Wild Card - Whose Shoes?

2. Dr Farzana Hussain - a fellow HSJ100 Wild Card!

• Gill Phillips @WhoseShoes

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My very first podcast guest!

Very special indeed that my good friend Dr Farzana Hussain, GP of the year 2020 and fellow #HSJ100 Wild Card,  dived in to do this with me. 

This is exactly the tone I am wanting for the podcast series – full of humanity, wisdom,  curiosity and very informal. Please give us some feedback. We are really hoping that you enjoy our conversation.

 Lots of lemon lightbulbs! (See 'chapter headings' for more detail and to pick out your favourite bits) including:

  • Understand the wider determinants of health
  • See the person and help them have the best life they can
  • Be curious and use it for good (how Farzana increased vaccination rates)
  • Build trusted relationships, continuity of carer ... and even a bit of banter! 
  • Build on the innovation that has happened during the pandemic: people pulling together, including faith groups and communities
  • Share the good stuff! 
  • Simple solutions can be the most effective – often they come from the community
  •  We're all learning, doing our best
  • You can’t have evidence until someone has done something!
  •  We are all human. We all need support, including healthcare professionals
  •  Shared decision-making. Listening deeply and valuing people; understand what is important to them.  All perspectives. True coproduction !
  • Be prepared to show  vulnerability
  • Work together! 
  •  Important role for social prescribing, non-medical solutions
  • Make sure we look after young people!
  •  Focus on wellbeing and prevention, as well as people with diagnosable conditions. 
    In particular mental health: young people in the context of the pandemic
  •  Welcome to Amanda Pritchard, new CEO of the NHS, and the first woman! Yay!
  • The wider wellness agenda - beyond the NHS
  • Quick wins and looking longer-term
  •  Support, time and resources ... Do things together! 


Supporting resources

London GP personally calling at-risk patients to boost COVID-19 vaccine uptake | GPonline

Sam Allen blog: Amanda Pritchard’s appointment: a moment in NHS history | NHS Confederation

Social prescribing: Home | The Social Prescribing Network

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Please recommend 'Wild Card - Whose Shoes' to others who enjoy hearing passionate people talk about their experiences of improving health care.

Gill Phillips:

So, I'm absolutely delighted to welcome my friend Dr. Farzana Hussain, my very first podcast guest. Now, Farzana is GP of the year. She's an amazing role model. She was absolutely, or IS, innovative and inspirational during the pandemic. She's incredibly person-centred. And I believe Farzana, that you were an HSJ, wildcard yourself last year. I love the way you've been prepared to just jump into the unknown here with me and start an adventure. So tell us a bit more about yourself, and what's important to you.

Farzana Hussain:

Well, thanks so much for having me Gill, a fellow wildcard and I'm delighted to be your first guest. So I just say Gill, I've been a GP, it's my 20th year this year as a GP, and I work in Newham in East London, and I trained there as a junior doctor as well. So it's my 24th year as a doctor. And I'm also a clinical director for one of our Primary Care Networks. Primary Care Network are a grouping up a number of general practices. And the idea of that that came out in the 2019 long-term plan is that the these Primary Care Networks are very much based in the community at place level, looking after between 30 to 70,000; mine is 67,000. And that we really work with our communities and with our hospitals with our mental health trust to really integrate that work together. And I found the concept of that really exciting because for like 15-16 years, I'd been a GP. And I just felt Gil, that things that I was doing in my consulting room, it was very much in isolation, I felt I was part of a jigsaw puzzle, but I couldn't see the other parts. So a very simple example, you know, some of my children with asthma ... it's all very well, giving them the inhalers, but actually, if they're living in damp conditions in their house, and actually, you know, mum is struggling and you know, smoking is the only thing that gets her through the day, because she's got so many other things. So that's why the determinants of health and addressing them is really quite important to me, because I don't think as a GP, I can offer good health, otherwise. So that's quite important to me, really Gill. And of course, it's great to be on your podcast, because you actually taught me a lot when I first met you through through the lovely Becky Malby, who I know is very passionate about communities and networks and all the great stuff she does at Southbank University, as a professor. And Gill, before I met you, my experience of dementia had been very much Well, the first thing was, Oh, this is going to be a very long letter that I'm going to read from the hospital. And this is going to take me a long time. And then it was, Oh, this probably is a home visit. And the third thing was, oh my gosh, will the family tell me off because I'm not looking after this person properly. And those were all the anxieties that were going through my head as a GP. And I think one of the things that you helped me with was, with your great board game idea, you made me realise - that sounds so obvious, doesn't it? - but that actually people suffer from dementia or people and that actually there's a lot of other assets out there that we as GPs can draw on. And, you know, just thinking about these people as frail old people who are extra work for us might not be the first thing to think about.

