Jeshni Appointed Presidency of the General Practice and Primary Care section at the Royal Society of Medicine
- 11 October 2021
- Posted by: Jeshni Amblum-Almér
- Category: Medical
I am honoured to step into the role of President of the General Practice and Primary Care Section at the Royal Society of Medicine. As the first nurse in this role, I look forward to jointly planning interprofessional events and working collaboratively with other organisations and sections in the council.
I have had a diverse career since my training in199, and it has had it’s challenges that helped me to constantly evolve. I started my nursing career in a trauma unit in South Africa and this has prepared me to develop intuitive assessment skills and the ability to work in busy, changing environments. Delivering babies then subsequently going into rural areas during my community studies to immunise children and provide health education, gave me the courage to later take on a role as a paediatric nurse. I worked at a new community hospital and together with a more senior colleague commissioned and lead staff setting up a paediatric centre. Cannulating children with chronic diarrhoea, HIV, poor nutrition or ill health has given me lifelong skills in the ability to find a vein, engage with parents and children when they are most distressed.
My Diploma in Psychiatry enabled me to work in different, challenging environments from a prison psychiatric hospital to acute wards and subsequently halfway houses and community placements. This invaluable experience of the patient journey through the system influenced my decision to complete a Masters in Medical Law and Ethics. My thesis focussed on consent, autonomy, treatment refusal and healthcare professionals’ responses to treatment refusal. It was an insightful exploration of how our own normative values, backgrounds, beliefs influence how we respond. It reiterated the importance of listening to the patient or colleagues voice and working collaboratively to develop a plan that is mutually aimed at improved outcomes.
My journey from the trauma unit of South Africa to the emergency department of a busy London hospital was during a time when the roles of healthcare professionals were going through a dramatic change. Roles were evolving to meet the demands of a transcultural, more diverse population with changing health needs and limited doctors. Hence, the evolution of the Advanced Practitioner – a journey I started in 2004 when I completed an independent prescribing module, which allowed me to see, treat and prescribe treatment to services users in primary care settings. I continued part time leadership roles included that of a senior clinical nurse, working between 3 hospitals, overseeing management and navigating clinical services especially at night.
In 2006 the role of lecturer at St Georges University teaching on the primary care postgraduate modules provided a platform for me to support colleagues both in academia and as a mentor within my clinical role in urgent care and general practice. As a senior lecturer I was module leader of the Degree and Masters programme for nurses and paramedics working in advanced roles. I also worked closely with the new physician associate programme and interprofessional curriculum at the medical school. Transforming the workforce and supporting roles that helped sustain general practice during our GP shortage included a programme of structured mentorship, portfolios and blended learning. I subsequently joined City University as the Course director of the RCN accredditted MSc Advanced Practice programme.
In 2012 I joined an American missionary company, Volunteers in medical Missions (VIMM), which has given me the chance to work in rural, underserved areas with a poor infrastructure that includes fragmented or no medical services. Having worked in Tanzania, Dominican Republic and the borders of Haiti reinforced the importance of education, diet and better stewardship of medication. This was an enlightening experience from which I took, more than I gave to the grateful and kind people who walked for days or hours to attend the clinics. It was a humbling experience, reminding me of my responsibility to stay up to date with current treatment options, use the basics in areas of deprivation and be clear and understood when faced with language barriers. In a world of increased travel, diversity and multicultural approaches to medicine, I am reminded of the importance of effective communication and translation.
My recent role as Clinical Lead and Head of Nursing at a busy practice with 16 000 patients and another smaller practice with 3500 patients has meant looking at more innovative ways to transform the way we work in general practice and the community. This has meant creating proactive, personalised and co ordinated, more integrated health and social care by enabling staff to work in advanced or lateral roles. The shortage of doctors and increasing demand has created a major gap in service provision highlighting the importance of working collaboratively with the local CCG, PCN, other practices and the multidisciplinary team within the local health and social care system.
