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 Rosie Benneyworth, a GP, and chief inspector for primary medical services and integrated care at the Care Quality Commission. Dr Benneyworth has had a series of senior leadership roles, including vice chair of the National Institute of Health and Care Excellence, and her work leading the national network of Patient Safety Collaboratives. Prior to this, Rosie worked as a GP for 15 years in Somerset.
A podcast of this interview is available here:
How did you get to where you are today?
I've been a GP for many years, in Somerset. During that time, I started to get involved in commissioning and was a clinical commissioner for several years. I’m really keen on looking at how we improve services, and also how we join up services to make them better for people's care.
I've also had a variety of other roles. I've led an Academic Health Science Network, which looks at the spread and adoption of innovation across the NHS. I was vice chair of NICE for three years, which was a fantastic opportunity. And I've been with the CQC for the last two years.
What attracted you to general practice as a career?
General practice is a fantastic career. I love the continuity of care. I love getting to know all of the families, the wider community, and the people working in the context of those communities.
I also think the breadth of what you have to deal with in general practice is brilliant.
It's brilliant that one moment you're looking after someone in an end-of-life situation, the next minute you're examining a newborn baby.
Then you're talking to someone about the difficulties they're having in their life. As a GP, the trust you develop between yourselves and the people you look after puts you in such a privileged position. It's a fantastic career.
Tell us about your leadership roles and what you did.
When I was the commissioner, I worked for both the primary care trust and the clinical commissioning group. I worked on lots of different areas including cancer and urgent care, and elected care. I worked right across the system, with colleagues from hospital and community services and social care, to see: how do we make improvements to people's care and the quality of care that they receive?
It was a fantastic opportunity, and I learnt a huge amount about how different parts of the system work together. I learnt how important it is for providers across the system to work together, to really look at how care is delivered.
Quality of care is partly related to the quality of care someone receives within a provider, but is actually very much about the quality of care that people get as they work together, and as they cross those provider boundaries. That was as a commissioner.
I led the work in the Academic Health Science Network, so I ran the organisation. It was a small organisation, but a really exciting place to work. That was looking at the interface of industry and academia and the NHS, and how we could scale up innovations and new ways of working. That could be digital innovation, new models of care, workforce innovation - a whole range of things - working with a real network across the country.
At NICE, my role was as a non-executive director, looking at how the organisation was run, and providing the oversight as a non-executive director. I also had responsibility for leading the appeals process in NICE, and making sure that people had the correct processes followed during the technology appraisal process.
At the CQC, I have a whole range of different areas under my portfolio, including general practice, dentistry, independent health, integrated care, defence medical services, health and justice, children's services, and online providers. There’s a whole range of different providers, which makes it a really interesting and challenging role.
What made you initially decide to take on these leadership roles?
I ended up falling into leadership roles by accident. After pregnancy, I developed rheumatoid arthritis, and my consultant got in touch with me and said: 'Rosie, I need someone who understands a little bit about rheumatology, who's a GP, to join a commissioning group’. That's when I started to get involved.
I joined a rheumatology group, and found I really liked having the opportunity to be able to improve care for a broader group of people, and not just the person in front of me. My journey through my leadership career has very much followed on from that, and has been very influenced by personal circumstances, and personal experiences of care, as a person whose family members have received care - as many of us have.
For me, the personal experiences have made me think that sometimes it's quite a confusing place to navigate the health and care system. Very often, you get fantastic care from the clinicians involved, but the system itself can be quite complex and confusing. If, as a GP, I find that to be the case, then how do people who don't understand the health service, in so many ways? That's been very much a key driver for me to want to improve things for people using services.
Tell us about your role as the national lead for the Network of Patient Safety Collaboratives.
I was involved in Patient Safety Collaboratives when I was the managing director for South West Academic Health Science Network.
Patient Safety Collaboratives sit with the Academic Health Science Networks, and look at sharing best practice, sharing learning across the country, introducing innovation into patient safety, and looking at patient safety culture and quality improvement, to really improve patient safety and care.
There was a huge amount of really great work that happened across this network of Patient Safety Collaboratives, and still does, such as looking at setting up communities of practice and at really understanding: how do you drive those really positive cultures that are going to improve safe care? For example, understanding how to encourage people to speak up about things that go wrong.
