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SoWhoCareAnyWay E24 Pushing Doors Open to Create Safe Spaces For Learning · SoWhoCaresAnyway

• 0:04
  Hi, I'm Ruth Germaine, and this is, so Who Cares? Anyway, a podcast shaped by my deep curiosity about who cares, what do they care about, what do they do, and why does it matter? My aspiration is to build a community that listens with intention.
• 0:20
  And explores care from every angle from the North Yorkshire malls to behind clinical doors.
• 0:27
  Each episode invites people to share their stories, their ideas, and talk about what matters to them.
• 0:34
  Together we reimagine what care could be and how we might shape health and wellbeing through the assets, values, and the lived wisdom of our communities.
• 0:44
  And why does it matter? Because for too long, health and care have been treated as things to be delivered, often depleting systems and the people around them, and it's time to rewrite the narrative to center everyone as a contributor, not just a recipient, to offer joy, hope, and meaningful belonging to invite each of us to shape the future of health and wellbeing with courage.
• 1:09
  With creativity and with care, so who cares? Anyway, to find out more about me, head over to my link Tree Dook four, reflective Ruth.
• 1:19
  Here you'll find links to my website, my LinkedIn profile, and in the future, my Facebook page, and there's the option to support this show by buying me a coffee to now for another episode of So Who Cares? Anyway.
• 1:35
  Hi and welcome to the next episode of So Who Cares.
• 1:38
  Anyway, and today I'm being joined by Jane Room, who I've known for quite some time.
• 1:42
  Jane is a GP in West Kent, and I'm really sorry Jane, I've forgotten now where, which practice you're in, but I'll let you introduce yourself in a moment.
• 1:49
  But you're also the simulation faculty lead, so you work with the training hub for primary care and you are the simulation faculty lead, and there's quite a bit there that I've been really interested in for some time.
• 1:59
  So I'm delighted to have you join me and I'll pass over to you to introduce yourself.
• 2:03
  Please Jane.
• 2:03
  Uh, yeah, thanks Ruth.
• 2:04
  So, so yeah, so I'm a GPI still do work, uh, clinically at Modern Medical Center.
• 2:09
  Actually I work in, in, in West Ken.
• 2:10
  Um, now, but yeah, most of my time I do spend sort of in education.
• 2:14
  So, um, like you said, lots of sort of different roles, but, um, yeah, gp, teacher, associate Dean, and then AAR training hub lead for West Kent.
• 2:22
  Um, and I do a lot within the training hub in Kenter, Medway Primary Care and also the primary care school for Ken area and Sussex.
• 2:30
  Um, and I've got a real kind of, I suppose, passion for sort of workforce development.
• 2:34
  So lots through my simulation work, but also through, um, leading on fellowships as well.
• 2:39
  Thank you Jane.
• 2:40
  And you've got quite a y portfolio there, so I just wonder if.
• 2:43
  Before we start and we go into the simulation faculty and talking about that a bit more, would you just give me a little bit of, um, a background, your route and what drove you into, particularly around this workforce development bit that you are talking about, but it might be that you want to go back a little bit more to explain that.
• 2:57
  So I'll leave that with you.
• 2:58
  Yeah, I think I go way back.
• 3:00
  I was thinking about it.
• 3:01
  Um, I first sort started getting interested in anything towards.
• 3:06
  And, um, probably 20 years ago actually, and I was sitting in some meetings that we had then they used to happen in the, um, in the hospital and they used to be sort of very, I dunno, sort of chalk and talk type things with the consultant standing at the top and being very, um, this is how things should be done.
• 3:21
  And there'd be a group of.
• 3:23
  At that time only gps, um, in the audience sort of listening really to what, you know, the sort of expert was saying.
• 3:30
  Um, and I remember being, I was relatively, nearly qualified and I was, wasn't really sure that was what I needed or wanted.
• 3:37
  I wanted to have a lot more sort of discussion.
• 3:39
  I wanted to talk about cases, I wanted to hear sort of, yeah, my sort of colleague's opinion.
• 3:44
  Um.
• 3:45
  And so, um, shows how long ago it was because at that stage actually I had to write to different practices.
• 3:51
  So I wrote out to sort of all the different practice managers in, um, at that stage, at T Wales and Tum Bridge because they were the local ones and saying, look, is anyone interested in, um, coming? And we can do some sort of small group learning and we can learn from each other.
• 4:04
  Um, and just doing a slightly different bit of education.
• 4:07
  Um.
• 4:08
  I had sort of 25 people who turned up in my, my living room actually, it was at that stage one evening and kind of things went from there.
• 4:15
  So I, I sort ofd my sort journey way, way back to that, um, as sort of a catalyst.
• 4:21
  And then, um, back in, I think it was 2017 actually, there, there was a role that came up for, um, being a GP tutor.
• 4:29
  I didn't have any other sort of roles.
• 4:31
  I'd got into appraisal, so I'd been a GP appraiser for quite some time as well.
• 4:34
  And that had been really helped sort of spark my interest in kind of developing people.
• 4:39
  Um, but I saw the role of GP Tutor, which was for West Kent, ort Wells.
• 4:44
  Um, I'm successful and applied for that.
• 4:46
  And that was just at the very beginning of what were the, um, community education provider networks, what were the precursors of the training hubs? Um, started to work with some really interesting different people as well.
• 4:58
  So not just gps.
• 4:59
  So with lots of, um, amazing sort of primary care workforce leads at that stage.
• 5:05
  Um, and really just started, started me thinking a little bit differently and then the simulation bit.
• 5:11
  I actually think I just fell into by, completely by accident.
• 5:14
  If I'm, if I'm honest.
• 5:16
  Do you want me to talk about that now or, yes.
• 5:17
  So my question as you're saying that, but yeah, I will get you to talk about it, is you say you fell into it, but usually we fall into things for a reason.
• 5:24
  There's something about it that lets us want to, makes us wanna fall in.
• 5:28
  If you like, you think, well that looks interesting, you know, so what, what was it on? Just tell me a bit more.
• 5:33
  I mean, it was, it was, at the time it was quite accidental.
• 5:36
  So I, um, in my GP tutor role, I was organizing, um, a joint injection workshop for clinicians.
• 5:42
  So I'd gone down to the education center at the local hospital to see if I could, um, borrow some of their rooms and also some of their kind of, their skills models around joint injections.
• 5:52
  And whilst I was there, I literally bumped into in the corridor and their simulation lead and was just chatting with them.
• 5:58
  Um.
• 5:59
  And when I, obviously simulation actually is something that's really embedded in all, um, undergraduate curriculums now.
