Estimated read time: 10 mins
I was born and grew up in a small town in South Wales in the UK. Since childhood, I was encouraged to be the best that I could be, and in my family, if we noticed a problem we should not just moan about things, but do our best to fix it. I’ve lived by this throughout my career, and early on it led me to set up a student union branch in sixth form college - which is where my interest in activism really started.
After attending medical school in London, I planned to become a gynaecology oncologist. However, as a junior doctor I changed course and moved into public health, on the basis that I felt I could do more good treating whole populations rather than treating patients one-to-one. In order to go into public health, I needed to gain experience in general practice. As I continued on this path, I took the incredible opportunity to become an academic GP as part of a new scheme at the University of Birmingham. I had the opportunity to build longitudinal interactions with patients, to do research, and be an educator. It was here that I was completely converted to general practice and haven’t strayed from this since.
From 2000 to 2024, I did my clinical work as a part time partner in general practice in the Midlands and the academic side at the University of Birmingham where I eventually became a professor of GP education in 2016. I also got involved in the royal colleges and was passionate about their mission of improving and maintaining patient safety, quality, and standards. I worked my way up from being a local representative of the Royal College of GPs to being on national committees and took up the role as their national Treasurer – the first woman to do so – before being elected as the Chair of the college. After completing my fixed term of three years, I moved on to stand for the Academy of Medical Royal Colleges, the umbrella body for the 24 colleges in the UK representing over 220,000 doctors. I worked in this position during the pandemic, at a time when so many forces were pushing us apart, and doing my bit to keep the medical disciplines together and supported.
When I was elected as the Chair of the Royal College of GPs, I had complete imposter syndrome. I really was standing on the shoulders of giants, and it was a really humbling moment. I spent three quite remarkable years in the role when there was a big change happening. We managed to convince the NHS and UK government to make a massive investment into general practice and to look at new ways of working, including expanding the use of different allied healthcare professionals and the big increase in training places for general practice. It was the biggest investment into general practice that had happened, and it was lovely to see an increase in the number of medical professionals training in general practice.
I still have a lot of energy and drive to work, and I didn’t want to slow down after my roles in the UK, I felt I had a lot left to give and lead on. The remarkable opportunity to move to New Zealand came up and I went for it. When I attended the interview in person, I was blown away by the incredible warmth of the people and the culturally kind approach to society. I’ve been on a journey since moving and have been determined to learn and understand the culture here.
As Health NZ continues to establish itself, since its creation in 2022, the role I take as part of six new clinical chiefs means that we can embed the clinical voice and partnership into the organisation. I started the role in turbulent times, where the organisation itself is changing at the highest levels. There are a whole series of challenges at the frontline where patients and clinicians have raised the alarm about problems that have been bubbling up in most cases for well over a decade. Meanwhile there are significant financial challenges and workforce pressures that mean we have hit a point where things have to change, and are changing.
I really want to bring hope to frontline clinicians during this time that the system is improving and also hope that the workforce pressures they are under will ease. I also want to give them the confidence and assurance that their voice is being heard. Healthcare workers are the lifeblood of the organisation and we are absolutely listening to them.
There is amazing clinical care happening every day in the community and in hospitals across New Zealand. I think it is important that we make sure to celebrate the incredible work going on.
Absolutely, so I work as a GP in New Zealand part-time, to ensure I maintain my clinical competency and authentically understand first-hand matters when they arise in New Zealand. General Practice in both New Zealand and the UK are set up as the first step of entry to healthcare for many patients. Practicing in both the UK and New Zealand in general is quite a similar process including the diagnostic pathways we use and the drugs we prescribe. Both have a range of healthcare professionals in them, but the UK has seen an explosion in the range of healthcare professionals within a surgery, for example physios, care navigators, link workers, and advanced nurses. New Zealand is embracing newer ways of working but having the range of different roles within general practice is not as commonplace currently.
A notable observation is that patients do pay a fee in New Zealand to see a GP. It is intended to be a low-level fee (ranging from NZ$20 to NZ$100). This range is based on personal circumstances and where you live. This is certainly a barrier to care for some, especially those managing long-term conditions. Consequently, the number of appointments per patient in a year is significantly less in New Zealand. All hospital care however is free, and this can place a burden on A&E departments for ambulatory sensitive conditions, where general practice is often far better placed to deal with the concern.
