EP 43: NHS 10-Year Plan - How to Answer 'Care Closer to Home' Questions in Your Consultant Interview

The candidates who talk successfully about the NHS 10-Year Plan are not the ones who've memorised the document. They're the ones who've either done a project that directly aligns to it or are able to describe processes along their patient care pathway that align with the 3 key elements.

Coming up in this episode, we're going to look at understanding the element of the NHS 10-Year Plan, which is from hospital to community, how this comes up in the examples we can use, the questions that you might get asked and how you can drop in your knowledge of the NHS 10-year plan throughout your interview. Let's get stuck in. So this week we are going to look at one specific theme, and this is something that comes up a lot in consultant interviews, which is one aspect of the NHS 10-year plan, which is from hospital to community. So it comes up a lot. I think it can stress people out, so we're going to look at some issues that come up and some questions that come up. Let's start with the student question of the week. This is where we look at a question from one of our Academy students. So what question are we going to look at this week?

So the question this week is, people keep asking about care closer to home, but I work in acute hospital medicine. How do I answer when I don't actually have a community project?

So what do you reckon about this?

So I think it's not uncommon, as you say, the NHS 10-year plan keeps coming up for a good reason. I think it's obvious for, you know, if people are working in a community clinic or whatever, or they've maybe set up, you know, some kind of satellite clinic that, you know, is in the community, that's very obvious. I think for people maybe like you work in our specialty, maybe that's a bit more diff— you know, a bit more difficult, you know, working in emergency medicine or a very hospital-based specialty. I think you could probably just think about things like, you know, how do we work across primary and secondary or tertiary care? You know, what are you doing maybe with your GP colleagues to improve pathways? How are you improving quality of referrals? What are you doing to support GPs to keep patients at home? I think that kind of thing, thinking across pathways, probably works in a specialty where you're not naturally having community interaction with patients. What do you think?

Yeah, I think pretty much every specialty has some element of being able to manage patients out of hospital. And I know we've got a couple of examples that we're going to talk about that are kind of good ways to illustrate that. But it's thinking, yeah, we know that the NHS 10-year plan is pushing everyone in that direction because we want to move care. It's better for patients and better for the NHS to keep patients out of hospital if we can. So, yeah, we do it in our specialty as well when we stream people away to get a hub appointment or whatever, where they don't need to be in emergency. They can go home and they can— or get a phone call appointment. And even the stuff like hospital at home is also trying to get people out of our emergency department and get them managed in the community. So, I think initially you might feel like your specialty, it's not applicable, but it probably is.

Mm-hmm.

And yeah, I think this is quite a common worry that people have. Yeah, I think it's just taking a bigger picture think about your specialty and how you might be able to do that. And it could even be how you manage outpatient appointments and doing virtual clinics. And I know we're going to chat about that a bit. But in every specialty, I think probably intensive care is maybe the only one where it would be less relevant.

Yeah.

But even so, you could probably do some follow-up appointments virtually or patient-initiated follow-up or something. So, I think every specialty pretty much should have a way that you can do this.

Yeah, yeah, I think you're right. I was just thinking about patient-initiated follow-up while you were talking. I think a lot of specialties that we hear about now are doing that, and I think that, that by definition does, you know, keep patients at home until they don't want to be, can't be at home. I suppose the other thing, you know, in addition to hospital at home, thinking about earlier discharge, maybe thinking about, you know, how you work with your community nursing teams or your specialist nursing teams to provide, you know, follow-up for patients or clinic appointments for patients in areas that are not in the hospital. So I think just thinking across whole pathways for patients.

Yeah.

how you support that. You know, like we do in the emergency department, we've got our list of patients who are under the hospital-at-home service, but we are still actively managing those patients. You probably initially have this reaction, but I don't do anything that, you know, that keeps patients at home. But you probably do if you think about it in a slightly broader way. So I think it is one of these things that's worth having a think about before the interview, because you probably can't come up with anything on the spot under pressure. No, you probably can't. If you spend 10 minutes thinking about it, you probably can think of something.