• 6:06
  Um, but when I trained, it wasn't a thing at all, so I had no clue actually what they were really talking about.
• 6:12
  So they were just like, oh, come down and just sort of see the simulation suite.
• 6:15
  Um, and I was standing in this amazing room that was all sort of set up to look like, um, a hospital ward and they had these amazing mannequins and the kind of the mirrors and everything.
• 6:25
  Um.
• 6:26
  We were just chatting and uh, uh, she sort of said, well, you know, do you think primary care would be interested? And we're like, oh, I dunno, really.
• 6:34
  But best way to do it is to try it, isn't it? Because we can't lose anything by trying.
• 6:40
  So, um.
• 6:42
  Ran this joint injection workshop.
• 6:44
  So it was a very sort of traditional kind of, um, learning how to, to do that as a clinical skill.
• 6:50
  But then at the end, um, designed like a, a small little scenario, which was around how people might manage, um, a cardiac arrest.
• 6:58
  In a waiting room, in a GP practice.
• 7:00
  And at the beginning of the, the, the session, I said, look, we're just doing this as an experiment.
• 7:05
  No idea.
• 7:06
  Um, you know, if you think this is something that's really good and we you think that I should really look into this and develop it a bit further than please tell me, but if you don't, you know, really happy to hear that as well.
• 7:16
  I just wanna know if this is something that it's worth investing my time in, because I think, you know, this could be really interesting.
• 7:23
  Who ran it.
• 7:24
  Um, and at the end sort of said, you know, and what did you think? And literally I was kind of mobbed everyone there.
• 7:29
  So there was like 24 people there.
• 7:31
  They were like, you know, it was amazing.
• 7:33
  You know, the, the learning was so much more powerful.
• 7:35
  It was so much more impactful.
• 7:36
  This has gotta come out to primary care.
• 7:38
  Yes, please do something about it.
• 7:40
  Um, and not only that, but actually two people stepped forward out that and said, look, and if you do this.
• 7:52
  It really kind of went from there.
• 7:54
  And the more that I did around simulation, the more I kind of really felt this is something, um, there's so many different, um, avenues that we can explore at it, and it's just so impactful.
• 8:04
  It's just so amazing for primary care teams, it helps.
• 8:08
  The culture, it sort of levels hierarchy.
• 8:10
  There's so much learning, there's so much patient safety.
• 8:13
  Um, and I'll stop there because there's so many different things to it.
• 8:16
  Uh, and it, it, it was a bit of a struggle.
• 8:18
  There were, there were a lot of ups and downs along the way to get to where we are now with it.
• 8:23
  Um, but it has been worth it.
• 8:25
  Thank you, Jane.
• 8:26
  And, um.
• 8:27
  I think probably, and you started to cut touch on some of those things that we've been talking about, and I find really interesting that sort of level of hierarchy and that impactful, powerful learning, which absolutely we know it is.
• 8:39
  But I think probably there are some listeners out there who don't know what.
• 8:43
  Simulation training is, and you've described it a little bit, but I wonder if you want to give a little bit more of a, of an idea or maybe even talk about, um, a particular scenario that you've used in general practice so that people who perhaps have used do know what it is, know whether it is elsewhere, can get an idea, but also anybody who's listening who doesn't know, if you can sort of give us a little picture of what it is and then perhaps we can come into some of those other bits later.
• 9:06
  Yeah, no, totally.
• 9:08
  It.
• 9:10
  You can do huge amounts with it.
• 9:11
  So in, in, in assess sort of simulation is just, um, a technique that you can use, um, to mimic a real life event.
• 9:19
  That could be clinical, doesn't have to be clinical, but for, for healthcare it tends to be clinical.
• 9:23
  Um, and you can use it for sort of training and education.
• 9:26
  Um, and it is also used sort of for assessment as well.
• 9:29
  So you can use it to allow people to sort of practice skills, um, decision making team make, uh, and teamwork and things as well.
• 9:38
  A safe environment and most importantly, obviously there isn't, uh, a real patient at the center of it.
• 9:44
  There may well be a simulated patient who we work with, who is the voice of the patient and, and gives that patient experience, but we're not, um, there's not a real patient that can come to harm from it.
• 9:55
  Um, so that's kind of in essence what it is of we're using in primary care or.
• 10:05
  Areas we're using, it's around managing medical emergencies in GP practices, um, in cancer and Sussex.
• 10:12
  So with that, we've got a number of different scenarios, um, that we can use.
• 10:17
  And one of ours is around an event that luckily is, is relatively infrequent, um, but is is a real, um.
• 10:25
  You know, it's really difficult when it does happen, which is say somebody who's becoming acutely unwell in, uh, the waiting room and then, uh, maybe ultimately goes on to have a cardiac arrest within the waiting room.
• 10:37
  And so the team have to manage that event and they have to manage the whole of that event, and the whole of the team is involved in that.
• 10:44
  So it also really importantly includes our operational staff, so our receptionists and our secretaries, as well as all of our clinical team members as well.
• 10:55
  Um, and that's where the difference comes because a lot of our training traditionally, um, it's say the more basic life support, which we have to do annually.
• 11:02
  And it's, it's fantastic about, uh, teaching us and empowering us to, to give good, effective, uh, chest compressions.
• 11:10
  But what it doesn't do is actually, uh, um, enable us to think as a team, to work as a team, and then actually obviously to effectively manage.
• 11:19
  And that, that situation, which does require a team approach.
• 11:22
  Thank you.
• 11:22
  And I think what I'll just bring in there, Jane, is that, um, 'cause it, it probably sort of came through, but we didn't say, you didn't say explicitly.
• 11:28
  This actually takes place in the general practice itself.
• 11:31
  So yes, it includes the whole team, but they're doing it in their real life.
• 11:36
  Scenario, if you like.
• 11:37
  So the scenario is actually in the real place where they work week in, week out.
• 11:42
  Um, so not only are they, um, working as a team and all those people together, but all the equipment, all the things that they normally use and everything that around them is there as well.
• 11:51
  So.
• 11:53
  It's, um, a real sort of in the context picture, if you like, and training that they're doing.
• 11:58
  So I'm gonna go back now and just ask you what is the positives of doing it in this way? You've talked a little bit about the fact that obviously if we just have a mannequin and we can practice how to do effective, you know, um, chest compressions and resus resuscitation, that is bigger.
• 12:14
  But what else is it that you've, um, a drawing on what you spoke about earlier on that you think is.
• 12:18
  The real impact of doing it in this way and why it's important.