How do you learn from things that go wrong and how do you make sustainable change, so that things that do go wrong don't happen again? We all know that mistakes will happen and that things do go wrong in healthcare from time to time.
Very often, those things are unforeseen. The key thing is that we learn from those mistakes - we put things in place, so that they can't happen again.
Were Patient Safety Collaboratives set up through the work of Don Berwick?
That's correct, and we were fantastically lucky to have his leadership in this area. We were also lucky to work with lots of other people who were passionate about patient safety.
People like Suzette Woodward, who led the ‘Sign up to Safety’ work, and the Health Foundation and the work they were doing around setting up the ‘Q Community’. There's a lot of expertise, and a lot of very passionate people, and a huge amount to do in this area.
It's such an important area, and we learn from people like Don Berwick and others who have those skills, knowledge and understanding.
Tell us about your role as vice chair for the National Institute of Health and Care Excellence.
I was a non-executive director on the board of NICE, and vice chair as part of that role. I felt hugely privileged to be part of NICE. It's a fantastic organisation that does a very complex task of turning research into recommendations, in a very structured and highly competent way.
I loved my time working with NICE. My role was firstly as a non-executive director, looking at: how do you make sure that you provide that oversight and scrutiny to the board of NICE, to ensure that the systems, processes, and the running of the organisation is to the standard that one would expect?
That's very much the role of the non-executive director - to support the executive team and to work with them, but also to be their critical friend, and bring your expertise into the board, to make sure it is successful at running the organisation.
My specific role as vice chair was to have oversight of the appeals process for the technology appraisal process and the highly specialist technology appraisals. This is where if NICE made a recommendation - usually about a drug - there is an opportunity for people, if they feel that the due process hasn't been made making that decision, for them to appeal against that process.
Essentially, there was a variety of either pharmaceutical companies, professional bodies, or sometimes patient bodies, that sometimes would appeal against the decision that was made. My role was to see whether that needed to go in front of an appeal panel, and make sure that we identified if there had been any defects in the process to get to that decision.
What is the role of the Care Quality Commission?
The purpose of the Care Quality Commission is to ensure that people get access to really good quality, safe care, in all sectors of the health and care system. We make sure that people have access to this good-quality care.
We also encourage and drive improvement to make sure that there is that continuous improvement of care. We look at all sectors across health and care, which includes social care, hospitals, GPs, dentists, community services, mental health services, independent care - a whole range of different services that provide care for people.
What are some common misconceptions about the CQC, particularly among GPs?
The most common misconception is about the relationship between regulation and the GP profession, and that they are somehow in opposition to each other. Whereas actually, we have a great relationship with GPs and practice teams across the country.
It's something we work hard at and really value. We know the vast majority of providers are rated ‘good’ and ‘outstanding’, and we saw a great deal of improvement when we completed our programme of comprehensive inspections. This was driven very much by hard-working practice teams, who were using the inspection findings constructively as a guide to improve the care they offered people using services.
We always encourage GPs to work with our inspectors - they are a resource to the general practices to help them provide great care, and help with local conversations if they need support.
What does your current role as the chief inspector for primary medical services and integrated care involve?
I have a team of inspectors who work across a whole variety of different sectors, including just over 6,500 GP practices in the country. There's about 10,000 dental practices, that are both NHS dentists and private dentists.
We regulate online providers - so providers that usually provide primary medical services through digital means. We also work in collaboration with Ofsted to look at children's services. We work in collaboration with Her Majesty's Inspectorate of Prisons to look at the health and justice system, which includes prisons and probation services and safe houses.
We have other areas we look at as well, including defence medical services, working with the defence medical regulator, and independent health. My other role is looking at driving the work around integration. This is a significant area of work at the moment, particularly with the development of integrated care systems.
We believe looking at systems, and how different parts of the health and care system work together, is a really important part of the quality of care someone receives. That's a big focus of my work at the moment.
What are some of your key priorities as chief inspector, going forward?
My key priority in each of the different sectors that we regulate is to make sure that we target our regulatory activity to the areas of highest risk. We want to make sure that good and outstanding providers have the space and the ability to get on, and continue to deliver good and high-quality care.