A large recruitment and training drive involved developing roles within the practice with team leads. This gave members of the team ownership and accountability to proactively work with local teams to improve patient outcomes. My experience working as a university lecturer for 10years and subsequently starting my own training company which focussed on primary care, meant we could quickly set up training provision for staff. Admin staff were trained in telephone triage and signposting so that calls were diverted to the correct team members. Roles were clearly defined and staff made aware of limitations of specific clinicians experience , reducing number of patients being given an appointment with a clinician not experienced in a specific condition. This resulted in a significant reduction in patient complaint and a more proactive patient group who met regularly with team leaders and this encouraged patients voices to be heard and acknowledged. This also resulted in patients and the local community being more supportive of preventative health campaigns such as the yearly flu clinic and smoking cessation. We also ran coffee mornings with the local community centre, which was located 50metres away, with sessions on BLS, choking, nutrition and mental health by clinicians, from the practice.
My role as facilitator meant that we supported clinicians with regular meetings, training to advance their roles in providing minor illness clinics, home visits, regular medication reviews, diet and exercise monitoring. Mental health, learning disabilities, over 75 patients and patients with no fixed abode are often part of an under served community of individuals, hence we recruited a social worker and disability nurse who worked with our over 75s nurse, paramedic and wider team including MUDAS to contact anyone with no fixed abode to put systems in place to support them, making contact with anyone over the age of 75 who had not made contact with the surgery in past 2 years. This resulted in them identifying practice members with depression, isolation, poor medication compliance.
Every person has the right to their own individuality and support through this process. Our team of doctors, nurses, healthcare assistants and admin staff focussed on a structured system to support individuals with Gender Dysphoria and we ensured a stronger focus on supporting individuals with mental health presentations with ring fenced clinics to ensure especially on a Friday, there were appointments available.
This role had many challenges and required constant reflection on my own leadership skills and looking for more innovative ways to deliver safe care. There were many learning curves and transforming roles can be challenging unless these roles are clearly defined and supported. The result was a turnaround in 6 months from possible closure due to poor CQC scoring to a CQC score of Good with elements of outstanding.
I have since focussed on founding my own training company Belmatt Healthcare Training and developing courses for general practice and primary care clinicians. These CPD courses provided me with the opportunity to meet experts in their field who provided evidence based, current information with practical tips. I continue to work clinically in general practice and urgent care including out of hours triage. This ensures that I keep abreast of current policy and practice and recognise the challenges faced in primary care.
I have been a member of the RSM since 2014. As a member of various advisory boards I have used my large network of colleagues to organise very successful educational programmes at the Royal Society of Medicine. My first experience of organising an event at the RSM was a little intimidating, especially when we recorded my interview Dr Kate Granger for the End of Life conference in 2014. Her wonderful optimism in the face of cancer and her honest accounts of her illness in her books has since resonated across the profession as I see “Hello my name is…..” lanyards and signs across healthcare organisations. This successful event resulted in me continuing to be involved in organising conferences which included the patient journey, practical tips for clinicians and talks by experts in the field. The Mandatory Training which was initially planned as an “all in one” practical session, to meet the yearly mandatory requirements of all clinicians, became incredibly popular resulting in a bi-annual workshop with a waiting list. During the pandemic, we continued to run the sessions as recorded presentations. I was subsequently involved in organising our Mental Health series, Mental Health conference, and the GP Primary Care Update. Working on the steering committee provided me with an opportunity to work closely with colleagues in planning events at the RSM and introducing new members who have contributed significantly to meetings ,with the wealth of experience and expertise.
I look forward to the next two years as President of the general practice and primary care section at the Royal Society of Medicine. I am looking forward to strengthening relationships, that allows all the team members of the multidisciplinary team in primary care, to contribute to the strategic agenda for healthcare initiatives in the UK. I hope to continue the efforts of my predecessors in encouraging collaboration through joint meetings and collaborative working with other sections and other organisations taking forward the agenda for change and improvement in healthcare. I am looking forward to showcasing the amazing work of GPs, nurses and all my allied healthcare colleagues, to sustain and transform general practice and primary care to meet current health needs.