Gill Phillips:

Well, so that could even be one of ... we mentioned before we started talking about leading up to some lemon lightbulbs. So that could perhaps be the the first one?

Farzana Hussain:

Could be a lemon light lightbulb! A lemon light lightbulb that when we think about ... now I'm using dementia as an example ... but when we think about somebody with an illness, and particularly if we're seeing a lot of complex conditions as we've got an ageing population, that we maybe frame it differently. Oh, and I think something you know - I am working in the NHS, I love the NHS, but I think something I would say the NHS perhaps doesn't maybe do as well as it could is that we very much start from a place of "How can we empty the hospital beds? How can we save more money?" And I wonder if we'll be better off starting thinking about how can we help so and so's mum, who happens to have dementia, live the best life she can. So it was because of you that I got interested in other things that people with dementia can have. And then of course our mayor of London Sadiq Khan talked about the London museum being the first museum that's dementia friendly, and I would never have gone to visit that if it wasn't for you. And I had a great day out myself and I saw what they did and it helped me think about my my patients in a more ... they are people! These are not you know, they are not just lying there dying right at this moment, which is sadly, you know, one of the things I used to think of when I thought about dementia. So, yeah, lemon lightbulb moment would be for me - even when we see a lot o illnesses, let's think about th person behind the illness. An if I were running the NHS, whic I'm not, I woulds maybe start b thinking about that, rather tha how do we keep people a hospital

Gill Phillips:

That's brilliant. And I mean, it's been so reciprocal, I think our whole relationship and as you were talking there, and about being interested in the social determinants of health and why people smoke, and so on. And o one of the things I mention d at the beginning that I'v been so impressed by how yo've been during the pandemic and the combination of you self and there's a doctor o Twitter called Dr. Bob Klaber, who I find fascinating, and he's got a concept 'be curious'. And I think in one or two se sions I've mentioned you, Farz na as a curious person. And I've absolutely loved the way that instead of just saying "C VID vaccination is good for yo, you must have it", you've fou d out WHY, you've got into t e shoes of your patients in te ms of, you know, talking throug with them what it is they re worried about, and as a trus ed person, chatting that through with them, and then naturally .. Tell us a bit more a

Farzana Hussain:

Yeah, Gill. So you know, I consider myself a really nosy person, and I think that's a positive thing if you're a GP. I think curiosity is so important. And you know, we kind of are born with that, or we I think it gets knocked out of people. Because if you see little children, they're always curious, something going into cupboards looking at people- they're curious! I think we're born with that ability. And I was noticing with the COVID vaccine Gill that, again, where I am in Newham sadly, we had the highest COVID death rates during the first wave. And I was noticing very early on in December, only about two, three weeks into the campaign where at that moment, we were still only vaccinating the over 65s and the extremely vulnerable. And in my own practice list, on a list of 5000 people, I noticed that the over 65s, that had been (only 50% of mine had been) and all the over 65s that had been(vaccinated) were Caucasian, and all the over 65 that hadn't been were all either BAME or Eastern Europeans. And it was so, it was so striking! And I just thought, I wonder what's going on here. And I'm very fortunate Gill, I'm very blessed to be, I've been in my practice for 18 years. And I know a lot of them. And my over-65 numbers are quite small, like I've got only 200 over 65. So we're talking about 100 people. And I started ringing them. I just thought just again out of curiosity, "let's ring" and it was so you know, various different reasons. I had a, you know, an African lady who's in her 80s, who was concerned about the long-term effects, you know, she's very concerned. And I know her really well, Gill. And I said, "Well, if you grow a second head in 20 years time when you're 103, I'm not upset and I'll come and cut it off for you myself. Because I know her, we were able to giggle and her son was also very instrumental. He wanted his mom to have it. So I was having a joke with her. And then I lost my own Mum, as you know, Gill, when I was 19. And I said to her, "My mum would have been just a year older than you now. She's not here. But if she was here, I would want her to have it. And even though you're not my mom, I would want you to have it". Three days later, she had it. She rang me back to say she'd had it.

