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Lyndsay: Hi, everyone. I just like to welcome you to our latest Realistic Medicine podcast. My name is Lyndsay Stewart and I am the programme manager for Realistic Medicine in NHS Highland. So in this episode today, I'm joined by Amanda, who is one of our programme managers in NHS Grampian. And what we're wanting to do today is just have general discussion about what we do, what made us want to be involved with Realistic Medicine and what sort of challenges and successes that we've had. And then our must do recommendations for anybody new who's starting with Realistic Medicine or looking to implement it in services in their health boards. So, like I said, my name is Lyndsay Stewart and I'm based in NHS Highland. So my background is non clinical, so I do a lot of work still currently within endoscopy service within Raigmore for NHS Highland. And as a programme manager for Realistic Medicine, really our role has been a central point of contact, so anybody can come to us for advice or any questions that they have, try to get communication out for Realistic Medicine and to manage and co-ordinate activity. So that's a little bit about myself and I will hand over to Amanda to introduce yourself.
Amanda: Thanks, Lyndsay. So, yeah, as Lyndsay said, I'm Amanda. Amanda Gotch. I am the realistic medicine programme manager for NHS Grampian and NHS Orkney. We actually have a collaboration with Orkney. We started that just around early this year, early 2022. And I will go into a bit more detail about that as Lyndsay and I chat. I am a midwife by clinical background. I've been a midwife for a very long time, but I really kind of came around to doing this work as a programme manager for Realistic Medicine after undertaking the Scottish Quality and Safety Fellowship. I Heard about Realistic Medicine whilst on the fellowship and thought, well, that makes sense to me as a midwife. So really, from there, when the opportunity came up to be the programme manager at the time for Grampian, I absolutely jumped on the opportunity and here I am.
Lyndsay: Absolutely, yeah, it's a bit like myself. So when I saw the post for the program manager for Realistic Medicine come up with my background, I look on a daily basis at the evergrowing waiting list within every hospital in Scotland, not just ourselves or with yourself in Grampian. And, you'll know, and the amount of times that I've seen patients who sat on a waiting list for weeks and weeks, then when we had capacity, we would call for the patient. And I can't stress the amount of times we had patients on the phone to us saying, oh, I don't know why I'm on the waiting list for that procedure. Or we'll phone them and say, yep, we're going to call you and you're going to come in for your colonoscopy. And when we say to them, you know, you'll have four litres of bowel prep what the procedure actually is straight away, they're going, oh, I can't do that, I don't want to do that. And if they used realistic medicine at either a clinic appointment or at the GP appointment and said, this is what might happen, you can have that conversation there, and then to the patient to say, you know, this is what to expect, there might be an alternative that they can do, but also, if there is no alternative, you're giving the patient the right information to prepare themselves. I know myself, I'm terrified of the dentist and I had to go for my first filling and I had a nightmare for a week until I actually asked the question and it put my mind at ease. So I think it makes sense. It absolutely makes sense.
Amanda: Yeah, absolutely. And I think that shared decision making and personalized care with the kind of two of the six principles that spoke to me most, lindsay as well, and I think, again, not just as well, yes, as a midwife, but also as a human being. And you're right. It is that we always imagine the worst case scenario. Don't we. When we've got to go through something and it might be bad. It might be bad. But being able to have the opportunity to prepare for it and at least start to maybe understand a bit more about the things that could happen and the things that definitely won't happen. It goes a long way. I think. To helping make people make decisions. And we do know there is evidence out there that when people are given all the information to help them to make a decision. They usually choose the most conservative option as well. Which I think is especially in today's healthcare kind of landscape that we're looking at. I think that's something we need to be aware of. That. You know. Like you say. Those people you phone up that say.
Lyndsay: Oh. No.