• 12:22
  Yeah.
• 12:22
  And thank you.
• 12:22
  I mean, I think there's loads of different things and I think on the surface, and when I first went into it, I was thinking this is gonna be about, um, helping people manage clinically the situation better.
• 12:33
  And absolutely.
• 12:34
  Um, it totally, totally is.
• 12:36
  But what we saw really, really early on is it's.
• 12:42
  The management, it's actually about that teamwork as well.
• 12:44
  And then actually seeing, um, all of the different people's roles within that and actually how you can value those roles, um, and how that really explicitly comes out through simulation.
• 12:58
  Um.
• 13:00
  So, uh, we very often see that receptionists when we first sort of start.
• 13:05
  They're a bit like, I'm not sure I should be here.
• 13:07
  I don't think, you know, what have I got to do with this? You know, what would I do? I'm not sure I have got a role.
• 13:12
  Um, but then see that they've got so many different roles and actually, um, you know, that can be obviously from, you know, being the person that that needs to be on.
• 13:21
  Um, and to call the ambulance or to, to, to help sort of direct, uh, people in, but also sort of manage that, the wider situation.
• 13:29
  So there may be other patients in the waiting room.
• 13:32
  Um, other things that sort of need managing.
• 13:34
  Um, the, the person themselves who has collapsed may have a family member.
• 13:40
  With them who also needs looking after.
• 13:41
  And that's a really important, um, other aspect that really good communication that can come through there.
• 13:48
  Um, and just generally being part of the team.
• 13:50
  So we sort of see, you know, we really, really clearly see, um, that coming through sort of time and time again and just often some really lovely language that that comes out.
• 14:00
  And, um, it's really powerful for the clinicians often to see their receptionist working in that way because they don't always get that opportunity.
• 14:08
  To, um, and equally the receptionist find, um, it's really.
• 14:13
  Helpful or they, they value being able to sort of see how clinicians work as well.
• 14:18
  So, um, just that, that concept of being a whole team working together.
• 14:22
  Thank you.
• 14:23
  And that's really interesting because you do, you are there painting that picture of all those other things that people sort of think just happen naturally and to an extent people might step into those spaces and say, oh actually I'll go and cast the people in the waiting room, or I'll, I'll talk to this relative.
• 14:36
  But actually it depends who's there, there on that day and some that takes us.
• 14:40
  Skill to do well, doesn't it? So I think people understanding that from both perspective is really important.
• 14:47
  You talked about there was some lovely language that comes out.
• 14:50
  So I dunno if I'm putting you on the spot here, Jane, but I'd really like to hear more about that.
• 14:54
  You know, what, what is that lovely language? What are you hearing or learning it? I mean, it could be really different because of the fact, but, um, there was one.
• 15:02
  So very often we will work with simulated patients who are, who are actors that come in and they will be our patient for the day.
• 15:07
  But there was one where they were unable to.
• 15:10
  Um, attendance at short notice.
• 15:12
  So I had to sort of step in and be that I was the relative of, of the patient who, who had collapsed.
• 15:17
  Um, and it's really, really well remembered.
• 15:20
  Just, um, wasn't necessarily the specifics of what they said, but, uh, they just completely distracted me in a lovely way.
• 15:26
  They were like, you know, tell me about, you know, tell me about, um, you know, your husband.
• 15:33
  Sort of talking to me in a really calm, measured voice, um, all that.
• 15:42
  You know, even if there wasn't the mannequin on the floor that, um, was for that, that experience.
• 15:47
  Um, yeah, my relative, I was completely sort of held by them and there was a bit where my eyes were kind of sort of flicking to the floor and they were like, no, it's fine.
• 15:55
  You know, look at me, look at me.
• 15:57
  Just been in a lovely, calm voice.
• 15:59
  Um, that was impossible to ignore as well, actually.
• 16:02
  And it was really good to see.
• 16:03
  And, uh, I think.
• 16:06
  Talked a lot about the simulation, but actually the event itself is just one very small part of the whole event.
• 16:12
  And actually it's the debriefing afterwards.
• 16:14
  So when we have the conversation, um, so as the facilitators, what you can then do is really help draw that out and, um, make sure that the whole team can have, did see that and, you know, reiterate.
• 16:27
  And so if, if somebody has said something specifically that's worked really well.
• 16:31
  You can get them to kind of repeat that.
• 16:33
  And um, it can mean that hopefully other members of their team can then pick up on that and that might be something that they then use, um, at a later stage as well.
• 16:42
  Thank you Jane.
• 16:43
  And as you were talking, that was coming into my mind thinking actually we've talked about how this training happens, but there is a lot of learning isn't there? Happens.
• 16:50
  I think you do some pre-learning with people and make sure people are prepared for the event.
• 16:55
  'cause this is quite, although it's not real and there's not a real person at the other end, it's quite.
• 16:58
  Big event that happens.
• 17:00
  It's not like just somebody coming in putting down a, a mannequin in front of you and saying, this is what you do.
• 17:05
  There is all these actors there.
• 17:07
  And as you say, you're like the, you are being the relative.
• 17:10
  Then that in itself is sort of something that you think, well, that's another aspect that people can practice and learn.
• 17:18
  And, but not everybody's gonna see all of that at the whole time or understand that because they might be busy watching another piece.
• 17:24
  'cause presumably there's more than one thing going on in the room.
• 17:26
  So, so it's.
• 17:27
  Tell me a little bit more about that afterwards, debrief perhaps, and, and have there, I mean, I know you probably want to sort of keep a certain amount of confidentiality and things, you know, so you might not want to choose about everything, but you know, has there been bits where you've really learned something powerful that perhaps either came from something that went well, like you were just talking about, or perhaps where things didn't go quite so well and you were able to really learn from that and draw on that and everybody go away feeling quite comfortable and think, okay, so we went like this, but now we know.
• 17:54
  Whatever.
• 17:54
  It's that we know.
• 17:55
  Yeah.
• 17:56
  And to honest, there's so much, it could probably be an entire afternoon all on its own.
• 17:59
  There's, there's, um, there's a bit obviously like you did sort of allude to.
• 18:03
  In fact, the pre the bit before we even run the simulations is really, really important.
• 18:08
  So the scene setting to.
• 18:10
  Enable people to feel, um, you know, psychologically safe is what, what we look for and actually how that can really vary for different people.
• 18:18
  So, um, and different, different members of the team and how that is quite a dynamic thing as well.
• 18:23
  So something that as the faculty we're constantly looking at and.
