Career Path: making health second nature

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Working at the Met Office and Natural England has helped one GP hone his management skills. Here, he charts his career path, explains what he has learned along the way and gives advice to those interested in similar roles

My training to become a GP followed a fairly standard course, seeing me move from medical school and house officer posts at the Royal London, via a rotation at Frimley Park and a spell running a hospital in Kenya, to the Sonning Common practice in South Oxfordshire.

I joined the Sonning Common practice in 1990. They were hugely innovative, bringing nurses into long-term condition management well ahead of many others. During the 10 years I was there, I set up the Green Gym scheme and won Doctor of the Year for Innovation in 1996 for my Health Walks project.

I went to the Met Office in 2000 to develop the health forecasting unit that now works with parts of the NHS predicting when climatic conditions will exacerbate symptoms in patients with chronic obstructive pulmonary disease.

In 2005, I moved on to set up my own company, looking at using mobile technology to help people get out and explore their local parks and footpaths, and just over a year ago I took up post as strategic health adviser with Natural England, the agency charged with conserving, enhancing and promoting the natural environment.

My job, along with a team of regional health leads, communicators and campaigners, all in collaboration with the Department of Health, the NHS and primary care, is helping with the development of strategy and policies that integrate the assets of the natural environment with health delivery and commissioning. In London, for instance, it is already embedded in the physical activity care pathway. 

The huge number of health and related cost benefits afforded by the natural environment are gradually being quantified and I regularly present this evidence at conference, to policy makers and influential organisations such as the NHS Alliance, the National Institute for Health and Clinical Excellence and the British Heart Foundation.

Put to the test

The learning curve that came with my shift, first to the commercial sector and now to a non-departmental public body, has been steep and at times quite a shock. GPs get very little management training and much of the work is about responding to what is thrown at you. Since moving, I have had to acquire some very different skills. The emphasis is much more on being proactive, planning, making things happen, selling and pushing.

Sometimes you get results, but what I wasn't prepared for was the rejection. In general practice, people always want to see you - but in the commercial world and in government circles, you soon learn that there are actually those who do not want you, your product or your ideas around. Sometimes you have to accept that you just need to do a better job of getting across to them.

The common thread running through my career and something I feel very passionate about is integrating health with the natural environment. Technology, pharmaceuticals and surgery are great to a point but our overdependence is starting to show. With a lot of problems like diabetes and obesity, reconnecting with the natural environment, where, rich or poor, we all have an equal status, can be far better than many well-meaning NHS initiatives.

Unique post

As I understand it, both my former Met Office and current Natural England jobs are unique in the UK, and perhaps in the world. The health benefits of the natural environment are understood by many organisations. What none of them have been able to do, however - and here I am thinking of Scandinavia, Australia and Canada - is get through to mainstream health services, which puts us further ahead.

Our aim is to have a national network of GPs who can look at the assets around them, take the evidence and, with my help on the cost benefits work, sell the natural environment to commissioners.

I imagine the person that comes into this post next will be well respected in health, looking to work with the NHS from a different angle and have the kind of passion for the natural environment that grabs the attention, because this can be a hard sell. They will also be familiar with research and have hands-on experience of management skills.

Looking back

The Green Gym scheme - which now runs across more than 80 sites - has to be one of my proudest achievements and in some cases has helped people put their drugs problems behind them and get back on their feet.

Throughout all of this, I have kept up my general practice. I currently do out-of-hours work from a base at the Royal Berkshire Hospital. I would find it very hard to give up and I am sure that if I lost that patient contact, the original source for all the innovation I have been involved in, the ideas would dry up.

A Scottish GP once suggested to me that innovation has to have enemies. If you are not treading on toes or rocking boats, you are not innovating. He told me to think of the enemies I was making as positives, not negatives. In my time I have found that very reassuring.

How to get there

James Stephens, development manager at the British Association of Medical Managers, offers the following advice to health professionals considering a similar move:

"We work with a lot of people taking on managerial or leadership roles. For them, maintaining credibility with colleagues and wider organisations is a frequent concern, so hanging on to some kind of caseload is a good move.

"Much of this type of job is about raising awareness and making sure messages aren't forgotten or ignored. This relies on presentation and relationship skills - communicating, influencing and negotiating - that you should have experience of or seek to develop through training.

"Also look to gain a broader understanding of NHS politics, so when you present evidence and arguments they are to the right audiences at the right time in the right way."

www.naturalengland.org.uk

If you would like to appear in the career path, e-mail rebecca.allmark@emap.com