Amanda: I don't know why I'm on that waiting list. That's some work we're going to be doing in Grampion. We've just been awarded funding in Grampian and in Orkney to look at why people are unnecessarily put on waiting lists. Why are people added to these? What is that? Is that just in case? Is that just we need to feel like we're doing something. I'm just kind of plucking things out here, but we've got an external company who's going to come. They did the it's okay to ask a campaign for the National Campaign for NHS 24, so we're going to employ them to do the research in the first year around. What that's about, these unnecessary or inappropriate referrals, and to work out how we can give colleagues the skills, the confidence, the permission to be able to say no sometimes. That actually that procedure is not going to add value to you. And that speaks to all six principles, I think, of RM.
Lyndsay: You definitely think as well. When we put a survey round to health care workers in Highland and just said, what do they feel the roadblocks were? And a few people did come back with saying, well, you know, we don't want it to look like we're saying, no, you can't have a treatment, and then a bad guy, I come back. And I think that's where it's so important that as program managers, that we have almost like a book of communication. Yeah, absolutely. And that's something we're working on. Just to say no. The point of realistic medicine is not just to say no. That's it.
Amanda: No.
Lyndsay: It is to offer and have a conversation and explore all the options. Yes, it might take a little bit longer at an initial appointment, but I think in the bigger picture, when you look at a patient's pathway, it will give patients a better experience. They'll be more streamlined. There won't be, you know, being put on one waiting list, have a long, long wait to then say no and get put on another waiting list. It's not great for anybody, for the initial clinician putting it on or for the patient's experience as a whole. So I think that's one of the really important aspects of realistic medicine, to look at those.
Amanda: Absolutely. And, you know, just to go back on what you said there and about the first appointment might be longer, I've had that conversation with clinicians because that could be one of the potential barriers, perceived barriers as well, is that it will mean it will take longer. And yeah, I mean, it could, but like you just said, the experience will be different. And also there's the chance that future appointments either will be shorter or will be required because they have such a good discussion at that first appointment that a decision can be made or the option to do nothing, which is one of the brand options, is what's chosen. And it's okay. I think we need to get better. Speaking as a clinician, I've been comfortable with the option of nothing, because you're right, there is the whole thing. I need to be seen to be doing something or making this person better. But again, this might be coming from because I work in maternity services, which is different. I appreciate that, but that the option of doing nothing should be a valid option and should be spoken about the same way as any other option.
Lyndsay: Yeah, definitely. Perfect. So that kind of sums up our very general opening discussion. So I've only been in my role for about six months now. And Amanda, I know you've been doing this a little bit longer. Probably this one's better for yourself than me, but what have been your successes? What has worked really well. And what have your challenges been implementing different things in different areas. Obviously, you know yourself some things what works in one area won't quite work the same in another. But yeah. How do you find out?
Amanda: Well, I'll start with the challenges, if that's okay. One of the biggest challenges has been how do we know we're doing this? Our measures. I'm fortunate in Grampian, I think, because we work across the two boards. We have a really robust program board and I have a full time project manager that works with me as well. And we have lots of different plates spinning in the air, lots of different projects, and we're not running all of them. Don't imagine that I'm changing the world, but we absolutely offer support to anybody doing any work where Realistic Medicine is featured, which is just about everything but being able to measure, if I go back to the 2025 vision that by 2025 in Scotland, we'll all be doing this work in health and social care using the ethos of Realistic Medicine. How do we know that? How are we going to be able to say yes in Grampian and Orkney? We are doing all our work through that. We can show small pieces of evidence and as I say, individual projects. But being able to say that we're utilizing the whole ethos of Realistic Medicine has always been a bit of a challenge. And anyone listening to this who's been any meetings with me around this will probably be sick of me saying it, but I think maybe it's just the understanding of that. How are we going to be able to demonstrate to Scottish government, to the people in Grampian and orkney we are a health and social care or health and care provider that embodies the principles of Realistic Medicine and it maybe is just pulling all that together. But that has been a big challenge. The other challenge is when I go in and speak with colleagues around this, I'm not teaching them how to do this. I think there is sometimes that perceived barrier. Here she comes. She's going to tell us how to do Realistic Medicine? Absolutely not. What I hope I do is that I show people where they're already doing it and where there might be opportunities to do it or to do it more better and being able to offer support. So Lee and myself do a lot of presentations and we go along to workshops, forums, meetings, and that's what we start with. We are not here to tell you