Yeah. And going back to the student's original question, which is, I don't have a project in the community, is fine. You can't make up projects that you don't have, and you're not expected to have. Obviously, ideally, you would have one, and that would be amazing, but that's not the way life works out. It's fine not to have a project, but that doesn't mean that you can't show an understanding of how your specialty does this, or where you've seen it done well before, or ideas about how you could do it. So just because it's not one of your unique selling points, it doesn't mean that you shouldn't be prepared to talk about it because it's commonly coming up, and I would be ready for it. Let's look at our golden example of the week. So this is when we get an example that one of our students has suggested they use. This is This is an example of working well within an MDT. And our student has used an example of where they were involved in setting up a virtual review clinic where patients— it was trying to prevent reattendances. So patients were followed up in a review clinic, which was a joint clinic that they did with primary care, and trying to manage patients outside of the hospital rather than inside of the hospital. So what do you think about this as an MDT example?

Great, I really like it. Yes, no reservations about this. I think that the key point with this and with any of the multidisciplinary team working examples, what you need to be able to show is how you specifically worked with each member of the multidisciplinary team and why it added value that you had all these different disciplines in that team. So, you know, what did the nurses bring? What did the physios bring? What did the, you know, speech and language therapy team bring? You know, how did you make that work with your admin team, for example? You know, what— how did you draw in the skills, the knowledge, the expertise of all of these different team members, value that, and then use it as a team to create something that works really well for our patients? So It's more than just demonstrating team leadership and team working. It's about showing that you are somebody who actively works with the MDT for the good of patients. And I think that's sometimes the bit that people miss. And this is a lovely example because you can probably talk about expediting care across pathways, you know, keeping patients at home. And valuing the team at the same time.

Yeah, I mean, this is an absolutely great example because they've set up a clinic. Like, most people have not set up a clinic or a service from scratch. So if you have, this is a big win, is definitely should be one of your USPs. And it is great to then use one of your USPs for the MDT example when you get asked, tell me about a time you worked well in an MDT. I think they could probably bring in some numbers here just to show us, because bearing in mind we don't know what the virtual review clinic looks like, um, I know they've said like they're working working with primary care, but, you know, how often does it run? How many patients do they see? What kind of impact have they seen on— so I would still add a bit of description at the beginning. But the important thing is what you said, which is the goal. The question is about MDT working, so the focus of your answer has to be on how you did MDT working well.

Yeah.

And I think the other thing to say with this is this is just a good example of why it's so much better to use example like this for MDT working than a case, rather than saying, oh, I had this patient and they were really complex, and we all worked together with the MDT to make sure their care was good and everyone was happy. That is also an example of good MDT working. But this is so much stronger because it's service change, it's senior level, you're talking about kind of complex setup and understanding organisations. And so you're going to get much more mileage out of using this than using a single case example.

I love hearing about a bit of data in an example.

Yeah.

It shows that the student's really got a great grasp of what they did and the impact that it had. And I think you're right, you know, anyone could describe a time when, you know, a patient was deteriorating and the team worked really well together, but any good registrar could do that, and you need to be demonstrating consultant-level thinking here. I really like this.

Yeah, so great example. Definitely use it. And definitely, this should be— you should be getting this in often in your interview because it's, I think, it's quite a unique thing to have set up a clinic like this, and it sounds great. So yes, we love it is the answer.

We love it.

