to contact the school or to work with a community organization or with a voluntary sector? Do really need to ask on if you do, then.
And somebody says, no, then why? And suddenly people went, oh, actually I, I can lead this, I can do this.
And when they spoke to people, people were quite interested and said, yeah, I'd be really interested in linking with you and to do a piece of work around this and think about it.
And it's broader context.
And that role came to an end because part of working within the NHS when you work in, at systems level or in that level is that roles change, politics changes, new leadership comes in and and that's sort of part of it.
So last year I was in a position where that role was ending and I thought, so I've been here for some time.
I've been an Indiana actress for some time.
Maybe it's time for me to step out and look from the outside in.
And I had in my head that there was so many stories, so many people, so many pockets of amazing things happening that what I wanted to do was just to build that network wider and share things wider and find out more about what was going on.
So I decided to go alone, set up.
As a reflective Ruth consultancy doing a number of things and linking in where I could and really using it as a time of discovery, and part of that discovery was setting up this podcast, which had been in my mind for some time, as so who cares? Anyway, I.
Because who cares who's out there, who's doing things to make a difference? Nurses, yeah.
I went to be a nurse, doctors, paramedics, pharmacists, as I mentioned earlier on drama therapists.
So many different people doing so many different things.
But actually there's also people as I've had on here,, doing things.
So many great speakers that have joined me who are in other roles.
And I'm just looking now, you know, I've had people on the.
From outside, so people from the Kings Run Night, Adam Lent who's pushing the do with movement.
And then I've had Poor Steps Act who was really pushing that co-creation and co-production working with these communities on a number of different social issues to make a difference.
Emma Snow, who's talking about those five giants, that goes right back to the NY Bevin report, those social determinants of health, Angela Catley, thinking about when I get old and asking those different questions, those different things that need to happen.
James Metcalf, he works for an organization.
In the Yorkshire malls, taking people on walks, but really take or introducing people to the countryside as a way of developing a natural health service and thinking of things in different ways.
So many people doing so many different things as well as the clinicians like Mark Spencer, who's working, connecting people, and creating hope as a gp.
Thinking about new and different ways to do those things.
Sarah Trust who instead of the pharmacy prescribing more thinking about how she could prescribe less others that I've already mentioned and so many more, and so many people more to still join me.
Sharing stories, ideas, innovations, new thoughts, breaking the status quo.
And just letting people know there are so many people out there that care, and together we can have so much more impact and do so much more.
So it's a bit of an unusual podcast today.
My key message is keep up, keep looking out.
Don't always feel like you need to ask per permission instead.
Just do things.
Do things with people, do things together.
Join the hashtag Do with movement.
This group of people leading that now.
And if you go onto the information's on the King's Fund and it's something that's bigger.
And it needs to grow.
So we all start to do things with people with our communities rather than for them.
So do with.
Network, learn, stay curious and if you have any feedback on my podcast then I'd really love to hear from you and if you have a key message to share, please do get in contact and let me know.
Thank you and bye.
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