• 18:28
  Trying to make sure that we, we, you know, get people on board because otherwise they can't engage in it and they certainly can't sort of, um, enable themselves to kind of open up enough to, um, really sort of reflect in the debrief.
• 18:40
  Um, but yeah, in the debrief there, there is, is loads.
• 18:44
  I mean, I, one of the reasons.
• 18:46
  I and all the members of faculty really, um, absolutely love these sessions.
• 18:51
  It's not just because we see the impact it makes on the practices, but actually how much learning, uh, we take away from it as well.
• 18:57
  So I constantly learn something.
• 18:59
  We constantly bring sort of new things into it.
• 19:02
  Um, there's often, yeah, some sort of latent safety threats that, that can come, um, away.
• 19:08
  So sort of things that, um, something that could have caused an issue and might have caused harm, um, or that that situation wouldn't have been managed as, as well.
• 19:19
  Um, if it happened for real that we've uncovered through the simulation.
• 19:23
  Um, and quite a few different sort of examples of that.
• 19:27
  I mean, one memorable one was, um.
• 19:30
  Where an A ED was, was shared with honor.
• 19:33
  It was a sort of jewel site and there was a keypad door that had been changed.
• 19:37
  But unfortunately the practice didn't know what the new code was.
• 19:40
  They hadn't been told that.
• 19:41
  So they had to go and try and get the a ED, which was in the neighboring building by kind of going out and around.
• 19:47
  And it, you know, it took over sort of 10 minutes to get the um, the A EDI was just gonna ask, what is aed? Oh, so it's automatic external defibrillator.
• 19:56
  So there was lots of sort of things that came out.
• 19:58
  Um, yeah.
• 20:00
  From that and including actually the end that the, the practice actually felt that it was, it was just the most appropriate thing was to get, um, also their own, um, a ED as well to have on site, um, lots of things about sort of equipment and things like that, um, amount as well.
• 20:15
  And there's loads of events, loads of things that, that, where things do go well as well, um, that are really good to sort of share and highlight as well.
• 20:21
  Because I think in healthcare we can get very focused on what goes wrong.
• 20:26
  Actually do need to recognize that the majority of times things do go right and we need to make sure that we, you know, yeah, celebrate and share those um, too.
• 20:35
  So again, probably it's sometimes something about some lovely language.
• 20:39
  So just, um.
• 20:41
  We talk about sort of leadership, uh, skills, um, within the scenarios because, uh, for most clinicians in primary care, we spend most of our times working on our own, in our own rooms.
• 20:52
  And then when you have to sort of step into this sort of environment where you're managing a team, you do need somebody to step, step up and go, um, you know, shall I lead? Um, or, you know, um, and then.
• 21:03
  Be that person that kind of delegates roles.
• 21:06
  Lots of things around sort of closed loop, uh, communication or good allocation where somebody will go, you know, Ruth, can you go next door and get the a d and then come back and tell me when you've got it.
• 21:17
  Or, um.
• 21:19
  You can you go off and, um, call the ambulance and then tell me you know, what they said and you know what the timescale is when you come back.
• 21:26
  So loads of things like that that you can kind of, um, reiterate, um, yeah, and, and take, um, forward.
• 21:32
  So what you've um, explained there, Jane is.
• 21:35
  A lot of, some really nice things, some practical things, but also a lot around that language.
• 21:39
  And learning from what went well, which I think is really important.
• 21:43
  And we tend not to do, 'cause in, in healthcare, we tend to be that something's gone wrong, so we need to learn so we don't do it again.
• 21:50
  But actually there's so many things that often go right, you know, so every.
• 21:54
  Buddy might focus on the fact, oh, we couldn't get the defi machine if only we got it sooner, or whatever that was.
• 22:00
  But actually that, uh, receptionist spoke to you in a really nice way when you as being the actor, as the relative.
• 22:06
  That's a really important thing to draw on and to talk about her skills and what she used.
• 22:11
  So what is it that's, um.
• 22:13
  And you mentioned earlier on about that you thought this would focus on clinical.
• 22:17
  What is it that you are seeing in teams that this is giving more of? And I know you sort of touched on it, but I suppose it is really around that culture bit, which I think is so important and imperative.
• 22:28
  What, what is the upshot? And maybe you've got other things, you don't have to particularly give another scenario, but you might want to think about some of the others.
• 22:34
  'cause I know you've lots of scenarios that you use now.
• 22:38
  What are the practices saying to you or the people that work in the practices and what, what's the difference that they're seeing and liking? Yeah, so, so yeah, lots and actually, um, we talked about sort of medical emergencies mainly, but we do do a lot of other scenarios, um, as well.
• 22:52
  So it's, it's not just, um, simulation around medical emergencies.
• 22:56
  That just tends to be our biggest, um, focus.
• 23:00
  Practices.
• 23:01
  One of the real things that, that comes out time and time again is that people say it gave them a, you know, a real shared, uh, sense of, of team working and focus together.
• 23:11
  That actually this is something that they all work on together and they need each person.
• 23:15
  So it doesn't matter if you've got one member of the team who.
• 23:23
  It's all about emergencies.
• 23:24
  'cause they work in a and e, uh, for one day a week.
• 23:27
  'cause you still need to have all of your other clinical team members that can work with it.
• 23:31
  And you also still need to have your receptionist who can help you manage the overall, um, scenario as well.
• 23:37
  And your practice manager and your secretary and whoever else to be there.
• 23:40
  You do need everybody.
• 23:43
  So that comes through and we have had now quite a few practices where we've.
• 23:49
  Have gone on, um, have real life emergencies and they have fed back actually what a difference it has made, including the fact that everyone knew what their role was and everyone knew that everyone had, you know, a value and a, and, um.
• 24:04
  Purpose within that.
• 24:06
  Um, we see a lot of practical things that happen.
• 24:09
  So, um, because like you said at, at the start with, obviously this happens in situ, this happens in practices.
• 24:16
  Um, so people get their own equipment out.
• 24:19
  We get them, we have sort of disposable, um, medications and things like that that they can, that can draw up.
• 24:25
  So aren't, they're not real live, um, adrenaline or, or other medication.
• 24:29
  But otherwise we get them to use their own equipment.
• 24:32
  And it does mean that they have to work out, you know, does this work, you know, for them? Have they got everything that they need? Or more often actually, have they got too much of everything? So they've got, you know.
• 24:45
  Absolutely everything.
• 24:45
  So it's really hard to see in the moment what they do need.
• 24:49
  Um, and then that often is a really lovely way of, um.
• 24:59
  You know, in charge and lead on, on stocking the equipment.