Gill Phillips:

That's amazing.

Farzana Hussain:

And I think that's the ... I forget how blessed and privileged I am. But also what a great privilege and position it is that actually, we have so much trust as GPs. And I think it's part of our duty to do. I didn't get a success rate with everybody at the time Gill, only about one in five went but as the months went, I'm happy to say that my over-65 vaccination rate at the practice is over 75% double vaccinated. And the rest of North- East London hasn't got that. I mean, most are still under 50% double vaccinated. So it does show me the power of those individual conversations. Now I know that takes time and I'm not suggesting that all GPs would have that time but it certainly worked for us and I think it was a great piece of work. So I'd definitely do it again. You know, now that we know how many lives are being saved by the vaccines.

Gill Phillips:

And I think what I'm hearing there is that you really know the patients ... the combination of ... you call it nosiness, be curious, whatever it might be, but people appreciate that and then the personalised care. So you couldn't write a manual saying, you know, if somebody of a certain age, you tell them that in 20 years time... You know, that's such a personalised story. And it reminds me of ... I mean, obviously I hear a lot of these stories through my work. So one of the mums that we worked with, she's been a brilliant #MatExp champion and leader, and her campaign became around hospital breastfeeding, because she knew that she was very good at breastfeeding, because her youngest son had had serious heart problems. And she got involved in, in care where it became difficult to do what she needed to do as a mum in terms of breastfeeding. And her older son, people in the hospital had nicknamed her Daisy as such a wonderful milk provider. Now, that seems to me a similar sort of story. And you know, what I love about the kind of properly person-centred approaches is it's about having that relationship and knowing that person well enough to do something that's a little bit quirky or a little bit cheeky,

Farzana Hussain:

That's it exactly Gill, again a lemon lightbulb moment, there's nothing that is a substitute for a good trusted relationship. Yeah, absolutely, you can get away with cheek, you can get away with so much. And of course, there's a lot of evidence that GPs that have continuity know their patients really well actually also reduce referrals and prescribing because, you know, they know them. I think one of my, one of my sadnesses is that, as I see, I understand about, you know, corporate care, but I do worry that we're losing that smallness and that family medicine that we had in primary care. I hope that there's still a place for it. I think primary care networks offer a solution to a different issue. I think ICSs - big, integrated care systems - offer different but I think you need an appropriate size for each place. And I am sad to see that small practices are becoming a thing of yesterday, because I don't think there is a there is a substitute for that trusted relationship.

Gill Phillips:

That's really interesting. Because when people you know, certainly of my age used to talk in terms of "my GP", you meant "my GP". It was the person that you saw, whereas now it can, you know, at worst be a name on a bit of paper. You know, from that big practice, you've been allocated to someone. So yeah, lots to think about isn't there?

Farzana Hussain:

Lots to think about. But I do think Gill that with the pandemic. I think that we've accelerated in many ways. I think that, you know, they say, don't they burning platform, there was an absolute need for the whole world to function differently. And unless I'd lived through it Gill ... Wow, what a roller coaster the last 18 months has been. But if you had asked me when I first met you, "You know Farzana, would you be able to, like go fully online triage at your practice? Would you be able to do a drive-thru clinic for your childhood immunizations? Would you be able to make all these changes, I would say, of course not Gill! And I think ... would primary care be able to do 75% of the delivery of a vaccinating an entire country? Well, I would just say, "You're off your rocker, Gill!" Do you know, we're good? We're not that good. But it happened. And it absolutely shows, you know, well, first of all, how lucky I am to live in England, and how great it is to be in the NHS, because actually, people pulled together. And it was again about those relationships Gill. I had a consultant call me, which doesn't happen that much. You know, we talk about integrated care, but we have sadly, it's really awful but in primary care we don't talk to the hospital that much. I had a consultant call me about a Covid patient. And he said, "Oh, is it alright, if I just talk to you?" and I was like, "Yes..." And I was waiting. I was waiting for what he was going to say. And he said, "They don't need admitting. I just wondered, could you write them up some antibiotics for me and just review them in two days?" I was like, "Yeah". And he said, "Can you?" And I said "Yeah, that's quite easy for me". It just, it really made me think about how we really need to pick up the phone more with each other because he thought he was asking me for a pot of gold. And this was actually an easy piece of work for me. So I hope that continues, again with the COVID vaccine, working with our councils, particularly working with our communities, and you know, faith groups, communities, that's been phenomenal. And I hope we don't lose that. I hope we can now do that for other things. You know, whether it's breastfeeding or obesity, or whatever we want to talk about.

