“I love the interaction with people”: Samir Dawlatly, GP

A GP from Birmingham on what his job is really like, why many health problems are related to social problems , and the tricks he uses to keep himself at his best while connecting with patients all day long. 

If our model of general practice were not so familiar, it would sound more like a slightly sadistic game show format than a job.

Sit in a room, see 30 or 40 patients a day for a few minutes, each time determining why they are there and whether they can be helped.

In the words of those who do it, being a GP is relentless, stimulating, exhausting and exciting, often all at the same time.

It is the job of more than 41,000 doctors in the UK today including Samir Dawlatly, a Birmingham GP.

Every doctor in general practice needs a coping mechanism to do their job well, says Samir.

For him, it is ensuring that the inevitable stress caused by some consultations does not accumulate throughout the day, affecting his ability to do his work and help his patients.

“Someone comes in and I’ve got a certain amount of time to find out what’s wrong and what they want, then come to some decision with them as to whether there is anything I can do or whether I can’t, so I just focus on what needs to be done.”

There may only be a few seconds between one patient leaving the consulting room and another entering, but to make sure each patient is served well, a type of selective amnesia is sometimes necessary.

People Person

While it was important for Samir that he had that balance of work and family, the real draw in becoming a GP was the people.

“I loved the interaction with people, had a really good think about what’s best for the family, for my sanity, and that’s when I decided to do general practice.”

Samir now works three days a week as a GP.

Considering the relentless flow of patients, his working day, between around 8am and 7pm, is long enough.

But at a time when an ever-increasing demand means that almost three-quarters of GPs say their workload is unmanageable or unsustainable, he is managing.

That’s in large part due to his own resilience, but he also works in a practice which discourages doctors from staying late, so most access their work computers remotely to finish paperwork in the late evening from home, enabling some semblance of family life.

In addition the GPs at his practice regularly meet to discuss their patients. He said there are practices ‘where you go into your room, work for 10 or 11 hours a day’, and never have the chance to talk to colleagues.

It’s important to stress that no GP wants to be isolated.

But if you consider that GPs are treating 40 million more patients per year than they did five years ago, it’s not surprising that such contact – even though it has a hugely important role in reducing stress and sharing knowledge – gets neglected.

Tha Gatekeepers

The NHS is, according to a respected international think tank, the most efficient healthcare system in the world.

A major reason for this is that the vast majority of medical problems are resolved or managed effectively in primary care, with GPs acting as the ‘gatekeepers’ for the rest of the system.

Samir identifies one overriding reason for the increasing pressure on GPs.

Every GP, every day, will see patients whose lack of wellbeing arises from something neither they nor the patient can influence – such as housing, relationships, or employment.

“When does ‘I’m unhappy with my job’ become clinical depression? That’s a real grey area.”

Health and social problems in the modern world, often do not neatly divide.

When asked what he would change about general practice, Samir cites the rolling out of a ‘neighbour scheme’ he saw in action during his training.

The programme gave patients access to an advisor who worked like a GP for everything non-medical, solving what they could themselves and referring on to other agencies for more complex problems.

Another similar scheme, ‘chaplains for wellbeing in primary care’ has been analysed and published recently.

Working like a hospital chaplain – so used to working with people of all religions and cultures – it was found to have particular benefit for patients whose unhappiness would otherwise be medicalised, for example with anti-depressants, or for patients who had symptoms that could not be medically explained.

The scheme takes the form of sympathetic listening, as Samir calls it, recognising crucially that social circumstances often inform patients’ difficulties as much as their illnesses.

The Real Reward

So how does he feel at the end of a working day?

Despite the daily challenges and resilience required to do the job, Samir says there is always cause for optimism.

“There will be something that goes well – even if it’s one patient saying thank you, a bit of appreciation, a chat with colleagues, getting something right. It’s very rewarding from that point of view.”

And like many of his colleagues, although he cannot solve everyone’s problems, he is still passionate about them being solved.

Meanwhile, back in his surgery, along with the thousands of other GPs around the country, Samir takes a breath, has a sip of coffee, and gets ready for the next patient to come through his door.