• 25:02
  And, um, so, you know, often then we'll draw them in, in the debrief and they will then sort of have a conversation and they may go and have a, you know, make a task group, um, or a plan to make sure that they're not.
• 25:16
  Although they're leading on it, that they draw in all of the other people so that they get to learn more and they get to kind of really feel that, um, all of that equipment is owned by all of them and that everyone knows where it's, they're just not all just down to one person.
• 25:29
  And I think that's what's coming for all the time.
• 25:31
  This is about that.
• 25:32
  It isn't about one person.
• 25:33
  This is about really bringing people together as a team as opposed to your traditional education where it would be somebody comes in, you practice on the mannequin, you have your go, and then that's almost.
• 25:45
  The end of it.
• 25:45
  You know, there might be a talk about where is everything, but you are really seeing everybody's assets.
• 25:50
  And it doesn't matter whether it's the practice nurse, the practice manager, the receptionist, you know, the doctor that happens to still work in a and e.
• 25:58
  Everybody's bringing something and I think that's what I really think is nice about this piece of work and the, the simulation training.
• 26:06
  So I know that this isn't happening.
• 26:08
  Everywhere.
• 26:09
  So it's quite unusual.
• 26:10
  Jane.
• 26:10
  So I started talking to you about this.
• 26:13
  Oh, I think I was, um, you know, obviously we've known each other for some years 'cause I was one of those primary care workforce tutors, but I think this was probably about 2017 and that when you first start, oh, 2018 when you started first telling me about it.
• 26:25
  And, um, I've, I've come along to one of your.
• 26:27
  Um, education sessions to link in and see and just understand a bit more.
• 26:31
  But I know that there's so much more that this does and so much more about where the, well, I suppose what I'm really trying to say is where this has come from and it has come from your drive, and I don't think this is happening elsewhere in primary care.
• 26:44
  It's happening.
• 26:45
  It happens in the universities for people that are doing their.
• 26:48
  Preregistration training.
• 26:49
  The hospitals use simulation quite a lot.
• 26:52
  Um, I think nearly every hospital's got their simulation suites, but actually it's not happening in primary care quite so often.
• 26:59
  Um, I want to say you are the only one doing it, but I could be completely wrong there.
• 27:03
  There might be other people as well.
• 27:04
  So I'll let you answer that and just sort of talk about what, why is that different and is there any, why is that important and is there anything different that people need to think about? Um, either the people that are doing it or also the people that are perhaps thinking, well, we, we could do this differently or better and make sure primary care is included or has access to these resources.
• 27:24
  Yeah, no, there's, there's.
• 27:28
  Um, doing it up, up and down the country.
• 27:30
  There are little pockets, um, elsewhere, but where we are unique in cancer in Sussex is that, is that having our simulation faculty and the fact that our simulation faculty is multi-professional, so it isn't just GP led, we have, um, nine different clinical roles within that, which I.
• 27:49
  A massive asset and also has been, um, a massive, um, reason.
• 27:54
  I feel for us being able to kind get as far as as we have, um, elsewhere.
• 27:59
  Sometimes it can be a little bit more led by by secondary care, so sometimes sort secondary care will like to come out and try and sort of deliver it and, um.
• 28:08
  Advantages in that, in that they have got a simulation sort of team.
• 28:12
  But, uh, we do work very differently in primary care.
• 28:15
  There are, there are lots of aspects that are very, very different to, to secondary care spaces.
• 28:20
  And also, um, I do work nationally.
• 28:22
  So one of the things I didn't mention at the beginning is actually I'm the only, or, and so first sort of primary care representative on the executive committee of A, which is the Association of Simulated practice in healthcare.
• 28:34
  So that's our.
• 28:36
  National simulation, um, body that sets the standards and, and drives a lot of the sort of simulation training education nationally.
• 28:44
  Um, and through that set up and, uh, co-chair, the primary care special interest group, which is really to try and help other people, um, in other areas of the country get up some things sort of similar and sort of share the learning, uh, and help support people.
• 29:00
  Because back in.
• 29:02
  It was, yeah, 2018, back of 2019 when I was trying to get this, um, forwards.
• 29:08
  A lot of people were like, I don't see why you, you know, I don't see why you're bothering.
• 29:11
  I don't see why you need this.
• 29:13
  Uh, we've got BBLs.
• 29:15
  It happens in secondary care.
• 29:16
  You know, it's something that happens in hospitals.
• 29:18
  It's, you know, why do you need it in GP practices? Um, and certainly when I started sort of popping up at different sort of simulation conferences and sort of regional events, um.
• 29:29
  A lot of people's initial reaction was like, oh, you have a gp.
• 29:31
  Whatcha you doing here? Um, and uh, you know, that's really changed actually to totally credit the simulation community on being this amazing group of people who are really happy and willing to go.
• 29:42
  Yeah, okay.
• 29:43
  You're right, actually it should happen in, in practices as well.
• 29:46
  Um, and, you know, we'll step forward and we'll help, um, do what we can to support that.
• 29:52
  Um.
• 29:53
  I think one of the biggest things is some of that, uh, some of the financial sort of decision making in terms of sort of where the equity goes to.
• 30:01
  So there is no, um, there hasn't traditionally been any funding stream for simulation within primary care.
• 30:07
  There still isn't.
• 30:07
  So, um, that's been quite a challenge for us over the, over the years, trying to sort of find that and, and that's what a lot of pace are finding in other areas as well.
• 30:17
  When I go right back to kind of thinking about how, um, we could get this.
• 30:21
  Uh, going.
• 30:22
  And so after that event that I mentioned about the joint injections workshop, I ran a, um, a sort of a pilot session, which was in the sim sway center with, um, some support from the, the, the faculty there, but also thought, actually this needs to be in situ, so let's do a, a trial one.
• 30:39
  So I.
• 30:40
  Did a trial, one trial in my practice.
• 30:43
  Um, and then obviously one of the things I found is like, we kind of needed some mannequins, but how are we gonna get some mannequins out of the hospital? And uh, I was very fortunate with my local team at Wales Hospital.
• 30:52
  They were like, you know, here's an old s Annie, um, that we don't need.
• 30:57
  Um, I think it had one arm actually missing as well.
• 30:59
  It was kind of, but you know, it was fine.
• 31:00
  They were very happy for me to take that offsite, but they were like, but you know, I'm really sorry.
• 31:06
  Our pediatric mannequins are really, really expensive and I don't think, you know, the insurance or the trust will let you take them off sides.
• 31:11
  I was like, okay.