So next up, we're going to look at the interview question of the week. So this was a question asked in a recent interview. This is a student who, which is quite a common scenario where you feel the pressure of one chance to get your job. And in fact, I was chatting to— I was just chatting to someone this morning before we recorded this who had geographical pressure for the interview that they were doing. They were working somewhere, they'd been working somewhere that's very far from home, and so doing a heavy commute. Although, They were already in a job that they were happy with, but the geography was far away. And so, there was a lot of pressure to basically get this job, and they were really feeling the stress of having to prep. And I think it's quite a common thing that comes up is that that stress can make you panic in the run-up to the interview. They messaged me the night before the interview and said I told them to pull themselves together, which I don't think is exactly my words, but maybe it was the vibe. But what actually one of the things they told me, which you'll probably like, Becky, is that they were doing a they were doing a this is a slight digression, but they were doing an experience where they had to walk on hot coals. This is I don't know. The part of me is like maybe I should try that. And the guy who was training them was the training was like the coals are not hot; it's in your head. Like you the coals are not hot. They're that's just in your mind. You're going to be able to walk over them and you're going to do it. And basically it was like. Like, get it together kind of vibe. And when I messaged her the night before the interview, I think it connected with the guy telling her to walk over hot coals, and she was like, okay, you're talking yourself out of this, you need to just pull it together. Um, so there's something to be said for that. It did make me wonder if we should be trying to walk on hot coals. Uh, do you fancy it?

I mean, I do think, you know, you and I love a challenge. Maybe we need to— after this call, we need to book ourselves an appointment to walk on some hot coals and just see how that goes for us.

I think it could be cool. I do like the idea of the coals are not hot, they're only hot on your head. I don't know how it works. Anyway, we're digressing. But the point is, yes, staying focused on the data. But this is a question that was asked, which is, have you any experience of bringing care from the hospital to the community? And can you give us an illustration of that? I think this is a hard question. It's obviously on point with the NHS 10-year plan. But what do you reckon? To this question.

Yeah, it's a, it's a bit of an ugly one, isn't it? Um, so if you were the candidate who we just talked about in the previous section who's set up that virtual clinic, well, you're gonna be ecstatic. That's absolute golden. Um, and you know, you can, you can talk about— I'd probably just take that project and break it down into 3 sections and talk about the, the different things that you did and the impact that it had. and bring in all of that lovely data that we talked about.

Yeah.

I guess if you're— if you haven't got a specific project like that, then, then really try not to panic. The coals are not hot. And I think just think about, you know, the things that we talked about before. What do you actually do sort of working across pathway, you know, whole patient pathway, those organisational boundaries between primary and secondary care. Is there anything that you do either to, you know, prevent people from coming into the hospital in a good way, or to facilitate earlier discharge so that they can be back at home earlier? And how do you support that in your practice? So I think, you know, you might say, look, we've set up an interface with, you know, our hospital at home team. We've agreed that they can take, you know, this, that, and the other type of patients. We're auditing that regularly. I support that by regular check-ins with them or whatever it is, but just try to give them some, something specific that you're doing day to day, even if you haven't got an actual project that you've set up.

Yeah, because it's the same with all, it's not just for this, but for anything. The number one is you've got a project that you led that's amazing. And if that is it, that's fabulous. Next is that you have seen it somewhere where you've worked, that you can bring in your experience and say, look, I don't, 'cause you would have to say, well, I haven't directly led a project on this, but I did work somewhere where we did X, Y, and Z. This is why it worked well, and then showcase your understanding. And then I guess next is you don't have experience, of that, but you've got some ideas. And so there are degrees of like, yes, obviously your ultimate would be you've done a project on everything they ask you about, but you're trying to still score points regardless. So yeah, I think you would have to do your best to come up with something. And also, I think part of it is probably acknowledging that this is part of the 10-year plan and just saying, yeah, this is really important because I know it's one of the goals of the NHS 10-year plan. And so we're all working towards that. And even that just shows you've got an understanding of why. They're not just picking the question out of the blue, they're, they're asking it. The other thing that comes up thinking about this is they must be asking it because they're doing something in relation to that as well. Um, and I wonder if there's stuff in your pre-interview visits that maybe you've got about this that you could drop it in here.

Yeah, and I think if that is the case, you can say, I know that you're doing X Um, and I can support that by doing this and that, you know, based on your other experience and your other examples. Um, I think going back to what you said before about the kind of levels of example, I think anything that you can say that's not hypothetical, you know, I would do this and I could do that and this is the sort of thing, and anything that you can say that's More specific than that is better. So even if that's just, in another place I've seen X working, or I've heard about this, or I've read about that, it's better than just saying something a bit sort of nebulous and hypothetical. Um, so if you haven't got something solid, just try to go with something at least a bit specific.

