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Dr Bola Owolabi, GP & Director of Health Inequalities at NHS England and Improvement

Published on: 9 Mar 2023
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AUTHORS:  Dr Sanketh Rampes and Dr Anvarjon Mukhammadaminov 

In this series the Medspire team interviews doctors about their career, their specialty, the choices they have made and their advice for doctors and medical students.

Today, the subject is Dr Bola Owolabi, a GP and director of health inequalities at NHS England and Improvement. Dr Owolabi was formerly the national speciality adviser for older people and integrated person-centred care. She has held senior leadership roles, and was heavily involved in the government's COVID-19 pandemic response.

A podcast of this interview is available here:

 

How did you get to where you are today?

It's been an interesting and varied journey. I describe my leadership journey as ‘taking the scenic route’. The alternative is the career ladder, but I discovered very quickly that the scenic route is more interesting and exciting. 

I'm a GP, and I still practise as one, but I also discovered early on in my career that I find a lot of energy in the leadership space. I started off my leadership journey as a prescribing lead within the practice where I started my first job as a salaried GP

That gave me the opportunity to meet other prescribing leads in the locality, and I learnt a huge amount about data, and how to have conversations with people that are data-driven, but not dry. Conversations that actually galvanise people to want to make a difference, such as with antibiotics prescribing.

I then had the opportunity to apply to be the clinical commissioning lead for maternity, children and young people in the CCG, which I did for a number of years.I went on to become systems lead for frailty, and then also for end-of-life care. 

I then had the opportunity to apply as national specialty adviser to NHS England and Improvement for older people and integrated care, and was delighted to have been successful in that application. 

I've really enjoyed that role. I led the anticipatory care workstream of the national Ageing Well programme. And then the opportunity came up to lead the work of the NHS on health inequalities, as health inequalities director.  I'm thoroughly enjoying this role. So that’s a very quick canter through my journey.

Great Place, Great Potential - NHS Somerset


 

What attracted you to general practice as a career?

When I finished my house jobs, I was actually going to be a psychiatrist, because I've always been fascinated by their ability to really make a difference in the lives of people experiencing mental ill health. 

But as I continued with my psychiatry training, I realised that I was becoming more and more interested in the other medical conditions that my patients were presenting  with. I had a gentleman who had serotonin syndrome, and remember talking to my consultant, and how we had to get the help of the medical team. 

That made me think I would love to be able to help people with their mental health, but would also  like to help them across the range of their health issues, and the most obvious way of doing that was general practice.

I love the fact that in general practice we are like detectives. People turn up in your consulting room, and they don't have a diagnostic label - they just present to you with a whole set of symptoms that could be anything. I love the process of really getting ‘under the bonnet’ of the patient’s history - getting close enough to the diagnosis just on the history, and then using diagnostics to nail it.

I get such a buzz from the undifferentiated nature of general practice. I just love it, and I also love the fact that you see the whole range of ages. I could be seeing a six-week baby check one minute, and then the next I could be looking after somebody with heart failure in their eighties. It's just the most fabulous medical specialty. 


 

What makes a great GP?

Apart from the technical expertise and the clinical acumen, I think you need to like people. You need to be  genuinely interested in people, because they don't arrive at your doorstep carrying labels - they arrive to tell the story of their lives. And in the middle of that story there will usually be a medical diagnosis. 

Often there is no medical diagnosis, but there is an issue that you can help with in other ways. Therefore,  the key thing to being a great GP is to be a person who is genuinely interested in people, not just practising medicine. 


 

What is meant by ‘health inequalities’ and what is the current situation in the UK?

I find the NHS England and Improvement definition very helpful. It talks about health inequalities being unfair, and avoidable differences in health outcomes within and between communities. It also talks about how those differences are driven by the circumstances of people's lives - where people are born, where they live, where they work, and the opportunities that are, and are not available to them. So, broadly, that's what we mean by health inequalities. 

In terms of understanding health inequalities currently, if you look at the COVID-19 pandemic and its disproportionate impact on different populations, we know that people from ethnic minority communities are more likely to contract COVID-19 infection. 

They are more likely to have more severe illness if they do pick up the infection, to be admitted to hospital, and to require intensive care unit support - and the data backs all of that up. 