• 31:12
  So I was speaking to one of my colleagues, she's like, oh, don't worry, don't worry.
• 31:15
  My son's got, I'm sure he's got a doll.
• 31:17
  He won't mind us using that.
• 31:18
  We can, we can, you know, we can use this doll.
• 31:20
  It'll be fine.
• 31:20
  I'll bring in this doll.
• 31:22
  And then on the day of the actual session she said, okay, max, I'm really sorry.
• 31:26
  I could not find this doll.
• 31:27
  And I knew we had to have something.
• 31:28
  So I've got this panda.
• 31:30
  Do you think we can use this panda? It says we had like a fluffy panda.
• 31:34
  Um, so, and I say it was kind of slightly mixed emotions 'cause there's a bit of that that goes, we used a panda, we kind of did a huge pre-brief going.
• 31:44
  What we've put today, but you know, we absolutely accept, you know, this is not, you know, please, you know, embrace it.
• 31:50
  Let's see what we can do.
• 31:51
  Let's work with what we've got.
• 31:53
  Um.
• 31:54
  And they totally did.
• 31:55
  In fact, actually one of the receptionists, um, we did an anaphylaxis scenario post of immunization it with this panda.
• 32:02
  Um, but um, one of the receptionists even with that got, you know, quite emotional about just seeing that in, in action.
• 32:09
  Um, but there's another bit and goes co.
• 32:12
  But that's such a difference.
• 32:14
  And the kind of, um, the gap between us using.
• 32:19
  A panda, um, a fluffy panda, and you, you know, some of the sort of really high tech, very, very expensive equipment that are available for use in secondary care is, is huge.
• 32:28
  And we don't need those really expensive ones, but we do perhaps need a little bit of budget to have a little bit of equipment.
• 32:33
  Um, and actually, fortunately, actually after that, the, um, southeast region, um.
• 32:40
  I actually did, did find some, some budgets.
• 32:44
  I'm very, very grateful for, um, for them, for doing that.
• 32:47
  Uh, but you, you have to almost like prove the concept.
• 32:50
  Before you can get the funding.
• 32:52
  Um, and so I'm hoping with the national work that maybe they don't have to find, you know, their, their colleagues sons pandas, um, they can actually have some equipment to start with.
• 33:01
  That's a really lovely story, Jane.
• 33:03
  Um, and it's so important, isn't it? Because actually why is it that hospital trust and naturally getting funding, um.
• 33:09
  For people you know that are in having education in primary care.
• 33:14
  Why, why is that not there? And I'm just, I wonder if it is that traditionally medical schools were usually related to hospitals, most hospital trusts or will have a sort of postgraduate center, which was mainly for medical students.
• 33:27
  Um, nursing students used to also be on site in hospital, but that sort of changed over the years and went into university.
• 33:33
  But there was all these, this post-grad center, which was about medicine, which has become more multidisciplinary now, which is.
• 33:39
  Eight, but actually that's never been there, which is why the, um, training hubs or community education provider networks that we've both, both started on working at came about, but there still isn't that funding yet.
• 33:52
  Within Kenton Midway, we know the new medical school, actually the focus for the first two years for those medical students is to come out to primary care.
• 34:00
  So they, they should.
• 34:01
  Be the funding to follow it.
• 34:02
  Particularly, you're not needed as much, but maybe in other areas of the country, but you having the panda, the bit, I'm just gonna go back to you, you spoke up with the panda and I, I just wanted to talk about this.
• 34:12
  The other, it's sort of going back in our conversation if you like, but you spoke about how one of the receptionists still became quite emotional and we didn't touch on that earlier on.
• 34:21
  Um, do you want to talk about how, or just talk to me about.
• 34:24
  How that emotion and the emotion of the event and how that's managed, but also the learning that comes from that as well.
• 34:30
  Please.
• 34:31
  Yeah.
• 34:32
  I, I think it's, it's difficult.
• 34:33
  There's, there's, there's quite a lot of work around, um, you know, yeah.
• 34:38
  Emotions within simulation 'cause to, to a degree.
• 34:41
  If, if you are managing to enable it to be, you know, realistic and authentic, then it's completely natural and normal that people should be, um, you know.
• 34:50
  Or at least moved by, by what they're experiencing because it's not human, not to, and it's really important that we recognize that, um, as part of healthcare as well.
• 35:00
  Um, so, um, yeah, so there's a bit in the, the pre-brief.
• 35:04
  Um, so there's a, there's a massive bit that we do.
• 35:09
  Um, again, I think when I first got into simulation, I didn't realize perhaps quite how important that was.
• 35:14
  We used to do it, but the, the more I've gone into it, um, the more that kind of scene setting, the more, um, enabling people to, yeah, to embrace what they're doing, but also to recognize that actually her getting upset is a completely natural, normal.
• 35:32
  Response and we shouldn't feel ashamed or upset about that, but, but actually what it does indicate was that one of the things that we also now discuss in the debrief is, you know, okay, if this did happen to you, what would you do next? Um, you know, after the patient has been successfully, you know, managed and they, um, the ambulance, um, team have come and they've taken them to hospital, you know, what actually would you do next? And, and often actually the clinicians in particular will go, oh, just, you know, there'll be a massive queue in the waiting.
• 36:00
  And I go straight back and, um.
• 36:03
  You know, see the next patient and have a conversation about actually, well, you know, actually is that appropriate? And how, how is your mind set? What are you thinking about in those moments? You know, do you think you're really able to kind of flex from being in this really sort of high vein sort of adrenaline response? Um.
• 36:21
  So going back to sort of, uh, you know, sort of seeing patients in that bit.
• 36:24
  Um, and also actually, what about those receptionists? You know, that probably is gonna be the first time they've ever seen somebody who is that sick.
• 36:33
  Um, and unwell.
• 36:35
  Um, because obviously they're not medically trained, but we expect, you know, a massive amount of them.
• 36:39
  Um, and it's really important to be able to have a conversation with them.
• 36:43
  Um.
• 36:45
  And yeah, again, so acknowledge and recognize those emotions are completely natural and completely normal.
• 36:50
  And yeah, talk it through with them and give that them that opportunity, um, and space to do so as well.
• 36:56
  And again, I think that comes down to, and actually that's an event as a team, you know, that's something that, you know, you learn from.
• 37:02
  Um, as a team.
• 37:03
  Thank you.
• 37:04
  Yeah.
• 37:04
  And it bring, it does, it brings in that team learning and recognizing that some people might just be able to, or, or may think that they're able to just carry on, but other people might be, but perhaps not showing their emotions, whereas other people are actually physically displaying them becoming upset and it's quite.