If there are any concerns to people's safety, or any potential harm to people using services, we want to pick that up early, and be able to support those providers to improve. I'm really keen that there is a consistent improvement offer for all providers, and that we make sure we work with all of our partner agencies to ensure there is that consistent improvement offer.
Sometimes people know what they need to improve, but finding either the time or the capacity, or having the skills to be able to make those improvements happen, sometimes are not there.
The other priority is around how do we regulate systems, and how do we really understand people's experiences as they pass through different parts of the health and care system? Most people, certainly with long-term conditions, don't just use one service. They don't go to one hospital or one GP practice.
They're often in and out of multiple services. As a person using those services, it can be very confusing, disjointed and difficult for people trying to navigate their way through those different parts of the system. We want the health and care system to work much more closely together, to embed quality and safety at the heart of what it does.
We're going to look at how our role can encourage that to happen. We're also very keen to put people's experiences of health and care at the centre of what we do. We describe this as 'regulating through the eyes of people who use services’. We want to make sure that we listen to people's experiences.
Sometimes, what a person experiences is very different to what a provider thinks they experience. We need to make sure we pull both of those lots of information when we're making judgements about a service.
How can medical students and doctors learn more about CQC and engage with the important work you do?
We would be delighted for medical students and doctors to really engage with us about what we do. There's a variety of ways to do that. First, we have a huge amount of information on our website that is accessible to everyone. There are a whole range of different publications we've done in the past, looking at what makes a good system, and what makes a practice outstanding, for example.
How do we drive improvement? There's a lot of information and reports that people can access. We also have ‘ Citizen Lab’, which is a way that people can engage with us. They can join in the conversation about our developments and how we're progressing our regulation.
We run a whole series of events that people can join. I would encourage you if there is an inspection happening at your local provider, to go along and listen to what's happening. Ask questions about it. If you get an opportunity to shadow some of the work that's going on, please do.
For people who are experiencing health and care, you can always feed back to us your experiences of that health and care through our 'Give feedback on care' mechanism, which is available on our website.
We would very much want to engage with you. We have a team of inspectors in every locality. Please do reach out to those inspectors and have a conversation with them. We also have a team of specialist advisors, who work with us on inspection.
For doctors who want to know more about the CQC, there's often opportunities to come and join the team and go out on inspection, as a specialist advisor on a sessional basis, so that you can really get an experience of other providers, learn from others and share that best practice.
If you could design a primary care service from scratch, what would it look like?
This is a really good question - particularly given the huge pressures on primary care, and the significant challenges with the workforce that there are in many parts of the country. I’ll just describe what we see in outstanding primary care because I would base my design on that.
First, we need to have a team that is valued, and that understands its competencies, and how to work. Multidisciplinary working across a primary care provider is really important. Bringing together those skills brings huge benefits to the people using services. It also makes sure that people get the right care they need, by the most appropriate person, early on.
My starting point would be a multidisciplinary team where everyone understands their roles and responsibilities. That they understand what's in their remit, and that they're properly supervised. That people working in the primary care team are valued.
We know there's a huge link between patient safety, and how people are supported and their health and well-being in their workplace, and how happy they feel in their workplace. There's a lot of evidence that shows if you've got a happy workforce, you have good patient outcomes.
We need to create the environment for people to be able to excel in their workplace, and have the development opportunities and the support they need.
Next, I'd like to mention data. A lot of the work we see around outstanding practices shows they really understand their population. They understand what the context of their population is. They understand where the inequalities in care might be, and they put steps to address those.
I would like to see us going into a place where practices work more with their local communities, so there's much more involvement of things that actually impact on the wider determinants of someone's health.
Working with the local councils, working with the local voluntary sector to look at, actually, how do we solve some of the intractable problems that people are struggling with, that aren't necessarily due to purely a medical problem? The outstanding practices we see really understand that data.
They change and design their services based on the data they have available. And they continue to measure things, to make sure that what they're doing continues to improve.
Are there any specific CQC documents about what makes an outstanding general practice that doctors and medical students can read about?
