Miad Internship Recap – Karthik Bhat

Miad Internship Recap – Karthik Bhat


To introduce myself to the readers, my name is Karthik and I am a final year medical student on my medical elective. I have a keen interest in primary care and healthcare management which prompted me to take a slightly different approach to my elective. When we graduate medical school, we as medical students become part of the workforce for one of the biggest organisations and employers in the UK and the world, the NHS. Interestingly, we are taught very little about how the NHS and its’ constituent components operate and how we as clinicians might be able to impact and lead operational change.

With this in mind, I contacted Miad Healthcare to ask for an internship to get involved with the organisational development work they do with Primary Care organisations across London.  As part of my internship I was given the opportunity to write this blog on the current state of primary care giving my take on how things are moving currently. I was able to interview multiple experts in this field as well as attend and participate in Miad’s workshops which has helped me to understand more about the primary care landscape. 

You can also watch a clip from our talk with Karthik below:

How does Primary Care function currently?

Before 2019, the landscape of primary care was quite different, where practices would be given funds to work largely independently and provide for the populations they serve. In order to meet the needs of a growing and more demanding population, primary care has shifted towards the concept of working at scale. GP Practices now work more closely together alongside community & social, pharmacy, mental health and hospital services.  GP practices that work together are known as primary care networks (PCNs).

What is the role of a PCN?

From my discussion with experts and through research online, PCNs have a role in:

  • Providing high quality patient care
  • Delivering personalised care that meets the needs of the local population
  • Being pro-active and providing co-ordinated care
  • Focusing on prevention
  • Addressing health inequalities
  • Allocating funds across the PCN appropriately
  • Collaborating with other PCNs
  • Innovation and influencing micro-change

PCN’s work alongside GP Federations, who support PCNs at a borough level and help them to collaborate with one another. These PCNs are led by Clinical Directors, a fairly new position with what I understand as a relatively undefined role description. With that in mind, however, clinical directors have done well to define it themselves and there is general unanimity that the role involves:

  • Being the driving force for innovation
  • Ensuring delivery of high quality patient care
  • Providing and commissioning
  • Advocating for and representing the constituent practices and organisations
  • Acting as a bridge between practices and the larger organisations above
  • Providing strong leadership to practices
  • Supporting and collaborating with other Clinical Directors

Leaders in Primary Care

Within primary care exists a variety of different leaders at different levels, whether that is practice staff who lead their specific department, the practice manager, GP partners or the PCN clinical director. All of these individuals have a role to play in ensuring success for the practices and also the PCN.

It is well established that GP partners and practice managers must work together as a senior leadership team to provide quality care to the local population. With PCNs covering even larger populations, the role of the clinical director, and the way by which they are able to collaborate with one another as well as the teams that they lead, is paramount to the success of primary care at a borough level.

So what are the challenges facing leaders in primary care?

At both a practice and a PCN level, primary care leaders seem to be torn between their clinical role and their managerial roles. Having carried out one-to-one interviews with several clinical directors/GP partners, they were in unanimous agreement that leadership and management responsibilities form an equal, if not larger, part of their day-to-day activities as a GP. This becomes especially difficult when we recognise that many of these GP leaders have never received formal training or education into leadership and management and are not skills that are usually trained during medical school.

Some of the difficulties that were mentioned were:

  • Direction setting and defining goals
  • Managing complicated working dynamics
  • Managing accounts and spending
  • Dealing with HR issues

As such I have great admiration for Primary Care leaders as they are required to learn these skills and responsibilities on the job.

PCNs are a relatively new organisational entity, and so many clinical directors find that there is a lack of role clarity and ambiguity as to what their day to day roles should entail and what their accountability is for different operations across the PCN.

For example, my time at clinical director forums highlighted that the role should be largely focused around making large scale clinical decisions for the population as well as leading clinical innovation. However, they often find themselves submerged in operational responsibilities which they were initially not aware would play such a big part of their daily job when they first accepted the position.

Moreover, in order to fulfil the supposed duties of a clinical director, there are other challenging elements that need to be addressed such as:

  • Bringing workforces together
  • Collaborating with organisations such as the Federation and the CCG
  • Staff recruitment

With this in mind, it became clear to me that some of the main challenges facing primary care leaders relates to organisational management and leadership.

Despite the challenges and uncertainties put in front of Primary Care leaders, they have done remarkably well to perform as well as they have been doing. It seems, however, that on occasion primary care establishments are “firefighting”, and if given some guidance would feel more comfortable being proactive in overcoming their challenges.

From what I have seen, Miad Healthcare provides real benefits through its team of vastly experienced facilitators, who boast immense experience in organisational development in both healthcare and corporate environments. This helps to provide the support and strategy needed for primary care organisations to build a concrete foundation for confronting the challenges that face them. At a practice level, I have seen Miad help GP Partners and senior leadership teams understand the core values of running a practice; looking into setting direction and goals and developing strategies to manage a successful team.

At a PCN level, during Miad’s PCN Clinical Director forums, CDs are brought together and engage in focused discussion specifically to identify pressing issues and develop realistic and implementable solutions. Miad helps them to construct these solutions in a coherent format in order to present them to the CCG and other organisations above.

The presence of Miad’s facilitators acted as a key to unlocking and unpacking key issues that arise across PCNs, and they are able to provide the perfect space for CDs to come together and openly discuss important agenda that they otherwise wouldn’t do during their own internal meetings.

Overall, I found the approach towards healthcare organisational development work to be surprisingly effective and seamless, with Miad acting more as enablers, facilitating creative and constructive group discussion. This method helps to empower primary care leaders to come together and create solutions as a team. Primary care leaders were quite satisfied with the overall utility of the strategies discussed with them. They were all very self-reflective, realising need for improvement in certain areas for them to be able to run a successful organisation. With a little input from Miad’s team of facilitators, there is no doubt that they can develop their organisational management skillset to lead their practices and networks at their optimum potential.

Interestingly, it became apparent to me that there may be an underlying stigma towards organisations that provide healthcare consulting as it is presumed that the output will not be worth both the time and money, and any help that they provide can quite easily be found within the NHS itself. I had my apprehensions about this as well. However, the feedback from Miad’s clients following their sessions is proof that primary care organisations can truly benefit from this type of service. They are offered very useful insight into organisational development strategies that may otherwise be very difficult to find within the NHS.

For me moving forward in my career, what I have definitely taken from this internship is to put value on developing my organisational development skills as a clinician. I feel it is important to feel empowered as a clinician to lead teams and organisations through drastic change without it impacting too much on clinical work. Of course, this is much easier said than done, but undoubtedly the first step in the journey is acknowledging the importance of both sides of my professional work, clinical and organisational. With this thought in mind I would urge more young clinicians to develop themselves to feel competent at both; especially as primary care, and the NHS as a whole, is increasingly shifting to multi-organisational working at scale.