This is a repost from the wonderful Real Doctors blog run by the British Medical Association. They profile the lives of real doctors working around the country to find out what the job is really like.

We recommend you read the rest of Samir’s story there, including how he manages his mental wellbeing and his experience fighting injustice as an activist. 

Photo by Dr. Samir Dawlatly.

First steps to thinking relationally

Take the first step in faith. You don’t have to see the whole staircase.

-Martin Luther King Jr

At Participle, we strongly believe that a 21st century welfare system must work relationally. (In fact we believe it so strongly, that’s what we’ve named our blog.) So what does that look like? We’ve got a vision of a future where our public services are dedicated to boosting citizens’ capabilities to lead thriving lives, every frontline worker has the time and ability to form relationships with the people they assist, and local networks of support are helping everyone find great jobs, stay healthy, and stay connected.

But let’s not get ahead of ourselves. We know that it’s not easy to make these types of changes in a system that resists them. But we also know that the role of the public servant is rapidly changing. We’ve always been happy to admit that you don’t need every single public service to function relationally – you don’t need a meaningful relationship with the people emptying out your bins in order for the waste disposal system to work properly. But lately I’m beginning to wonder. In our current environment, even the fire service are expected to reach out and work with the communities around them to a surprising degree. It’s evident that those of us in public service need to understand the thinking behind working relationally, and it’s also evident that we aren’t going to be able to change our systems overnight. So where do we begin? If you’re a public servant, here are some easy places to start:

  • Map out your day. When we spent time with social workers who assisted troubled families, we found that they spent 80% of their working time filling out paperwork and dealing with forms, and 20% of their working time interacting with the people they were meant to help. Of course, a good portion of that 20% was spent seeking data to input into the forms. Still, when we asked them beforehand how their day was spent, they reported that most of their time was spent with the families. You might not realise how much time you’re spending with people until you sit down and purposely map it out. Realising how much or how little you actually have to work with is the first step to thinking about what a different way might look like. If you’re in management, think about the structures and tools you’re giving to the people who do frontline work, and if those are helping or hindering them in forming relationships with service users.
  • Learn about active listening. This might seem a little unusual, but if you’re in a role where you need to understand people’s lives and what motivates them to change, a little bit of listening will go a long way. Most of us are not in the habit of truly listening to what people are saying, or helping others reflect on their thoughts. These are skills which are easily sharpened with a bit of practice, and will help you do your job much better. We’ve found that even just simply giving people the space to get things off their chest while you listen makes them much more receptive to what you’ll have to say in turn.
  • Stay in touch with how people are helping each other in the communities where you work. This is a dual-purpose suggestion. Understanding how people are connecting to support one another will make it easier for you to point your clients in the right direction. Go beyond what large charities are offering, and pay attention to what small community groups are up to and which local businesses are the informal gathering places where people go to chat. Getting plugged in to these networks will help you understand your clients better, and might even act as inspiration as to how your service could function more efficiently in that context.

In the face of diminishing resources and time, even the above can look easier said than done. But give it a try. It could help you see your work in a new light, and it’s quite likely to make your job easier in the long run.

Kate Bagley is Campaigns and Content Manager at Participle.

This post was originally featured as part of the 21st Century Public Servant blog.

Photo by Alexander Wende, via Flickr Creative Commons.

Communication can be a sore subject… or is that sensitive?

We’ve been thinking a lot lately about what it takes to make a good relational worker – someone who can work with people to help them live the life they want. Whether you’re a social worker, a nurse, or in one of the many other kinds of roles helping people sort out problems, a big part of this is listening. At the same time, if you want to work together, you’ve also got to make sure they get what you’re saying too.

A lot of terms that seem totally clear to people who’ve been in the non-profit or public sector for ages mean something quite different to others. It’s not that one interpretation is more valid; they’re all reasonable depending on what context you’re coming from. But you’d best be aware of it if you want to be understood!