We know that some of the drivers of that are the disproportionate incidence and prevalence of multimorbidity among these communities. We also know that they will, generally, tend to be in frontline occupations, where they cannot work remotely. 

These drivers - whether this is in terms of disease incidence and/or prevalence, the wider determinants, and the type of work people do - have driven that disproportionate impact of the COVID-19 pandemic on ethnic minority communities and people from the most deprived communities - regardless of their race or ethnicity. 


 

Early on in the COVID vaccination programme there were identified disparities and uptake, particularly among BAME staff and patients. How did you combat this?

I will start by acknowledging the incredible effort and work of every single person working in the NHS - all the volunteers that have come forward to help us, and the brilliant leadership of people like Emily Lawson, Dr Nikki Kanani, and so many other colleagues right across the NHS, including Preranar Issar, our chief people officer. It has been a team effort, and it's very important to emphasise that.

The learning that I draw on is, first of all, the importance of working as a team. I don't think there is any individual or team within NHS England and Improvement, or more broadly, who won't agree that the success we have achieved is because we have all pulled together in the same direction.

My second observation is the importance of listening and working with our communities. It's our communities who helped us to see that by making the vaccines available in places of worship, and in pop-up centres closer to where people live, that we stand a far better chance of correcting those disparities in uptake. So the second lesson for me is listening to the community and taking on board their suggestions. 

Finally, there is the importance of taking that quality improvement approach. When we first saw the data showing us that there were disparities in uptake, the key thing was to then use this data as a vehicle to drive improvement, because sometimes the temptation is to just look at the data and talk about it. 

That was very different in the vaccination programme - the data was driving improvement in real time. So those are my three takeaways: working as a team, listening to the community and taking their ideas seriously, and  using an equality improvement approach. Those three things together are how we will narrow health inequalities in other areas, in addition to the vaccination programme.


 

Has the success of this programme paved the way for addressing other health inequalities among different community groups, and do you plan to write a report as a blueprint for others to use?

The COVID vaccination programme, and our COVID pandemic response more broadly, has set that roadmap of how we address wider health inequalities, without a shadow of a doubt. I would also say that those three things I’ve just referred to are the common themes that one can distil.

There is also the role of taking a strength-based approach. Many times when we talk about health inequalities, there is a temptation to only talk about the things that are wrong. But my learning is that communities have things that are strong about them, and you actually get further when you build from strength. 

We realise that faith is very important to the communities who had the lower uptake in the vaccines. We discovered that there was a very strong sense of identity amongst those communities. So rather than having a conversation that said: 'Why aren't you taking the vaccines?’ It was a conversation about, 'Faith is important to you, community spirit is important to you. How can we harness those two strengths?'. 

And you can see the results of doing it that way. So for me, going forward, it's about three things: using data for improvement, taking a strength-based approach, and co-producing solutions with people and communities.

In terms of whether we will be publishing a blueprint about how to take this forward, there is work going on now looking at the learning that we can derive from the vaccination programme and the pandemic response more broadly. I expect that report will be telling us key things that we can do in relation to wider health inequalities, so I'm really looking forward to that.


 

Tell us about some of your key priorities as director going forwards?

We've set out five key priorities within the NHS operational planning guidance. As we move out of this pandemic phase, the number one priority is to restore NHS services inclusively - so that as we restore our services, we do so in a way that carries all communities with us.

The second priority is to make sure that we mitigate against digital exclusion. We have gone onto a digital footing in terms of how we look after people, and that's brilliant. As we do that we need to make sure that we are mindful of people who may struggle with that digital approach, and that we put interventions in place to help them. So the second priority is to mitigate against digital exclusion.

The third priority is for us to accelerate on our preventative programmes of work - so making sure that the annual health checks for people with learning disability and the annual checks for people with severe mental illness continue, and that pregnant women have continuity of care.

The fourth priority is to ensure leadership and accountability, because unless we have strong leadership, and clear accountability, we're not going to deliver on any of these initiatives and objectives. 

Our fifth priority around the data that we collect is making sure that data is timely and complete, especially the recording of ethnicity data, so that we can see where the gaps are.

These are the five priorities, and they are in service of one thing: to deliver our vision. Our vision is to ensure that we get to a place where we're delivering exceptional-quality healthcare for all, but ensuring equitable access, excellent experience, and optimal outcomes.


