Clinician of the Month: Dr Junaid Bajwa

Dr Junaid Bajwa is a GP, Clinical Associate on the NHSE New Models of Care Programme, and Executive Director of Healthcare Services for MSD (UK).

Junaid qualified as a GP in 2009 and has since undertaken a number of roles within the NHS spanning the provider and commissioning landscape. This includes Governing Body Member for the NHS Greenwich CCG (leading on Mental Health, IT and supporting Integrated Care), working with the Royal Borough of Greenwich as a Public Health Associate, and Council Member for the London Clinical Senate.

In recognition of the impact Junaid has made to his profession, he has been named this month’s DigitalHealth.London Clinician of the Month.

Here, Junaid tells us how he’s making use of tech to deliver benefits to patients, and offers his advice for clinicians looking to embrace innovation.,

You’re a clinician, but with many hats. Could you tell us more about your various roles, and how they work together for the benefit of patients and the wider healthcare system?

In many respects I’ve done the same job since finishing medical school, it’s just that I’ve been delivering care in lots of different ways and settings. In addition to being a GP in Plumstead, I am a Clinical Associate on the New Models of Care Programme, and the Executive Director of Healthcare Services for MSD in the UK. All three roles share the objective of delivering population health improvement, improving the experience of care for the patients I serve, be that at practice level, in an advisory capacity with NHS England or through the healthcare services group at MSD. At MSD we work to come up with novel solutions for population health improvement that can can be scaled nationally, or potentially globally, with a focus on data driven insights that reduce variation in care, drive quality and promote self care.

Which role has allowed you to make the biggest impact, either to patient care, clinical practice, or financial sustainability?

I have to say that it was the first job I ever did after training; the same job I do today, and that’s the job I do at Conway Road Surgery in Plumstead. It was unfortunately a failing practice when I joined, and had been for a number of years.

The public health data for that practice was distinctly different to more affluent parts of Greenwich, and the health inequalities were inequitable. Driving change at that practice (through working with clinical and non clinical team members); improving the quality of care delivered using technology and patient-centred care, has probably been the thing that has taught me the most. It’s reinforced every job I’ve done since.

Have there been any really great tech initiatives that have helped you to achieve your objectives?

It’s what the technology has enabled: how I use data to drive insights, and data the use of day-to-day consumer apps to drive impact.

If you think about technology that allows you to improve data quality or do in depth analytics on primary care data, it’s possible to translate that into changing patient behaviour. Once you have the data quality right, you can gain better insights, and for me, using that data to change and challenge both clinical and non clinical behaviour has been really helpful.

In terms of technology and apps in the context of lifestyle change, the stand-out ones have been those I’ve used personally. If I’m not a digital advocate myself, how can I expect my patients to adopt technology or digital services? I remember a patient saying to me, “Dr Bajwa, you’re getting love handles, you should really go for a walk!” They told me about ‘My Fitness Pal’. It wasn’t yet a popular app, but I checked it out and it really helped. Having used it myself I could then encourage others to try it.

Have you been able to actually measure the impact of your data-driven approach on patient population?

My first interaction with MSD was as an end user, using their quality improvement tools (in a project supported by Pubilc Health) to support the creation of a data-driven practice at Conway, which allowed me to improve the cardio metabolic risk for my population in a quantifiable way. The project was known as “Evidence into Practice” (EiP) and the data was extrapolated using Oxford UKPDS Algorithm (http://www.evidenceintopractice.co.uk/). The results showed that through our interventions with EiP, over a one year period, as we became more confident in the management of diabetes and cardio metabolic disease, we improved blood pressure control, HBa1C, and Cholesterol metrics for our patients.

The evaluation demonstrated the impact that our quality improvement interventions would make over a ten-year period if there was nothing else in the practice: it showed that from a our list size of 5,000 patients, including 385 diabetics, the changes and improvements we made across our practice  would have saved 50 lives from significant harm, be it death, a stroke or heart attack over a ten-year extrapolation of the data (UKPDS Algorithm).

(Data from the Evidence into Practice project is available here)

Self-management is key for the healthcare service. Are there any opportunities you’d be keen to share with peers?

We know that if you shift settings of care, it becomes a lot cheaper. So if you move it from secondary care to primary care, you make a significant difference; if you move it from primary care to the patients at home, you make a difference. It is therefore important to educate clinicians to adopt a less paternalistic view of healthcare and to try to empower patients. Unfortunately, I don’t think medical schools, training schemes, or indeed specialties are really set up at the moment for care professionals to empower patients and support them to take ownership over their own care. If we are able to address our foundations, we could then impart that self care notion to the 1.4 million staff across the NHS and use that as a catalyst for change, and translate that into improved care for the patients we serve.

I think that where self management is really winning at the minute is around the consumer healthcare space. We need to learn from this, and apply that learning to chronic disease management. I do think that telehealth and remote monitoring play a role, but it’s important we have a whole system approach. Technology is important, but it cannot be used to deliver self care in isolation.

The health and care system faces financial challenges in the years ahead. What advice do you have to clinical peers looking to work more with innovative organisations outside of the NHS in seeking potential solutions?

Just do it! We often inherently put regulation and other things in the way of trying to change things, but my question is, why?

There’s an incredible ecosystem out there with an infectious and ambitious desire to make change happen. Why don’t we begin to engage with the start up communities, the Microsoft Ventures, the DigitalHealth.London Accelerator, Wayra, Velocity Health, all of whom bring very different perspectives. Just be curious. Don’t maintain the status quo but push for change to happen.

Is there anything more that could be done to support clinicians?

I think by definition, clinicians are generally innovative. The thing that gets in the way is the day to day capacity – the workload makes it difficult for them to think outside the box.

Don’t accept that the way you do things, always has to be the way you do things; challenge yourself to consider whether there’s a better way. Essentially, quality needs to be at the heart of everything you do. Find inspirational leaders who will give you some air cover, accept that there will be times when things don’t go well (there needs to be support for when this happens), and seek out those who are willing to challenge the status quo. These things make the world of difference.

How can DigitalHealth.London help support this?

• It’s the broader leadership role.
• The role in galvanizing and changing the system via the network.
• London needs to consider how we get our start-ups to understand how they can win in the NHS, then as we (as a collective) learn how to do that, rapidly scale beyond DigitalHealth.London, nationally or internationally.
• Press the thought-leadership agenda to become more than just the sum of its individual parts.

Finally, for the benefit of innovators and SMEs, what are you looking for in an innovation right now? How can innovators demonstrate that they have the perfect solution?

Companies need to ensure that they are clear about framing the problem that their innovation addresses, ensuring that they have had good buy in from their networks, from people who actually understand healthcare (not just the proposed financial benefits), and that they have a good idea of how to scale within healthcare settings. Co-design and co-creation does not just with clinicians, but with patients too if possible.