• 37:19
  Obvious and there is something isn't there When things happen in primary care or anywhere you, you know, just going back to carrying on and just being the same, the brain doesn't work in that way.
• 37:30
  It does need that little moment to, to take that, you know, that breath before it does the next bit.
• 37:35
  I do archery, um, as a hobby and between arrows, I'm always told Stop, breathe.
• 37:41
  And start the next one as a brand new thing and be sure that you are ready before you do the next one.
• 37:46
  And I think this is the same.
• 37:48
  I always say, you know, you just need that time just to stop, breathe and, and make sure you're okay before you move on to doing whatever it was that you've been doing previously.
• 37:58
  Just feels so routine, so normal, but actually to do it and do it well and do it properly.
• 38:03
  You, you do need that little bit of moment and perhaps some time later on to reflect on it.
• 38:08
  Is there any, after anything that you do afterwards to that you, um.
• 38:12
  Or that you say to the practice, perhaps, you know, revisit this in a week or a, a later event or something.
• 38:18
  What we do at the end of the debrief, um, is kind of quite specific about what the action point should be for that practice.
• 38:25
  So getting them to kind of work out, you know, what do they want to do next? And very often yeah, that will be around, um, changing.
• 38:35
  Be sort of handover.
• 38:46
  Um, look at doing sort of things differently.
• 38:50
  Um, so we went one place, which is kind of quite a new, um, town center practice.
• 38:56
  And then they had, you know, those sort of lockable bollards that, um, you couldn't access their car park without them.
• 39:02
  So actually they had to, they wrote a protocol for their kind of receptionist if they called an ambulance, which included the fact that, you know, somebody needed to go out.
• 39:11
  Do these ards.
• 39:12
  So they come across some quite specific sort of, um, actionable learning that comes out.
• 39:18
  Um, and actually a lot of this work did also stems about going back into 2021.
• 39:24
  It, it came out of a lot of work we did with the COVID vaccination hubs in West Kent.
• 39:28
  Um, so we did some specific kind of LAIs training there and then pause.
• 39:43
  Where they did actually have cases of, of anaphylaxis, but then did do a, a team's debrief with them afterwards to kind of try and, again, unpick all of those things that worked well, but also just give the staff a space to talk about it, um, and not hold it.
• 39:59
  Um, because again, um, going back to the debrief and then kind of getting emotional, what we found, um.
• 40:07
  An awful lot of people are holding things or traumatic events, either that have happened to them in their kind of working life, but also a lot of people, um, in their, in their personal life.
• 40:18
  Um, so particularly with the, uh, cardiac arrest scenario, we, we often have people coming up to the.
• 40:25
  Debrief.
• 40:25
  So we talk, you know, about the, you know, this could be a triggering event and it's actually important that if you think that might be you come, you know, come and have a chat with us beforehand.
• 40:34
  Um, so a lot of people who it's been their family member, um, that, you know, perhaps has been through that and that's been their last experience.
• 40:42
  Um.
• 40:44
  And again, sometimes the, the pediatric ones in particular are really quite high emotional and a lot of people who've had, um, some quite sort of traumatic events with their own children too.
• 40:53
  And I suppose that brings us to that, um, emotional labor and that emotional to toil.
• 40:59
  I so often come back to, this is Dr.
• Rebecca Myers spoke about this and actually the work that we do is emotionally, um, it is, there is an emotional toll.
• 41:09
  That it takes and, and absolutely when things happen for most of us, and I hadn't sort of thought about what or thought about this explicitly because I, I'm immediately thinking of scenarios where it has happened, where something happens, whether it be a simulation event or a real life one where you're taken back to something that's happened with your own family or something personal that has also take, had an emotional.
• 41:30
  Toll and you need to sort of think about and just be aware of for people.
• 41:34
  So I think there's so much that comes from this, Jane.
• 41:37
  So I've asked you lots of questions and I feel like I've taken you around the houses a little bit actually today.
• 41:41
  Jane, is there anything else before you came on you're thinking, oh, when I'm, when I'm on with Ruth, I really want to talk about or to say about, I know I was quite keen on that culture bit because that's the bit that I really.
• 41:52
  Got from this, from the, that move from, yes, we've got a clinical skill, but actually all that emotional, um, and team say emotional.
• 42:00
  What I meant was teamworking, that teamworking part and that culture, which I think there is, but is there anything else that, for you that you want to sort of say or, or touch upon? It's interesting because we've talked about the sort of medical emergencies, but actually I think the recognition that, um, in, in GP.
• 42:16
  Uh, primary care.
• 42:17
  We have been work running simulations for quite some time, but they've really been around consultation, training and communication skills.
• 42:24
  And actually just recognizing that, um, in the big world of simulation, that uh, there's a lot that I feel that, you know, GP.
• 42:36
  Primary care, primary as in the big, I don't mean just, just gps, I mean all of, um, the clinicians that work in, in primary care can also offer our secondary care colleagues in terms of how, um, we deal with patients in terms of sort of consultation skills, training and communication skills as well.
• 42:50
  So I feel there's, there's a bit about that.
• 42:52
  Um, and also actually that.
• 42:54
  This has springboarded so many different aspects.
• 42:57
  So we have some human factors workshops that we run.
• 43:01
  We're doing some specific workshops with receptionists or managing, um, conversations at the desk, which may be challenging.
• 43:09
  Uh, we've got a number of different sort of fellows who were working on various, sort of different, different projects.
• 43:15
  Um.
• 43:17
  And, uh, yeah, sort of different things around sort of end of life care.
• 43:20
  There's, there's actually so much you can do with simulation.
• 43:23
  Um, so I suppose it would be just, yeah, recognizing it's, it's, there's a massive sort of big picture.
• 43:29
  So, um, although this is definitely kind of all core work and there's so much learning and so many ripple effects that come from it, um.
• 43:39
  And also, I suppose I just, yeah, thank you.
• 43:41
  I think to our kind of simulation faculty, because they're the most amazing bunch of, of clinicians, um, out there who are working clinically, but, um, just love doing these sessions and that the passion that they.
• 43:54
  To the work is absolutely massive.
• 43:56
  Thank you Jane.
• 43:57
  And I will just say, I believe you've been not, I think I got in touch with you on uh, 'cause I saw on LinkedIn and said, Jane, you need to come on.
• 44:03
  'cause you've been nominated for a wall because of the amazing team and the work that you are doing as well, haven't you? So I think it's a nomination at this point.
• 44:11
  Am I right? Yeah.