 

What can medical students and doctors do to play an active role in reducing health inequalities and engaging with your work?

My first reflection is to understand your spheres of influence. Health inequalities are so large, broad and complex, there is a danger that people feel powerless, but actually you do have a sphere of influence. I am talking to the Medical Schools Council about the medical school curriculum and how we can make sure that it is strengthened around the health inequalities agenda. 

As medical students, recognise that, in addition to everything that you are learning about disease processes - anatomy, physiology, biochemistry, everything you've done in your clinical placements - health inequalities are beyond just disease. 

Remember that your patients will have wider determinants of health driving their health inequalities - housing, employment, income - and how those things impact on people's experience of disease and illness is incredibly important. 

Finally, use this knowledge in your daily practice. So when people come through your doors with high blood pressure for example, if you're starting them on medications and they keep coming back and their blood pressure is not controlled, it's not about adding more and more medications. Pause, and consider alternative explanations. 

Can your patient afford the tablets that you are prescribing? Because if your patient is unemployed and not in receipt of adequate benefits, the reason their high blood pressure is uncontrolled may be nothing to do with medications - it may be because they just can't afford it. That's what I mean by your ‘spheres of influence’. So be aware, bring that awareness into your clinical practice, and you can make a real difference in people's lives.


 

Are there any specific resources you would recommend?

In terms of your own leadership journey and development, I recommend Sheryl Sandberg's Lean In. It's a great book. I recommend Liz Wiggins' Relational Leadership [sic]. And I also recommend Living Leadership by George Binney, et al. 

It really explains what it is to be a leader - not as a hero, but as an ordinary human being trying to make a difference. So those three are my top picks. Then in the sphere of health inequalities, I will signpost you to Marmot's health inequalities seminar report from 2010, and also the ten-years-on Marmot paper published in 2020. 

If you start there, it will be a great place to begin your journey in understanding health inequalities.


 

What made you choose to get involved in leadership initially?

It was about wanting to make a difference, and recognising that I was able to make a difference in the lives of my patients, which was, and remains very important, and why I still practise. But I also recognised there were things that I didn't have any way of influencing if I only stayed within a clinical space. 

Rather than getting frustrated about edicts from on high, I took the view that what you need to do is pull up a chair, sit at the table, and let your voice be heard. So I got to the point where I realised that shouting at my computer screen wasn't going to change a lot, and that what I needed to do was to place myself where those influential conversations are being had. 

I realised that actually I could make an even bigger difference for many patients that way, and that was the biggest driver for me in stepping into the leadership space.


 

Before your current role you were a national speciality adviser for NHS England. Tell us about this role and some of your achievements.

It's a role I enjoyed immensely. I was a national specialty adviser for older people and integrated person-centred care, and I led the anticipatory care workstream of that programme. I also led the development of the anticipatory care framework, and successfully secured funding for us to have some accelerated sites across the country testing out the anticipatory care model. 

I also feel really proud to have brought anticipatory care very much into people's consciousness, and awareness, which is a proactive, holistic care model that looks at people as whole individuals, not the sum of their medical diagnoses. 

So for me, that's the thing that I'm proudest of -  being able to reframe the narrative. That it's not just multimorbidity - it's about holistic care, person-centred care, and the rest of the system coming together to support an individual with their health, and also with those wider determinants. 

The anticipatory care framework is the document that I'm really proud of, and it will stand for years to come - the way we put in writing what we were trying to do in that space. 


 

What does it take to be a good leader?

That question is as broad and long and deep as one can imagine. First of all, it's to remember that leadership in the end is about people. The theories and frameworks are important, but in order to lead you need to have a genuine interest in people. You can only get your work done as a leader with people. 

Therefore, I think what makes a great leader is a person who does four things. First of all, a person who is able to lead themselves - your own personal leadership, understanding of yourself, being aware of how you come across, and how you impact. 

The second is your relationships, how you relate to people, and really mastering the art of conversation. There is a way to get stuff done without making people feel small. 

The third one is to understand your context. What you need to succeed as a leader in one environment is not going to necessarily be exactly the same in another environment. Your ability to read your context is incredibly important, so that you can flex and adapt your leadership style to suit the context.