Here’s a chart we came across in our files that illustrates the point really well:

Misinterpreting Language

Commonly used words What people using the service thought
Voluntary agencies People with no experience, volunteers.
Maintain Mixed up with maintenance – money paid for children in divorce settlements.
Sensitive Tender and sore.
Encompass A way of finding directions.
Agencies Second-hand clothes shops.
Common Cheap and nasty – don’t talk about ‘common values’.
Eligibility A good marriage catch.
Allocation process Being offered re-housing.
Function Wedding (party), funeral.
Format What you wipe your feet on.
Gender Most did not know this word.
Criteria Most did not know this word.
Equitable manner Most did not know this term.
Networks No one knew this word.
Advocacy Some users thought this word meant if they did not agree with the assessment they would have to go to court. They wondered who would pay the bill.

Now, the solution isn’t necessarily to stop using these particular words. It’s more that you can’t just assume there’s going to be mutual understanding from the get-go. Communication, and relationships, take time. It’s vitally important that we give workers in our public services the time they need to get to know the people they support. Misunderstandings can be massively counterproductive, which in turn creates distrust and wastes money, time and resources. When it comes to building relationships what you hear matters a lot, but what you say is important too!

Note: We don’t have many background notes on this list, but we believe it is associated with Reconstruct, a brilliant training organisation,  and it’s out of a small survey of 100 service users.

Great Interactions in Social Care: Nature plus Nurture

Across MacIntyre we use the slogan ‘It ain’t what you do, it’s the way that you do it’, to sum up our way of working. Social care is all about relationships: every minute of the day, across the country in care homes, home care services, day centres etc there are countless thousands of interactions between the 1.5m people employed in the social care workforce and the people they are supporting. Regardless of what the activity is it is the quality of these every day interactions that people say make the difference to how they feel and how happy there are with their service.

At MacIntyre, we were quick to embrace the new thinking around person centred approaches in the late 1990s. We recognised that good person-centred outcomes relied on having good staff who worked in a particular way. They need to be engaging yet not dominating, responsive but not controlling. We wanted staff who were thoughtful, attentive and warm.

There’s been some debate over whether you can train people to work relationally, and whether it’s a question of “nature versus nurture”. We figured that the challenge was to recruit more of people with this intuitive way of working and find a way to up-skill the rest of the workforce. Why choose between nature and nurture when you can have both?

With this in mind, we created a plan that would suit our own needs. We called it Great Interactions.

First off, we figured out how to find people to whom relationships came naturally, by identifying the personality traits that were working well and using them to creating a profile and competency framework for use in interviews. Then we set out to nurture good relationship building in the rest of our staff, teaching key soft skills we had identified. We had to adapt that training for the diverse range of settings across MacIntyre, which eventually resulted in a national roll-out and intensive training for both senior staff and frontline workers. Finally, we reinforced the message that relationships were important by integrating Great Interactions into all our systems and processes, from staff contracts to appraisals to service outcomes. We made it clear that this was something everyone needed to take seriously. Luckily, it’s a more pleasant way of working, so it wasn’t too difficult to get everyone on board.

Nature: Recruiting to the MacIntyre Profile

Profiling applicants against the competencies required in a role is an established practice in commercial organisations, yet in the social care sector, it’s something of a radical concept. Working with HR consultants, we created a personality questionnaire, and competency framework of an ‘ideal’ practitioner; someone predisposed to work in a facilitative way, with a growth mindset, openness to learning and ability to cope with the demands of the role.

Our approach to recruiting practitioners makes no assumptions that previous experience or qualifications brings better staff, rather focuses on a person’s predisposition to working in a facilitative and reflective way.

Nurture: Great Interactions

Determined to distil the soft skills we now knew to make an ‘ideal’ practitioner we studied video footage of staff supporting people in their everyday lives. We began to identify the subtle behaviours that appeared to lead to positive experiences for each person filmed. Looking into these behaviours further resulted in the development of a training programme to upskill staff.