• 44:12
  So we're finalist in, um, through of the HSJ Patient Safety Award, so the patient safety education and training award and the urgent and emergency initiative of the care.
• 44:22
  Uh, care award.
• 44:24
  Uh, so yes, we've done the presentations for them and then the, the, uh, finalists are actually revealed in September.
• 44:30
  Congratulations on that point.
• 44:31
  And it's come from some amazing work as well.
• 44:34
  And you just, and I will just come back 'cause it's one of those things you mentioned about the human factors.
• 44:38
  You know, we talked about that team culture and that sort of culture of learning as well.
• 44:42
  But actually when, afterwards, after this event, I think that debriefing, because often after events we do have to do look into what, why did something happen? What went well or not so well? Does that help with people to actually do that? Think about how they look at an event afterwards and think about the human factors that are in there and that emotional side or all the other factors that can come in as well.
• 45:03
  Yeah, I'd, I'd certainly like to think.
• 45:05
  So there's a lot, again, simulation about, you know, how you need container.
• 45:17
  That, that things do leak out after the, after the event as well.
• 45:21
  You know, people get very tied up on the, you know, the, the simulation.
• 45:24
  And the simulation obviously is the bit, but that is just the bit that you hang the learning off and you, you could have a simulation and you could virtually have no learning at all.
• 45:32
  'cause unless you have that really well facilitated, um, debrief, you will not get the level of, of learning, um, at all.
• 45:40
  And actually it's a huge skill, uh, to learn that.
• 45:45
  Um, as faculty, um, it's something we work really, really hard on.
• 45:50
  Uh, we debrief in pair so that we can go debrief and we can help support each other, but also so that we are also constantly learning.
• 45:58
  So we always do a debrief afterwards.
• 46:00
  Um, for us as faculty, again, kind of practicing what we're showing so that we're, um.
• 46:07
  You know, constantly embedding our own learning as well.
• 46:09
  So we also work out, you know, what did go well? Let's do that again.
• 46:13
  Okay.
• 46:13
  That question didn't land how I wanted it to land.
• 46:16
  So maybe I'll rephrase that.
• 46:17
  How about I use, you know, that in a slightly different way or, you know, perhaps we should have intervened a little bit earlier or, you know, all of those sort of things.
• 46:26
  Um, we do and we have, um, an amazing community of practice.
• 46:30
  Um, so we have.
• 46:33
  To be able ability share that learning as well within that as well.
• 46:36
  So that's, you know, really core and crucial, um, to our faculty.
• 46:40
  Before we go, um, are there any key messages that you want people to perhaps take away or key points? And then is there any sort of, um, a call to action, if you like, of what needs to happen next? Yeah.
• 46:56
  I think not just about simulation, but just generally I think right back to that, you know, however, many years ago now when I had that idea and was being, having quite a few doors sort of shuffle me to being told that it wasn't something for primary care.
• 47:09
  I think it's about, um.
• 47:11
  Finding your people.
• 47:12
  Um, kind of that, that, you know, that guiding coalition, if we go back to, you know, something work of change, but you know those people that are gonna help sort of support you and if you really believe in it, then actually, you know, you're gonna have some people that are gonna say, no, it's not gonna work.
• 47:26
  But, you know, keep going, keep driving it forward.
• 47:30
  I think there's sort of definitely, um, something around that.
• 47:40
  Because I think I spent quite a lot of time going, you know, simulation's amazing.
• 47:43
  You know, why won't you fund it in a kind of, you know, in a nutshell, essentially.
• 47:47
  But I needed to learn to go, okay, well this audience perhaps needs to hear, it's gonna hit X, Y, and Z priorities, which is important for that organization, and these people need to A, B, and C, because maybe that's going to, um, align with their priorities.
• 48:00
  So a bit about kind of being strategic in, in, in, in who and how you talk to.
• 48:06
  Um, people.
• 48:08
  And then ultimately I think the call for action is, I think, you know, this is something that we need in primary care.
• 48:15
  I, um, you know, we know it works.
• 48:18
  The evidence is there.
• 48:20
  The evidence is that it's, this isn't just clinical learning.
• 48:23
  This is learning that really empowers and improves team working, improves and enhances, uh, team culture in practices.
• 48:34
  If we're looking at things like the sort of the, the 10 year plan and looking at more work coming into primary care and into the community, what we also need to do is actually work out how these people work together.
• 48:46
  And simulation is a, a really good way of being able to do that.
• 48:49
  Um, whether it is around managing an emergency that crosses our organizational boundaries or actually whether we look at, um, other aspects, but just kind of putting it.
• 48:59
  In a room and doing some sort of tabletop simulation around of care and getting people to communicate in that way, but using the same principles of simulation, that pre-brief about how you get people to who's in the room, who's in the room, and then simulation, and then the debrief.
• 49:16
  When you do some really fantastic facilitated learning and people are able to kind of voice.
• 49:22
  Um, so I think there's some really powerful learning we could, we could do with simulation.
• 49:26
  I think that's a whole bit that we could probably touch on.
• 49:29
  Again, that sort of across organizational learning 'cause that would be the ideal.
• 49:33
  And as you say, as things are starting to move out more and more community, um, I mean this is a 10 year plan, but I think it's been in lots of plans before.
• 49:41
  Um, but you know, we have a new plan every sort of through a 10 year plan, don't we, every three or four years.
• 49:48
  Actually they, they are often saying the same things that everything needs to move to the community, but to do that, then everybody from the hospital trusts and everywhere else needs to understand community and primary care.
• 49:57
  And we need to understand them, uh, or people need to understand them the other way round.
• 50:01
  So thank you for that, Jane.
• 50:02
  It's been really fascinating and interesting to have you on the show.
• 50:05
  Um, right back to the beginning when you spoke.
• 50:07
  Spoke to me about the fact that you started that training just in your living room.
• 50:11
  Uh, what was it, 2020.
• 50:13
  Uh, so your passion came from there to think actually we don't just need talk and talk.
• 50:17
  We need to question think, um, think critically and work out.
• 50:21
  And that's obviously driven you all the way through to what you're doing now.
• 50:24
  So good luck with your awards.
• 50:26
  I think that you should get both of them, but I'm not on the judging, um, the judging panel.
• 50:31
  So we will wait and see.
• 50:32
  But yeah, it's been really nice to speak to you today.
• 50:33
  Thank you very much.
• 50:34
  Pleasure.
• 50:38
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• 50:41
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• 50:46
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• 50:50
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• 50:54
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• 51:07
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• 51:13
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