Finally, you need a technical understanding. As some people have said, becoming a better version of yourself. Do the training, do the courses, do the studying. Being a doctor doesn't automatically qualify you to be a leader. 

It equips you with a lot of what you need, but it doesn't automatically make you a leader. So personal leadership, relational leadership, contextual leadership, as well as technical leadership. And I credit my brilliant colleagues at Ashridge Executive Education, and Hult International Business School, who came up with that leadership framework, and it's the best I've seen so far.


 

Are there any leaders in your career that acted as role models for you?

The first person that comes to my mind is Dr Elizabeth Barrett, who was the senior partner in the practice where I first worked as a salaried GP. She was the first person who tapped me on the shoulder and said: 'I think you just have a natural ability as a leader’, and then made it her personal business to nurture that. 

I also would reflect Rick Meredith, a fantastic clinician and an extraordinary leader, because of his compassion, kindness and inclusiveness. 

Finally, I think of my mum, and I've deliberately put my mum last, because I want to just spend some time there. My mum didn't live very long. She died when she was 48, but she was such a powerful woman, who never took no for an answer. There was always going to be a way. She is my greatest leadership model. 


 

What advice would you give to medical students and doctors who want to take on management and leadership roles during their career?

My first piece of advice is to start with ‘why’, because when you understand your purpose it will guide you to make the right decisions. It's not about titles. There's a big temptation. It's not about position. 

Why do you want to be a leader and a manager? It may sound boring, but it's an important thing to say, because it will guide the decisions you make. 

It will determine the opportunities that come your way. I do believe that as medics our ‘why’ must be: ‘to be able to make a tangible, positive difference in people's lives’. If you start with that ‘why,’ I don't think you'll go wrong, because if that's your purpose, you will attract people to yourself who are similarly-minded. 

Opportunities will find you, because that's how you think and, therefore, that's how you talk, and therefore, how you walk. There's a way that the way you think, talk and walk lead you to the opportunities that line up with your values. So start with ‘why’.


 

What are some of your proudest achievements?

They're not what you might expect, in terms of the scale and the size of them. Being able to support an agoraphobic patient, many years ago, to achieve her English A Levels will always be the number one achievement of my career, whatever else I go on to do, because it made a difference between a future limited by the lack of qualifications to opening up possibilities for that person. 

The second one is leading the turnaround of a GP practice in a very deprived area - where the community had endured many years of a lack of high-quality general practice - and to work as part of a community trust to lead the turnaround of that practice from failing, to being rated good across the board by the CQC. 

The practice is now also a training practice, training medical students and GP registrars. I think those two by a long mile are out in front. I'm proud of everything else, but those always give me a huge smile. 


 

What are some important lessons that you've learnt during your career that have shaped you as a clinician or leader?

A lesson that has shaped me is the importance of networks - ‘you go much further when you travel together than when you travel alone’. I think it's an African proverb. Networks are so powerful and important, and every time you invest in building your networks, you are investing in your leadership, and in your efficacy as a leader. 

Then there is the importance of investing in learning, and recognising that just because we've been through the rigour of medical school, doesn't automatically make us leaders. Invest in leadership training and development. That's another lesson that I've learnt. 

Don't be too wedded to plans. Sometimes people have this five-year plan, and a ten-year plan, and it's down to a tee. Rather than having a plan, have a scaffold. Scaffolds can be flexed easily, because if your plans are too rigid, you end up closing the door on many opportunities. 

So it's not about going through life completely planless - that's not what I'm saying. I'm saying, let your plans be more scaffolds than rigid structures. 

Don't be afraid to try, even if you've not done it before. Your answer to opportunity should never be, 'No'; it should be, 'Yes', and, 'How?' Once you say, 'No', you slam that door shut, but if you say, 'Yes', and, 'How?' you've left the door of possibilities open. You are a pluripotent stem cell. 

You can lead in any sphere because your training to become a medic has equipped you with extraordinary abilities beyond simply being a doctor. It might not feel like it just now, but trust me, it has. Those foundations, those disciplines, the resilience, the rigour, everything you've needed to have to get through medical school - don't ever take it for granted. 