Gill Phillips:

And hanging on to that, that good stuff. I mean, I think that was another point at which our paths crossed because you remember last year I was trying to develop virtual Whose Shoes and basically the plan was, and I think one thing I really enjoy ... and there's good practice out there. There's great practice out there, people do things well and quickly. So you get perhaps the negativity about certain things. So my take on it is often "Well if you can share the good stuff, so and so is says managing to do that, so and so is doing that and whether that comes from the NHS, or social care or from the community ... I mean, obviously, the community and the way they responded, saved us in some ways. But at that early stage, I remember picking up ... I mean, I think you're quite diffident in that ... it wasn't just 'the NHS doing those various things', you were a leader in terms of, you know, certainly I saw the outdoor vaccinations and the children's immunizations and so on, and I suppose what I loved about it was, I really love simple things, and things that we've never have thought of in a million years, actually, if you're trying to keep people apart, or not spend too long in contact with each other but this intervention is really, really important, to give the child their jab ... It's not rocket science!

Farzana Hussain:

It's not rocket science, and I think you've hit the nail on the head Gill. And actually, sometimes those simple solutions are the ones that are the most effective. And often they come from the community, because, again - I'm not tryin to put down the NHS. I love the NHS - but someth ng that we, particularly as do tors, we're very keen on evid nce Gill like everything is evid nce, and I understand th t, I mean you wouldn't ant to put an injection of a dr g in somebody without good ev dence that it won't kill them I understand that. But I also hink that sometimes, if we wa t to look for evidence, we can also hold ourselves back becaus somebody needs to do it to create evidence. So if we ll waited for evidence, there as 100 of us in the room, nd we all thought, let's see th evidence and everybody waited, hen nobody's going to achie e anything, because nobody's d ne anything to create any vidence. So sometimes I think and that's what I love abou being a GP, because we can e a bit more rough and ready an we can work with our patients. didn't know if I was doing th right thing with the childhood mmunizations clinic, Gill a d we quickly realised that not e erybody in Newham has a car so it's great to have a drive-th u but, we quickly changed t to 'bring a buggy through' as well. Your buggy can be c assed as a vehicle! So our li tle kiddies were coming in in t eir buggies and I was vaccin ting - well, my nurse and I were both out there in our fron garden. And it was a bit indy. And I said to dad - da had brought this one in ... an only a four month old. And I s id "I'm really sorry, I hope he's not too cold. You know, w're just like trying things out" And the dad, who is the perso I'll always remember, it wa only our second week doing it. nd he said, "Doctor, we're a l learning and I know you'r doing your best". And that, to me meant a lot because I asn't quite sure. And I still fe l emotional about that. Because I needed to hear that from im. He said, "We're all learn ng doctorand I know you're do ng your best". You know, that w s March 2020. And our vac ination rates went up becau e our vaccination rates h ve gone down Gill and we know hat measles had made a comebac in London a few years ago anyw y. And that was my fear that we' e in the middle of a pandemic with Covid. And now we're goi g to get other infectious d seases resurging, where we do have vaccines. So it was r ally important

Gill Phillips:

And I think, you know, that's another lemon lightbulb. That feedback from the community that it's not all one-way is it? That, you know, you need that reinforcement, you need that support. You know, that's really nice to hear. And I'm glad that ... I'm sure he'd be delighted that that's ... like stuck with you.