These behaviours are now widely known as ‘MacIntyre’s 10 Facilitation Skills’:

MacIntyre Facilitation Skills
By codifying what behaviour results in great interactions between people, we’ve been able to hire staff who are more comfortable working this way, as well as supporting all of our staff to do their jobs more safely, effectively, and compassionately. While hiring the right people is important, it’s our responsibility as an organisation to make sure our staff have the structure, encouragement and time to build relationships with the people they support. Since establishing this framework for Great Interactions, we’ve won several industry awards for our hiring and staff development practices. But obviously, the whole point of creating Great Interactions is that it makes a difference to the people who use our services. Their feedback means a lot to us:

‘Great interactions means a heck of a lot to me, because it comes down to me being at the centre of my service.  It means that staff can make things better’  Rosie, Milton Keynes

 ‘I think the Key is a good idea because it makes the staff think about their skills and how to get better at the skills.  I think My Key will help staff to support people better’ Jess, MacIntyre Expert by Experience, Worcester

 ‘It’s special skills, you get really special skills’ Ian, Milton Keynes


Bill Mumford is CEO of MacIntyre, and Gwenne McFadzean is Facilitation Advisor of the Great Interactions team at MacIntyre. You can read more about how MacIntyre staff are making Great Interactions happen on their blog.

The Living Wage: “It has made me happier and less isolated.”

Perrine works as a home care support worker. In her job, she needs to build relationships with her clients, so that she can understand and support them as well as she can. This type of work requires a lot of emotional labour, which is difficult to do if you are exhausted, hungry, or lacking in your own social support network. Here’s how being paid the Living Wage helps her do her best work and lead a better life, in her own words: 

As a single woman who experienced life on a minimum wage, I can tell you that it’s close to poverty. It meant I wasn’t able to even buy enough food – let alone good quality food. Quite often, by the end of the month when I was running out of money, I could only afford to eat once a day. I could never buy clothes even when I really needed them – such as a warm winter coat, and obviously, I could never go on a holiday. It’s also very lonely. You get by on the bare minimum, and can’t afford to socialize.

Being paid the Living Wage has made a huge difference in my life. I can eat better food, and I buy more meat and vegetables now, and I take the tube instead of the bus which is faster and easier. It’s definitely made me feel healthier and less worried. I can even join colleagues or friends occasionally for an after work drink, so I feel much more connected to people and less isolated.

To me, it’s a sign that my employer acknowledges me as a human being with my own life and needs, not just someone who contributes to the profits. It shows respect for employees and that builds confidence and good relationships. It has created a really good atmosphere at work, and means I’m committed to doing the best job I can. I feel connected to the business and want it do well., because it deserves to do well. “

Thanks to the Living Wage Foundation for providing us the material for this post. You can find them online at @LivingWageUK

Photo by Ry, via the Flickr Creative Commons.

Value workers, pay your fair share. It’s really not that hard.

This week is Living Wage Week. Here are just a few of the reasons we support it. 

Here at Participle we believe everyone who works deserves to be paid enough to live on. That’s the deal: you give your time and skills to us, we pay you enough to make it worth your while. It’s not a complicated concept and yet it appears to be one that hundreds and thousands of firms across the UK are confused by. These firms seem to think that doing a fair day’s work doesn’t deserve a fair day’s pay; that it’s acceptable to pay less than it actually takes to live.

Firms like this are in effect doing two thing to their workers: 1) they are saying that the work they do isn’t important enough or valued enough to be worth a living wage and 2) they are relying on the state to pick up the shortfall.

By not paying a living wage, those firms know that their workers will need to get more money from somewhere to pay the bills – and that money will come in the form of benefits. It’s an unintended consequence of the welfare state that by providing a safety net for people in need, some firms choose to deliberately put their workers in that position knowing they’ll be caught by the safety net. Why pay your workers more if you know the state will make up the difference between what you pay (likely the be just the legal minimum) and what they need to survive (the living wage)? In this way it is firms that have become the largest beneficiary of welfare – not just small firms either, but huge multinational ones! These firms don’t pay a living wage, so their workforce is being subsidised by the state.

Not quite what Beveridge had in mind, surely?

But it’s not just the injustice of relying on state funds to top up a worker’s salary that is the effect of paying less than the living wage, it is also what that says about how those workers are valued. Let’s face it: it’s hard to think you’re a valued member of the team if your time and skills aren’t even deemed important enough to warrant a wage high enough to pay your bills. Many of these underpaid workers are the same people we task with taking care of people at their most vulnerable – social workers, home carers, NHS staff, and all manner of other frontline workers. If the hours you spend at work don’t even mean that you can actually live what does that say about the value your company, and us a society, places on the work you do?