We've got quite a lot of information on our website. There's documents about outstanding general practice and the characteristics of outstanding general practices. We've also done a podcast, which is available for people to have a listen to, about what makes an outstanding general practice.
If there's specific areas people want to look at, we have a series of what we call ‘myth busters’. For example, what does good safeguarding look like? What does good medicines management look like?
There's a whole series of guidance and information, and links to other information on the website that's available. I'd encourage everyone to have a look.
What are some of your proudest achievements?
From a career point of view, I'm proud of the work I've done in all of my different roles, in different ways. I can't claim that any of them were me on my own, but I've been lucky enough to work with fantastically dedicated teams, both as a GP, and through my management career, that have enabled us to make some great improvements to people's care.
In my personal life, I'm proud of my two, lovely, teenage sons, and the way they're growing up. As a parent, it's always wonderful to see your children grow up and develop, and develop a questioning mind and leadership skills, even at an early stage.
What important lessons have you learnt during your career that have shaped you as a clinician or leader?
The most important lesson is that making change is hard. It's not something that always goes to plan. There's often lots of ‘bumps’ that get in the way. The main thing is to focus on what you're trying to do. Always bring it back to the patient. What are you trying to do that's going to improve patient care?
Keep going until you've worked round those ‘bumps’, or worked through them. That's really important. I also think building relationships, building networks, working with people in a way that really enables great team-working, is always going to deliver far more results than trying to do things on your own.
Is there anything you wish you were taught in medical school that you were not? And would you recommend any resources to readers to learn more?
One of the things I didn't learn at medical school - which I think has probably changed through the curriculum now - were quality improvement skills. I would have liked to know more about ‘how do you make change?’ ‘How do you know if a change is an improvement?’ ‘How do you use data to measure change?’
It would also have been good to understand teamwork and culture. I think culture is vital for everything we do. Understanding how you have a positive culture, how you develop the culture that's going to enable really good care for people, Is important. I would have liked to understand that when I started my career in the way that I do now.
There's an enormous amount of resources available for people who are interested in patient safety and improvement. The Institute for Healthcare Improvement has a huge number of resources. There's also the work done by think-tanks, such as the Health Foundation, the King's Fund, and the Nuffield Trust.
Have a look, and keep an eye out on their websites because they've often got interesting articles about what's happening. Reach out to local quality improvement teams in the Trust that you work in if you're in a hospital, or link up with your local Academic Health Science Network, who can identify the good practice that's going on across the different areas.
One of the things that we need to get much better at in the NHS is learning from each other and identifying good practice, and being able to pick it up and work out how we put that into our day-to-day practice as well.
There's too much small-scale, brilliant work going on. The challenge we've all got is: how do we make that happen everywhere, so people get great care wherever they are in the country?
Is there any other advice you'd like to give medical students, and doctors starting out, on how to excel and have a fulfilling career?
Don't be afraid to jump out of your comfort zone. If you get an opportunity, jump at it with two feet forward. You might not have all of the skills, and all of the knowledge you need to go into something, but you will learn that.
Put yourself forward for things. Be inquisitive. If you're not sure about something, go and ask someone. Reach out to someone, find out more about it. Don't be put off. If you really want to do something and you have a goal in mind, then keep going. You might get some knock-backs on the way, but that happens.
Get feedback, find out why you haven't been successful. Learn from that, be open to people's feedback. Listen to it and take it on board, and then look at how you can use that in the next steps of your career. The main thing is, be passionate about what you want to do.
Be passionate about what you're trying to achieve, and keep going. It won't always be easy. I've been very lucky because I love what I do, I've loved all my career, and I've been lucky to have a lot of opportunities. With that passion, combined with hard work and some tenacity, you will succeed.
What's your favourite book?
I've got lots of favourite books. Workwise, I've got two favourites. One is Black Box Thinking by Matthew Syed, which talks about how you make incremental improvement. If you haven't read that, I would thoroughly recommend it.
Another book is by Patrick Lencioni, called Five Dysfunctions of a Team, which talks about good team-working and how you can build that. Captain Corelli's Mandolin, I enjoyed. I rather like books that are easier reads when I get to the end of the day, because usually by that time, my brain needs to switch off.
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.