Farzana Hussain:

It is so important. And I think that now when we are all feeling a bit jaded and tired after 18 months, and we know that, you know, a lot of people have waited for their GP appointments during lockdown. And we're seeing this real, like there's been a 25% increase. This is the time when now we need to work together with our communities, because sometimes under times of stress, it becomes a bit tribal. And you can see "Oh, those patients are asking for too many appointments!". And "those GPs are not seeing us face to face!" And actually the answer is if we talk to each other and you know, both of us need reassurance. I hope that we do that more as we get to integrated care systems. And we don't continue, perhaps sometimes that patriarchal matriarchal nature that the NHS and doctors have had, you know, you've come to see the doctor. And I know, and I will tell you what to do. Because I don't think that works.

Gill Phillips:

No, the whole shared decision making, I think, you know, in terms of the work that we do, seeing the power of people who perhaps come along to a workshop as complainants, and expecting perhaps, I don't know, to have a battle or not be heard or whatever. I think one of the key things I've seen throughout all of our work is as soon as people realise that the healthcare professionals are actually very keen to listen properly, and to value the people and value their perspectives. Then it's almost like a balloon coming down, that instead of everyone being kind of like defensive and then they realise well that the healthcare professionals have got problems as well and we're all human together. And then you can always sort of feel the collective relief that we then just start talking to each other as human beings. And it's amazing, then anything's possible at that point, and very often the outcomes aren't things that you'd have predicted at the beginning. And sometimes it worries me if people want, you know, an apparent in inverted commas 'co production workshop', but to achieve a certain outcome, well, actually, the coproduction needs to determine what the outcome is. A bit like our podcast here!

Farzana Hussain:

Yeah, we're just learning as we go! And I think there's a lot of, you know, fun in that. And I do think that requires people to let themselves be a bit vulnerable. And again, you've said a light bulb thing there, again, that we're talking about trusting relationships. And we're talking about the same thing, again, aren't we that we need to trust the people that we're looking after that they also ... I might have a bit more scientific knowledge, because I've been to medical school, just like if I take my car in to be serviced, I'm expecting the car mechanic will know more about the car than me. But But otherwise, I'm here to provide a bit of the knowledge, and then think about what my patients want to do. And I think that, I think we lose that a bit sometimes. And I think this is a really good time to do it do Gill because now that obviously, primary care networks are here, we're two years old, we've got a lot of supporters, GPs with our additional staff. So we've got pharmacists, we've got physicians associates, and we've got social prescribers. And social prescribers are people who are not medical, and I think that's an asset. And they, we think about the whole person, and what they might or might not need. And I think that's a brilliant role. And I think that has enhanced care for our people and our patients. And I'm hoping that that's going to span out actually. We're, in our network, looking at getting a specific young person's social prescriber now.

Gill Phillips:

Wow, that sounds interesting.

Farzana Hussain:

So, so because we're quite a young borough, and we've got issues like, you know, knife crime and other things. And, you know, everybody's got a lot of mental health isssues that are affecting young people. So I think that that's quite an exciting thing. And I, I do think that, I might say this because I'm a GP, but obviously, I'm in the community. I live in Newham, I work in Newham, Newham is very important to me. And I think sometimes again, we spend a lot of time in the NHS talking about getting people out of hospital and how much it costs for the 89 year old with five different illnesses to be in hospital. But what are we doing for our young people in that prevention thing, because their lives are no less important. And just because they don't spend a lot of time in hospital in bed, doesn't mean that they're not important. So, if it was up to me, I would try and turn that on its head and really look at that prevention agenda. And also think about what we can do in the community and how the community can help us.

Gill Phillips:

And probably, particularly after the pandemic,

Farzana Hussain:

Absolutely, Gill. And just as a parent of a I would guess, in that we've all thought about protecting older people - and children and you g people have, you know, be n safer from COVID but missi g their education, missing th 17 year old and an 18 year old, I forget what a big portion of ir friends. You know, I'd like to see a lot of focus going on young people in terms of making up for all that they've lost eally. their life 18 months has been because me at 48, 2 years doesn't seem that long when you're my age, but I forget that, you know, my 17 year old didn't take GCSEs, she didn't say goodbye to her friends, and went to a different sixth form. And I hadn't fully understood like how angry she was about that. And how she, you know, she desperately wants to see her friends and go out a lot more now. And you know, she hasn't

