What makes a leader? GP trainee, Dr Nish Manek, on getting people behind a purpose

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  • Posted:Wednesday 03 March 2021

 A podcast about big ideas in health and care. We talk with experts from The King’s Fund and beyond about the NHS, social care, and all things health policy and leadership. New episodes monthly.

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Helen McKenna speaks with Dr Nish Manek, a GP trainee and founder of the NextGen leadership programme, about her leadership journey, how she’s dealt with imposter syndrome, and the impact of Covid-19 on how we deliver primary care. 

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  • HM:     Helen McKenna
  • NM:      Dr Nish Manek

HM:       Hello, and welcome to the Kings Fund Podcast where we talk about the big issues and ideas in health and care.  I’m Helen McKenna, I’m Senior Fellow here at The Kings Fund and I’m your host for this episode.  Like many people at the moment, we at the Fund are working from home which means we’re recording this episode remotely so please excuse any background noises that you might hear.  Today, I’m super pleased to be joined by Doctor Nish Manek.  Nish, you’ve had a stellar career journey so far, you’re a GP trainee, a former Clinical Fellow NHS England, you founded Next Gen GP which is a national leadership programme for trainees and new GPs and I think you recently started hosting your own podcast.  So loads to ask you about and it’s great to have you with us today.

NM:       Thank you so much Helen, I’m utterly humbled to be here and I’m a big fan of the podcast, I listen to it all the time and I can’t quite believe that I’m sitting in this chair (laughter) so thank you for asking me.

HM:       So we’re going to be talking more about your leadership journey later in the episode but I know you’re currently working as a GP trainee and obviously we’re in the middle of a pandemic.  I just wanted to ask how you are?

NM:       Oh thank you, I’m okay actually, you know, being a GP trainee gives me a sense of purpose.  I’m really lucky, I get to leave the house, I get to talk to people, I get to talk to lots of people every day.  I came back from maternity leave, that was last September, and before I went on maternity leave COVID wasn’t a word and of course when I came back it was a word that had transformed general practice into a speciality that I frankly didn’t recognise so it was very hard, it was hard coming back and everything just felt a bit unfamiliar, I was a bit disorientated.  Everyone was a bit muffled and detached because they were behind PPE so it was a very strange world to come back to, a very different style of working.  It’s been a journey, I feel like I’m starting to find my feet about six months later.

HM:       As you say, I mean, we’ve seen some pretty significant transformation of general practice during the pandemic in order to continue to be able to deliver care to patients despite all the obstacles that the pandemic has presented.  What have been the main changes that you’ve observed and do you think that we’re going to see a lot more changes in the coming years?

NM:       Yes, so good question.  I mean, there’s of course the digital transformation.  We’ve been trying to encourage people to embrace and adopt digital ways of working in general practice for decades and then all of a sudden people were doing it overnight which was quite incredible, I think shows the strength of general practice and the way that it can adapt like that and that’s mostly been really good.  Previously I’ve been quite frustrated by some of the inefficiencies in general practice so I’d sit there and, you know, a child’s been dragged out of the middle of a school day or a parent with an important job has had to fit an appointment around everything else and I sit there and I think, I’m listening to them and thinking we could have just done this on the phone or even a text message sometimes.  So we’ve become incredibly efficient in that respect even with the way that we communicate the secondary care and I think some of that’s amazing and it should continue but some things have been really hard. 

So when a patient enters the consulting room and sits down with a GP and you shut the door, what happens in that room is really quite sacrosanct, it’s very special, you know, even if it’s just sitting in silence with someone or it might be the twinkle in the eye of an elderly gentleman, it might be the hand on an arm of someone that’s really struggling to cope and there’s often that people turn around and open the door and whilst I’m here doctor, there’s something else I want to mention, and all of that, it felt to me like it disappeared overnight and if I’m being honest, I found it really hard. 

I described it to someone the other day as, you know, I feel like I’m working in a black and white animation and what we previously had was watercolour.  So what we have now, it kind of just lacks that texture, it’s a bit sterile, it’s a bit detached because you’re on the phone and I think in a way I haven’t quite come to terms with the fact that we probably won’t ever get back to the way that we were working before and it was one of the aspects that drew me to general practice but I think on a positive note we’ve also seen incredible strength of general practice, like I said, in the ways that we have been able to flex to what’s happened, the agility, the autonomy that we’ve shown, the way that we’ve continued to absorb risk and keep people safe at home and away from secondary care at a time when we really needed to do that, so there are some positives.

HM:       Thanks Nish, and I loved some of the description that you just gave in that answer that just brought to life, just made it really vivid, particularly the description of what happens in the consulting room being the sort of sacrosanct, sacred, magical thing.  Is that something that drew you to general practice?  Was it something about that kind of one on one relationship that drew you into it?     