So how about this? If you employ someone, pay them enough to live on. Make that the very minimum of the deal you make with each and every one who works for you – directly or indirectly. Be proud to say, ‘If you work for us we’ll make sure you can at least have enough to live on; working for us will mean you won’t have to turn to the state for more money; that we won’t have our workforce subsidised and that we believe that the work you do is important; that’s it’s valued, that it’s at the very least worth enough to live on.’

It’s really not a hard concept is it? And to make things even easier, there’s even an organisation that can help work out what a living wage actually is. So this week of all weeks, show you care enough about those that work for you to pay them enough to live on. Simple.

Check out the Living Wage Foundation’s website for more information and to register your support.

Photo by LIVING WAGE, via Flickr Creative Commons.

I Wish I Could Cry With You, But I Can’t

Nurse Eye Roll blogs about her life as a nurse. Most of her posts are pretty funny, but this one hit us hard. You can see what a lot of emotional labour it takes to do this job right. That’s why we think it’s so important that nurses (and everyone else that does this type of intensive work with the public) get proper support to do it well and with dignity for everyone.  

I just saw the doctor walk out of the room…the room of your husband on a ventilator, who after 12 days of no improvements, has had set back after set back. I talked to the doctor before he walked into the room. I know what he told you.

Forgive me. I have to avoid you for a short time. I’m going to go do something else for a little while.

You see, I’ve seen that look before, that look on someone’s face where they are about to sob uncontrollably and throw up from the sheer emotional pain. People usually put on a strong face when the doctor delivers the news. And as soon as the physician has vacated the area, they allow themselves to break down.

But guess who is still in the room?

The nurse.

Through their tears, they ask us the questions they were either too shocked or too scared to ask the doctor. Somehow, what we say stings even more.

Shift after shift, we see lives permanently altered. We see people walk into the hospital with hope and we see them walk out with despair.

It never gets easier to do this. You just get used to it. You figure out how to do it.

So, I’m sorry. I’m sorry to the wife who needs me right now. I know you have questions you want to ask me. Questions you didn’t think to ask the doctor. Questions you didn’t want to ask him because you didn’t want him to think you were stupid. Things you want me to explain. I know you want my honest opinion.

I need to collect myself first before I walk into your husband’s hospital room. I need to put up my wall. I need to mentally prepare myself to not compare you and your husband to my mother and father. I need to disconnect the dots.

I have to do that because as soon as I’m done being there for you, I have to go see my other patient. My patient that will probably recover from the massive stroke he suffered, but is a little down today. I have to go in with a smile on my face and tell him that he’s doing great. I have to be happy for him. I have to motivate him. I have to inspire him.

So, please forgive me. I know that because I’m not emotionally upset with you right now, I may look cold and heartless. I promise I’m not. It is out of self-preservation that I am not going into that deep, dark pit of despair with you right now. I’m going to get as close as I can without losing it. I’m going to take a ladder down into that pit with you, but I’m going to stay on that last step. I’m going to stay on that step because I have to be able to quickly climb out on a moment’s notice for the man in the room next door.

You see, I’ve gotten pretty good at that. I’ve gotten really good at lowering myself into that pit and getting as close as I can to your pain, but not quite there. And I’ve got even better at running up that ladder and out as fast as I can.

I’ve gotten good at that because I’ve had to. If I take that last step, I cannot continue on. I cannot do my job. I cannot be there for any other patients. I cannot talk to physicians and coordinate your husband’s care or the care of any others. I cannot hold myself up. All I will think about is my husband dying. Or my father.  Or my mother.

So, I put up my wall. My boundary of empathy. I will get as close as I possibly can for you. I want to support you. I want to be there for you. I want you to feel cared for. So I will give you as much as I can bear. I pray that will do, for I have no more left.

You can read the rest of this post, and lots of other interesting comments from her fellow nurses, over at the Nurse Eye Roll blog where this was originally posted. Thank you so much Kati for allowing us to share this here. 

Photo by Alyssa L. Miller, via Flickr Creative Commons.


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