Gill Phillips:

And I think in terms of, you know, you use that got a diagnosable mental health issue, but many of my young people have. And I wonder about many of my patients who aren't coming forward, because of course, they could deteriorate. They're only young people, their whole lives are ahead of them. phrase 'diagnosable mental health condition'. And I suppose, part of the work that I'd hoped to do, and perhaps particularly a role for this podcast series might be to think about how the NHS needs to concentrate on wellness and wellbeing as opposed to just illness and you know, the opportunity to reach out to the community. I suppose I've got this dream of just like linking everything up and the community is a very big part of that. And the people who are well at the moment, but if you don't giv them any, you know, not neces arily NHS support, but general s pport, then they'll become il and they'll come into the syste.

Farzana Hussain:

Well, I couldn't agree more and we were talking before we came on, weren't we, about what would you say to the new CEO of the NHS? Because now we know it's Amanda Pritchard and I had the privilege of meeting her before the pandemic. I was fortunate to be invited to a roundtable event on ICS and she was just so lovely. She was just so like ... I went and said hello. And she was just so down to earth, just so just normal and lovely. So I think we're very fortunate to have her and obviously the first woman to run the NHS, it's fantastic. But if we're really going to think about the wellness agenda now, we have to do exactly as you say. We need to think about, what can we put in, and it doesn't necessarily need to be NHS. But those little interventions, I think, will have huge gains. And people around the country are doing it, you were talking earlier about pockets of good practice. I know in the north-west, you know, they've had mental health cafes for a number of years. And sometimes, if somebody just has one, that's not a huge resource, but you might be actually saving somebody going into a psychiatric hospital years down the line, you know, you might not be, but you might be. And I think we just need to prioritise that as well, because I think these are quite quick wins that aren't even particularly expensive. And I think sometimes I understand when you're on a tight budget, as obviously the NHS is, you probably think about your biggest spends, but I wonder if we should also be looking overall, and looking at the long term thing that if we keep these guys well, not only to increase their quality of life, probably save a lot of money as well.

Gill Phillips:

Yeah. Lots to think about. I was reading a blog, I don't know if it's only come out today, but I read it today, Sam Allen has written a blog about the new Chief Executive and delighted that she's a woman, etc, etc. But that that's only part of the story. And I was thinking , I've set up this podcast series, specifically as a result of being named as a 'Wild Card'. And the brief was basically, people who'd have something to say to the new Chief Exec, I'm thinking, poor woman, she's gonna have her ears battered from every direction, and whether she'll ever get the chance to listen to my podcast, but I think she'll gain something if she does. I think the three things mentioned in this article that she would need was support and time and resources. So we can all have all these fantastic ideas, but she's only a human being as well and actually to run a service that's properly resourced, and with, you know, the right priorities is key.

Farzana Hussain:

Definitely support, time and resources. And that time is always something we feel very short of. And I think it's up to each one of us in the NHS to support her with that as well, you know, with the communication and the feedback. And then I guess, someone like me, who is a GP, seeing patients on the front line is then to also get that feedback from our community. So it's a chain, isn't it? And because we do all need to do this together, it isn't like one person's issue. It's a whole society issue. And I think never more important now than the period we're in, living in a pandemic.

Gill Phillips:

So, that's another key message. Do things together!

Farzana Hussain:

Do things together! Yeah, I'm really enjoying these lemon lightbulb moments. Trusted relationships, do things together. And certainly that feedback we get from our patients is priceless. It does keep us going.

Gill Phillips:

That's amazing. Farzana, was there anything? I'm just thinking we mentioned time just then ... we'd set ourselves a notional 30 minutes. Is there anything you think that we've... I mean, obviously, we could talk all day!

Farzana Hussain:

No, I think I've chatted away there. Thank you so much for having me. I really enjoyed that.

Gill Phillips:

OK, that's the end of our first guest podcast. I'm over the moon with speaking to you Farzana for the first session, and let's hope the podcast series makes a big difference to improving healthcare and lots of interesting chats and connections.

Farzana Hussain:

And thanks for having me, Gill. Take care.

Gill Phillips:

Thank you Farzana!