Uh, I, I agree. Um, I, I do think this is A hard question, but possibly they hinted towards it in the pre-interview visit, so maybe you would have had a heads up. But yeah, hopefully now you'll be confident in answering, or at least have thought about it.

So, I obviously loved the hot coals story, but how did the student get on in their interview?

She did actually smash it, and she got her job, which she was absolutely ecstatic about. So, it is moving closer to home and getting started in her new job, and I'm very happy for her. She has both walked on coals and also managed to secure her a substantive job. So what a win.

I love this. She's properly winning at life. Great stuff.

Yep. All right, and next up we're gonna talk about our tip and trick of the week. So the tip and trick is how to drop in the stuff that you know about the NHS 10-year plan, um, through your interview. Because we know people will read it, they'll know about it, but how do you actually get it in there without it sort of shoehorning it in? What do you reckon here?

So I think there are multiple different ways of doing this. So you might, if you're talking about, let's say, a change project that you've done, and maybe you've done something around use of AI, you've been part of a team who introduced digital note-taking in your department, you talk about that, and then you say, and of course, this aligns with with the NHS 10-year plan, analogue to digital. And so you're referencing it. It doesn't have to be a massive thing, but it just shows that you're aware. I think, you know, similarly, if you're talking about improving, you know, pathways across primary and secondary care, you can say, and obviously this aligns with the NHS 10-year plan around keeping care closer to home. And I think it could be just as simple as that. Sometimes it doesn't specifically come up as a question, but it's still nice if you can show that you have done a bit of reading, that you are aware of the bigger picture and where the NHS is going in 10 years, clearly, because it's the 10-year plan.

Although it's not 10 years anymore because it's already been whenever it was published. Exactly. So hopefully We're almost there. And just to be clear, the 3 key themes to draw out of the 10-year plan are from hospital to community, from treatment to prevention, and from analog to digital. So these are the 3 broad themes. Also, one of the things that where that is commonly used is when people get a presentation for their interview. So probably around 50% of people get a presentation, maybe more. Do you think more? Maybe it's a bit more.

Maybe.

Around that. And that question is often about the ideal service or your future vision for the service. And your future vision for the service has to be, will be in line with where the NHS is headed. So these 3 themes are good to draw out. So often people will have had a chance to drop it in then, but all you're trying to do is just show that you know it. You're not trying to give them a whole debrief of the whole 10-year plan. You're just showing you know it, this is the way things are moving. When you're coming up with ideas for where the service is going, it's with that in mind. And I don't think you need to make a bigger deal of it than that. I don't think— I don't know, how commonly does it come up that you literally get asked, tell me about the NHS 10-year plan?

I don't really recall it.

Not really, but then you could get questions like the community one, um, that we've discussed where they want you to recognise that this is part of the 10-year plan. So it's good to kind of have it in mind, um, and just drop it in subtly.

Yeah, I guess I was just— I mean, I, I suppose a question would be, you know, how does your— how are you, you know, how are you aligning, you know, your service to the 10-year plan? I, I've never heard that come up, but I still think that it probably is useful to just think about that. If you had to think of an example for each bit of that, each bit of the 10-year plan, what would you say? Because it's still useful to think about it in those terms, and then you can just weave it in in other ways.

Yeah, I think it probably has come up as a presentation topic, but I'm not sure it's come up as a question. And yeah, but be ready. Be ready for it. Okay, cool. So I think we're going to wrap up there. And just to remind anyone who's watching or listening, uh, when this goes out, we're going to be running our next free live training on the 17th of June. Um, and registration will be opening imminently. Uh, I'm going to be doing some free training on 7 Simple Steps to Ace Your Consultant Interview. So come along, register. We'll put the link in the show notes here. You can come along and register and join us, and we will see you in the next episode. when we will be looking at lots more great stuff. And we're going to be looking specifically around what happens when you get asked questions and you've used an example already that involves that question. Does it matter if you're reusing examples in your interview? So I will see you then.

See you then.