In terms of prescribing, most drugs are supported by Pharmac in New Zealand, which is a national body involved in the licensing and approval of drugs, therefore are provided on a reduced cost if prescribed. Some drugs that fall outside of Pharmac mean that patients pay a lot more.
More broadly, I think that the UK is really good at having standardised coding of national healthcare data, meaning it is much easier for researchers to interrogate huge NHS data sets. There seems to be less standardisation of data in New Zealand. This has historic links from the range of districts that acted as totally autonomous healthcare systems prior to the 2022 creation of Health New Zealand
For me, the Accident Compensation Corporation (ACC) scheme is fascinating for me to understand. Before I got to New Zealand I don’t think I fully appreciated how enormous it is and the positive reach and impact that it has.
It is a very equitable system in that everyone is treated the same. It gives incredible peace of mind to people that they have financial support in place if it is needed. As a GP I make the referral to the ACC on behalf of the patient and then, lets say they hurt their shoulder falling off a ladder, they would be entitled to private physio rather than state physio, and paid time off work if needed.
I’ve also been struck by how we start and end all meetings of note in New Zealand with a Karakia, or a blessing, in Māori. It sets the tone of the meeting and it’s a moment of reflection together that is really special. It is a pause that just brings us all together, and another pause before we go off to do other things. This specific cultural observation is something I really respect and have embraced.
Yes, it is interesting to see this phenomenon, that is happening similarly in the UK. There is a distinction between the number of GPs and the ratio of GPs to hospital consultants, it is the latter which has dropped. So, there is more demand for GPs, and they are spread more thinly compared to hospital specialists. The healthcare divide between primary and secondary care feels even greater here than in the UK.
Commissioning and funding are totally separate and so when money initiatives appear it is easier for the system to invest into hospitals and secondary care than it is in primary care. I hope that in my role I will be able to help highlight some of these issues and challenges. The evidence is clear cut that if we invest more in general practice and disease prevention, we save much more money further downstream, as it is far better to be keeping people healthy and supported in their own community than escalating to hospital care. Of course, secondary care needs greater resourcing too, but the long-term benefits for a wider population comes from investing upstream in that initial care.
When I started this role there was a lot of talk about new models of care and how we can work differently and better. I have been asked about PAs and the challenges the UK experienced and any reflections I had on this. From my understanding there are currently around 50 PAs in New Zealand, most of whom trained in the USA and they are not currently regulated. There is no training of PAs happening in New Zealand and the government has just announced that the workforce will become regulated. This is a clear learning from the UK, who have had PAs for almost two decades and is only now bringing in regulation, which has been a key part of the problem. Regulation is very important to provide assurance, ensure standardisation and give people confidence in the profession.
For me, my question has repeatedly been “what is the problem we are trying to solve?” are PAs right for New Zealand? My personal experience of PAs in the UK has been very constructive over the years. I have had huge respect for PA colleagues and am very grateful for them. However, I think we should learn lessons on how this has been managed, and what went wrong in the UK, so that if a decision is taken that more are to be introduced, there is no unwelcome backlash. Rather that they are supervised appropriately and then welcomed as valued additional members of the team who are wanted and needed.
I really want to give clinicians here back their hope and pride in the remarkable job that they do. I want to help them feel valued and find an outlet for their voice. I am keen to help make this happen and to nurture the next generation of medical clinical leaders in New Zealand. I have always been a firm believer in helping others up the ladder in their career and the marker of success of any leader is that you create better leaders than yourself to take over from you.
There is the importance of working alongside management and administration and providing the clinical and patient lens. All decisions in healthcare should be taken with the benefit of the clinician and patient view. Now that is not to say clinicians should be leading everything, far from it, but it is for us to be providing advice, guidance and honesty to those who are making the operational decisions to ensure they are made in an informed way. I want to play my part in supporting this and helping the clinical voice and patient perspective be heard at the highest levels.