how to do this. I'd love to be able to say that to everybody. And another challenge, which we're just cracking, so it's not maybe so much of a challenge now is engaging with the public because they are 50% of this. We're not doing this to them, we're doing this with them. So we are just now we're meeting with our public involvement network. But we absolutely we need to get the information out there to the public, to the people that are going to be accessing the care with us. Because if their expectations are realistic and of Realistic Medicine, then we're going to be able to meet those so much better. So those would be some of the challenges, the successes, our communication and engagement. I'm going to end on a high no. Absolutely. Our communication and engagement. Lee and I, if we're not presenting at some point in a week, we think something's wrong. I'm presenting this afternoon to our clinical board for Grampian and then I've got another one later in the week with Orkney. So we do a lot of communication, engagement and we're going to be going on the local hospital radio. As I say, we're getting into the universities now as well, but that has been a real success and I really think this will kind of bleed into your probably the last thing we're going to talk about is what advice I would give. But networking, networking, networking, networking. Honestly, that's one thing I've learned again on the fellowship. The power of networks, the power of collaboration. We've done work in Grampian on our longest waiting list, which is community led vasectomy, so GP, minor surgery. We're continuing with that work just now, but that has been a big success in that we're finally cutting our waiting list. But it was even just engaging with our colleagues in primary care, you know, our GPs, our ANPs, I would put a massive tick next to that because I think from the collaboration point of view, it was a great piece of work. It really was, and will continue to be. Also, the endowment funding application for the work I mentioned earlier around value based health care and looking at how we can have those really meaningful conversations and make true shared decisions with people has just been great. So there's two of the big things. I could go on forever, Lyndsay, so I'll stop there.
Lyndsay: I think as well, when you start having the discussions with clinicians or any healthcare workers, when they actually start to hear about realistic medicine, I think a lot of people actually find, oh, I already do some of this. Everybody has that conversation. And I suppose about how it comes across and very aware just now that everybody within the NHS everywhere is overstretched and everybody is overworked and working so hard in their own areas. I think what we want to do within Highland is to really highlight what people are doing within their areas, because a lot of things that are done in one area can be done in others. And I think everybody does get so busy that they then start on their own projects. But if there is somewhere that's promoting what somebody else is doing within Endoscopy. We have been doing a lot of work within our accreditation. So we've been doing so much work on our waiting list. Doing validation. So we utilized our nursing staff slightly differently and we did pre assessments for our long waiting patients and we didn't remove huge numbers of patients from the waiting list. But we improved our patient care hugely by giving the patients the option of speaking to somebody and reassuring them by saying. Look. Your symptoms are the same. We're quite happy. We're not worried about you. But again, at the same time, if one of the nurses were slightly concerned, it gave them the opportunity to say, OK, we're going to go and speak to somebody about this and we'll get back to you. Luckily, we were good, there was nobody in that situation. But if there was, highlighting at an earlier point, rather than just leaving the waiting list, again, that's similar to the.
Amanda: Work in the minor surgery, the effective waiting list. We did something similar. We did it with clerical staff, though, in the community, and this is probably one of the other, I would say, successes.
Lyndsay: Absolutely.
Amanda: Realistic medicine is not for doctors.
Lyndsay: Realistic medicine, so much of it is not medicine.
Amanda: In a way, it is shared personalized care. Yeah, absolutely. And that can be done at all sorts of levels. And even that whole thing about the waiting list validation, you're managing risk, you're reducing waste and harm. Hopefully those small number of people that maybe have their condition has worsened or has deteriorated in that time, you're reducing harm to them by capturing them with that phone call. As I say, it shouldn't be perceived as just medicine. And I think, yeah, that's a brilliant example.
Lyndsay: Yeah, absolutely. And what I'm trying to do is get the communication out there. Because every time I speak to a different person. They have a different perception or they've only heard some bits about medicine. They haven't they don't fully know what it is. So they don't fully understand. So they assume that it's extra work. That we're trying to give them something else to do. Tell them how to do things. But it really isn't, and it is the common sense. So with the newsletters we're doing, we've been putting them out every few months, just highlighting information where you can go on to that you can get the tools on shared decision making, just making things available to different groups of people. And again, this is kind of one of the reason why we've been looking at doing the podcast as well, is just something you can have on in the backgrounds. If you want to listen to us chat, it's something you could still be doing something else at the same time. But, yeah, I know everybody is so busy, but I think just being informed really does help everywhere.