NM:       Yes, absolutely.  I think it was, there was the heart of the reason why I chose to be a GP.  I remember when I was at medical school I was really lucky, I came across Iona Heath who was President of the college at the time and she said something that just summed it up for me and I think still really rings true today, she said, “In hospital, diseases stay and patients come and go and in general practice, patients stay and diseases come and go,” and I just think that’s really powerful, it just encapsulates the way that we look after our patients over time, the way that we are so heavily involved in all the other aspects that impact on a patient’s health beyond just what we do in the consulting room, the way we understand how a patient’s illness shapes and influences their identity; being a part of stories in that way is such a privilege.

HM:       So, aside from general practice, am I right in saying that in recent years, I mean, I guess it’s also built in to your role in general practice as well, it’s not entirely separate, but then in recent years you’ve been developing a growing interest in leadership and policy, what’s behind your interest in those areas?     

NM:       I probably have to go back to when it started which was quite a while ago but if I look back there are probably two pivotal moments in my career that I think that if it wasn’t for those two things I don’t think I’d have the interest that I have in leadership and policy today and the first is when I was at medical school, in our fourth year, you got to choose a subject to specialise in, to do a BSc in so I decided to do the one non-science subject that was on offer and that was healthcare management at the Business School.  My dad’s an accountant, my brother’s an accountant and I thought well finally, I might be able to understand what on earth they’re talking about at home and it was completely transformative for me in a way that I generally didn’t expect, it was one of the best years I had at medical school and it was because, I mean firstly I got to understand what the NHS looks like and I’m slightly embarrassed to say that I didn’t know what the structure of the NHS looked like.  I was very much in this medical bubble and hadn’t had the time or the training to really think about what was beyond the consulting room and I also realised that so much of that was going to influence the care that I was going to get to deliver as a clinician and I think the other thing I realised was that as a doctor, you could potentially influence that and maybe even because of the insights that you have into your patients and because of the trusted position you hold in society and in the eyes of your patients, maybe you have a responsibility to influence that.

So, that was a key moment for me and I remember Don Berwick saying, I can’t remember if he was quoting someone else but he said, “There’s always two jobs, you have your job and then you have the job of improving your job,” and something about that sowed a seed in me because I then went onto my foundation training and I was focusing on my core job, which was to become a doctor and a good doctor, but there was something about that other job of what could I be doing to improve things for my colleagues, for my patients and for the system.  The next pivotal moment was when I did the Clinical Fellowship that you mentioned working for the National Medical Director which was Sir Bruce Keogh at the time and again, that was utterly transformative.  For people that don’t know, it’s a scheme for junior doctors who are from all different specialities, all different stages of training and they get put in an NHS organisation like an arms-length body or a charity or a college and it’s sort of like a leadership apprenticeship, real hands-on leadership experience and that was incredible.  So I think it was those two things that if it wasn’t for them, I definitely wouldn’t have this interest.

HM:       And you said there while you were studying you felt you didn’t, you didn’t understand what the NHS looked like, you didn’t have that overview.  Is that something that you think is typical of the Medical School experience and the training that doctors get?          

NM:       I think it has changed a little bit.  I’d like to think it has a bit because I’ve spoken to people who say they do cover a bit of that in the curriculum.  It’s not a criticism because I think we have an awful lot to learn in a really short time but I’m always struck by the way that if you look at other sectors most people go into the world of work knowing what the world of work looks like beyond just their job and I definitely didn’t, I don’t think any of my peers really did when I entered the world of medicine.  I couldn’t have told you what a CCG is or what it does or any of those things or even how money flows, none of it, and I guess it’s not core to the job but in the same way that we now really understand that communication skills are an important part of medicine and we get loads of training on that and we realise that in order to be a good clinician you need good communication skills alongside it, I really think that in order to be a good clinician you also need to understand the structures that underpin everything that you’re working within and think about how you can influence those.

HM:       And so I guess that takes me onto the programme which you set up, the Next Gen GP programme.  So, can you tell us a bit about what the programme is?          

NM:       Yes, sure. So I was doing this leadership fellowship working for Sir Bruce Keogh at NHS England and I just got this sense really that it was going to change things for me permanently.  I was, you know, I was getting to understand a bit more, like I said, about the structure of the NHS and a bit about myself as a leader which I’d never had the time or the tools to think about before.  I began to see that the conception that I had about leadership was totally wrong because I used to always think it was about titles and authority, you know, having lots of letters after your name and proving yourself and then once you’ve done all of that maybe you can start to actually change things but I realised that that’s nonsense (laughter) and leadership is a verb, it’s about changing things around you.

