The Business of Healthcare | An interview with Sue Baldwin

Sue started training as a nurse in 1982. After 17 years on the front line, she moved into operational management and commissioning roles. Most recently, Sue has been working as a consultant with organisations including Channel Health Alliance GP Federation.

What do you do in a typical week at Channel Health Alliance?

Sue: I advise and guide on corporate, operational and clinical governance matters. I look at complaints or incidents and advise on how we manage those.

I lead on getting agendas and papers together for board meetings and provide my own reports to the board on things like performance and new service delivery.

If there’s a contract meeting with the Clinical Commissioning Group (CCG), I’ll look at the performance reports and double-check details to make sure that we're giving an accurate reflection of the service delivery. It’s very varied.

What training and education have you taken to support your management role?

Sue: I did a master's in health and social care, which included a module on leadership and management. I’ve obviously also had a lot of experiential learning over my years in management. I’ve done a six-month training programme on leadership and change management in primary care.

What are your strongest areas and where could you improve?

Sue: I have a basic knowledge of finance but I always think NHS finance is a complete mystery. I could do with a more in-depth knowledge. We’ve normally got someone who’s an expert, so I don't necessarily need it but it wouldn’t hurt for me to have that knowledge.

I've got a pretty good handle on governance. We’ve just been commended on our governance by the CQC. I learnt a lot of that from when I was a Director of Nursing and also from my years on boards. That’s all really stood me in good stead for the Chief Officer role.

What are your top challenges or pressures at work?

Sue: Managing the day-to-day operations is sometimes challenging because there is just so much going on.

Politics is another area. It doesn't matter where you are in the NHS, there are always challenges and people with their own agendas. That’s difficult when you're trying to make a difference. As a consultant, I try to be clear about what I’m there to do. If I’m delivering those things, the frustrations aren't there because others are trusting you as the expert.

What does the development of primary care networks mean for a federation?

Sue: I think it will help federations support their practices. The NHS long-term plan demonstrates that there are opportunities to support practices working at scale. Without a federation around them, many practices would not be able to do it as easily.

I also think it's an opportunity to stabilise primary care, get some investment in and for GPs to build good services for their patients. It’s the first opportunity in a long time where primary care is being given a stronger position in the market.

Is there ever a tension between the federation and the practices?

Sue: The practices recognise us as their organisation supporting them. They’ll come for advice and the contracts we deliver also help them. The tension comes when you've got tight specifications for a service that aren’t flexible enough for primary care to get out of it what they really need. The federation doesn’t have the ability to change that contract easily, because it's governed by the commissioners. Practices understand that we're stifled by what the contract dictates but, equally, they’ve got everyday frustrations and pressures.

Do you feel that there is a lack of business leaders in the NHS and primary care?

Sue: There are those very good business people who get it, and some who just don't. Those that are forward-thinking will grasp what’s in that long term plan, translate it and really make it happen. But others possibly won’t grasp that opportunity.

I've been in commissioning and it was frustrating. I understand the political landscape, but tough decisions need to be made and I don't always think they make them from a business or patient care delivery perspective.

How did you go from nursing to being a management consultant?

Sue: I've always wanted to be in a position where I had enough authority to make a difference to patients. When I first set up a team, that was my dawning of the realisation that you can make a difference. Although I grieved for my clinical role, I knew I was using all those skills in a different way.

I got the job in the CCG and worked with GPs who were on the governing body. I’d worked closely with the GP who became the chairman of the new GP Federation. He always said: ‘you just get it, and you get a job done. You’re a doer.’

What skills do you need to be successful in that kind of health care management role?

Sue: It's often about relationships, but it's also more than that. People have got to trust you and that you know what you're doing. They’ve got to know that you’ve got the skills and have proven yourself. It’s frustrating and demoralising when you work with people above who you don’t trust because they can’t support you. I was in that position once and so I left.

How is your federation using technology to drive efficiencies?

Sue: We're very paper light. We use iPads to access records electronically. All of our corporate processes and information is electronic. But there's more that we need to do. The contracts we've got limit us, but we would want to use other technologies to help with things like care flow, where you connect your clinical teams and your MDTs. It’s early days for us as an organisation.

How long did it take the federation get get started?

Sue: The federation started a little before my time, But the contract for the Hub service was signed in December ’17 and started recruiting and applying for CQC registration in the January. We recruited and trained nine nurses. On 2 April we were ready to mobilise five primary care access hubs with all the equipment in place. The CCG were keen to make sure we had our corporate governance in place which we did.

Do you still refer to all those governance documents when making decisions?

Sue: It's the only way to assure yourself that you are functioning and delivering. So you do have a regular finance report to the board, you do have a chief officer report, you do have a chairman's report, you do have a staff survey in place and you do engage with partners. It becomes a real risk when you don't have these systems and structures in place. It means the sustainability isn't there and there's no succession planning.

In conclusion: good management makes a difference

Before speaking to Sue, I was intrigued by her journey from front line nurse, to management consultant. It’s clear that what runs through everything she has done is a desire to make a difference for patients. I love how Sue sees the big picture. To her, governance and business leadership isn’t the dry, theoretical bit that just needs to get done, it’s central to her career-long ambition to make healthcare better.

Tara Humphrey is the founder of THC Primary Care, a leading healthcare consultancy specialising in workforce transformation and the only consultancy to have worked with 11 Training Hubs across South London, Kent, Surrey and Sussex.

Tara and her team also work with GP federations supporting the implementation of clinical services.

Tara has over 20 years of project management and business development experience across the private and public sector and has an MBA in Leadership and Management in Healthcare, is published in the London Journal of Primary Care and is the author of over 150 blogs articles. She presents her own podcast: The Business of Healthcare With Tara Humphrey.