Those are the foundational pieces of being a leader. Yes, you need to refine them and hone them further, but you've got the foundational pieces there. Go forward into your journey as a pluripotent stem cell that can turn your hand successfully in any sphere. 


 

How do you build your network? 

It depends on the phase that you're in. The people and the networks you need will be determined by two things: where you currently are at, and where you're trying to get to. So in terms of where you currently are at, it's the people whose values align with yours. 

Notice I use the word ‘values’. They don't necessarily need to believe the same thing as you, because you'll get into ‘group think’. You need the diversity of thought, because there lies the richest opportunities to learn. But the values need to align, otherwise they will jar against you, you will jar against them, and you won't get very far. 

So that's the first thing - where you're at. And think about where you're trying to get to. If you see somebody doing something that you would love to be able to do, don't be afraid to reach out and say: 'I really like what you're doing. Would you mind a 15-minute conversation to just help me understand it a little bit better?' 

A lot of people say, 'Will you be my mentor?' Let me give you a nugget of advice. Rather than asking, 'Will you be my mentor?', find a role model whom you really admire, and diligently update them on what you're up to? 'Hello so-and-so. I'm working on XY project. I just thought you might want to know about it.

I'm happy to chat about it if it's of interest’. Leave them alone for a month or two, come back, and say to them: ‘That project that I mentioned a few months ago, it's doing great. We've now been able to do this'. 

You will register in that person's mind. And without ever asking the question: 'Will you be my mentor?', you have adopted them as your mentor just by telling them what you are doing, and inviting their views about it. 

Because most people do genuinely want others to succeed. Even if it's one line that says, 'That's fantastic. I'll remember to mention it at XYZ', you've started the conversation. Because what is mentorship? It's being able to have a conversation with somebody whom you would like to be like, or who will help you to get to your destination. 

You don't need to plaster that label on the conversation. Just have a conversation. Just tell them what you're up to and keep saying it, and follow them. Now you've got social media, you can see what the person is interested in. So if somebody dropped me a line and said: 'Dr Owolabi, I'm doing this piece on health inequalities', you can be sure that it would immediately catch my attention. 


 

What advice would you offer to medical students and junior doctors about how to excel in their careers?

Excelling means different things to different people. So when you say: 'excel in your career', first of all, start with what that means for you. If it means becoming a celebrated academic, be clear about that, and begin to put one foot in front of the other to get to that destination. 

If excelling in your career is being the best GP that anyone has ever seen - fantastic - pour your energy and your effort into that. Be clear what excelling means to you, and also ‘stay in your lane’. There is a temptation to try and be like everybody else around you, and there is nothing worse for dissipating your energy and your effort than that. 

That's why, being clear in your own mind what excelling means, will mean you don't end up veering into all kinds of lanes because so-and-so is doing great and you want to be them. Then you get into that lane and realise: ‘I don't like that at all’, so then you try something else. I'm not saying this hypothetically - I've watched it happen. 

So be clear what excelling means to you. Stay in your lane, and invest in all the basic disciplines that we all know about: diligence, the ‘putting in the hours’, the ‘putting in the effort’. The best dreams come to pass when you're awake. Having the right conversations at the right point in time. 

Get people to mentor you without necessarily expressly saying it. Look for people to sponsor the work that you're doing. Get people to mention it. There are many ways of sponsoring something. Just by mentioning it in the right space can be all you need. 

Build your networks. So there are some hygiene principles: hard work, punctuality, respecting the views of others, and all the basics that you all know incredibly well. 


 

What's your favourite book?

My favourite book is Lean In by Sheryl Sandberg - she's the chief operating officer of Facebook. It's not a very big book, but it had such a transformative impact on me, because it suddenly helped me answer the question, 'What would I do if I wasn't afraid?' So I ask you: ‘What opportunities would you take if you were not afraid?’ It talks about ‘imposter syndrome’. 

We all have this syndrome. It doesn't matter how senior you get. Imposter syndrome is actually not a bad thing. It keeps you humble. It keeps your feet firmly planted on the ground. It reminds you that you are not the ‘be all and the end all’ of everything. 



Medspire podcasts are produced by Dr Sanketh Rampes and Dr Anvarjon Mukhammadaminov, both full-time junior doctors. They aim to inspire the next generation of doctors and scientists by exploring the career journeys of leading clinicians and researchers.