Amanda: Definitely.
Lyndsay: Just moving on, then, to our final. You'll have more recommendations, again, than I would, but I know there is a few openings within different health boards for program managers for realistic Medicine and I know when I first started in the post, I was very much going, oh, my word. As such, you have so many options of where to start. So what would you give the advice to somebody just starting? Where would you say is your easy wins all doesn't it? What would be your go to if you were just starting?
Amanda: So utilize the national network for a start. There's the big national network, which is the Clinical Leads and Program Managers, which is there's a team's channel for that. But then they kind of nick that idea from the program managers, I have to say, because that was started early last year with the program managers that were in post initially. And it is the program and project managers network across Scotland and an amazing bunch of people, but also just everybody is talking the same language on the same wavelength, but he's able to collaborate, share ideas, share support. And you know yourself, Lindsay, if you've got something, you just think, how am I going to do this? You send a quick message on the team's channel and someone will get back to you.
Lyndsay: Yes, someone will have either started it or has done it, and all the information is there to share, because it is a national program. It's not just one health board, which is great.
Amanda: So do not reinvent the wheel if you have an idea or speak to each other and get it. Kind of get a lay of the land across Scotland as to who's doing what, because you're right, Lindsay. There'll be somebody doing something, I think, in Grandpa and Orkney, our action plan is aligned to the board's action plan for the year. So we've got the plan for the future in Grandpa and we've got the clinical strategy in Orkney, so our work is completely aligned to that and we are front and center in both of those documents as well, which is great. But I think that the scorpion idea. So when I came into post early last year, I thought, yeah, I'll get an idea of where Realistic Medicine is done in the board. Oh, my word. I now liken that to looking at a plate of spaghetti. It is absolutely vast, complex, complicated, all those words. So I think start small, start attending meetings, find out in your board what are the kind of high hitter meetings. Again, we've got a clinical board in Grampian, the GP subcommittee, the Public Health Monthly meeting. I've been to these. It helps having an unusual surname, but I think I've kind of got my name out there. And Lee is doing the same. She's now leading on our communication and engagement plan. But I absolutely think start making like a broken record with this, but the networks start finding out who's doing this. I'm still finding people doing work in Grandpa and Orkney that I'm thinking, I had no idea how to care, making every opportunity count. These are all things that were started years ago that link in with realistic medicine. Why would we redo it? We shouldn't. We should be linking in with it, probably. And I think anyone thinking of getting involved in applying to do these jobs as a midwife, I thought, Why am I doing this and I absolutely love it. I come to work every morning and I feel so lucky that this doesn't feel like a job. You know, I get to do some really fun stuff. Yes, of course there are difficult and headbutting days where you just think, I'm never going to crack this, but then when you do, it's so much more worth it. And I think find the people in your organization who corporate comes are our best friends. They really are. We can get a message out on our daily briefing grampian, no problem. And that's through our relationship with them. So if we need to get something outraged about realistic medicine, they will be there for us. And the same with your clinical leads as well. I know you've got Kate in Highland who is awesome and she's probably listening to this now cringing, but I think having clinical leads that are really invested in realistic medicine is your other thing. Yeah, definitely. So not an exhaustive list, but anyone listening to this, feel free to get in touch with me on teams, on email at any time.
Lyndsay: So, yeah, perfect. So thank you so much for spending some time with me today. I hope that anybody who's listening has found some of the information we've talked about useful, interesting and like Amanda said, if you want to get in touch with us, we'll put our contact information and for the generic mailbox within Highland. So if there is a project that you are working on or looking to get some support with, we will put the addresses and the links for some of the resources that we have available in the comments section at the end of the page.
Amanda: Perfect.
Lyndsay: Thank you so much.
Amanda: Thank you.