You know, sometimes I think we over complicate it.  I could probably say if there was one word that sometimes I think is slightly better than leadership it would be influence and I mean that as a verb, to influence, which is just getting people behind a purpose.  It’s what we do every day as GPs in our consulting rooms and the thing about that is you don’t have to wait until you’ve got lots of letters after your name and your far along in your career, we can all influence in whatever sphere that we’re in.  A bit of a frustration brewed, I started to think yes, why aren’t we investing in more leaders and assistants especially in primary care instead of just leaving it there which I maybe previously would have done.  I suddenly began to think, you know, Nish, that’s not the right way to think about it.  What you should be asking yourself is what can you do about it and after that, just by chance I think it was about six or eight weeks into my fellowship and I went to the RCTP annual conference and I was chatting to somebody in a pub there, this makes it sound like I had a terrible chat in a pub (laughter). 

I was chatting to him about this frustration and he said, “You should speak to someone in The Midlands called Nick Harding.  He’s a GP that’s running a programme for aspiring CCG leaders because he’s doing what you sound like what you want to do,” and then that weekend I went up to Newcastle to do the Great North Run and I was driving back with my husband, and it’s a six hour drive from Newcastle to Cambridge, and normally that length of drive we would share it but my legs were total jelly after this run and I think about an hour in he said, “Nish, I’m having to drive but you need to talk to me or give me something interesting to think about.” 

I found myself talking to him about this idea that I’d had about leadership training for GPs and then in the same breath I was telling him all the reasons why I couldn’t do it and he said to me, you know, “Park the reasons to one side why you think it can’t be done and tell me what the end product would look like,” and I found myself telling him exactly what Next Generation GP is, I even had a name at that time in my head but with a weird clarity and conviction, and I don’t know where it came from but I told him about this end vision I had of training young GPs early on in their careers in a very accessible way, a way that would be so easy for them to dip their toe in the water of leadership and doing this across the country and then he said, “Okay, so what’s stopping you?” and over the next, I don’t know, three, four hours, we went through each of the things that I was really worried about and he very cleverly sort of dismantled each of those and I remember we got home and he got out of the car looking utterly wrecked (laughter) and he turned around and he said to me, “You know, you just have to do this bloody thing now, you just have to do it.  You’ve spent the last four hours talking to me about it, you have to do it,” and I think what I learnt from that and the reason I tell that story is talking to other people when you’ve got an idea is really valuable.

Other peoples’ belief in you can be such a power motivator and I guess in a way it can also hold you to account a bit in a light way and The Kings Fund is a very important place in this story because I think a day or two later I was at a conference at The Kings Fund sitting on the doorstep when I had this call with Nick Harding who I hadn’t heard of before and he hadn’t heard of me but there he was going, “I really believe you can do this,” (laughter) you know, he said, “I believe you can create this programme.”

HM:       It’s a brilliant story and I also particularly love, Nish, that you said that The Kings Fund played an important role -

NM:       Yes (laughter).

HM:       - and I really liked your definition; it’s often very hard to get people to define leadership but it also made me think as you said it the NHS and lots of other kind of large institutions like it can be quite hierarchical, is it easy to influence without kind of titles and letters to your name and obviously you now do have titles.  I think you also, you were honoured in the Queen’s Honours List right?

NM:       Yes.  Let’s not talk about that (laughter) but yes.

HM:       (Laughter) Does the hierarchy get in the way?

NM:       It can do in some places if you let it.  It’s about how you look at it.  If you look at senior leaders and you think, you know, I want to be like them, I want to have that job and that decision and that power it’s very seductive.  I think that’s the wrong way to look at leadership.  It’s a bit like being in the gym and you know if you look at people that are lifting weights and you think oh, that person’s a weightlifter and I want to be like them and you go over, (laughter) as you can tell, I’m talking from personal experience, you go over and you try and lift a really heavy weight like what they’re lifting and you look a bit stupid and you fall over and it hurts and you think I’m never going to do that again but that’s totally the wrong way to approach it. 

What you need to do is think what is the smallest weight that I can lift in front of me today and you do that, you know, maybe week in, week out consistently and you stretch yourself a little further each time and slowly you’ll lift heavier and heavier weights and maybe one day someone will turn around and look at you and say that there’s a weightlifter but that’s not the point.  Going after the title is not the point, it’s about the verb of doing things in front of you and leadership is the same, it’s just about looking at what’s within your sphere of influence, what one thing can you change within your sphere of influence and usually if you work in a culture that’s permissive and you work with good people there will always be something that you can change.

HM:       Yes, that’s a brilliant answer.  I wanted to ask you obviously the programme the Next Gen GP programme, I think it attracts national funding now and I think has presence across the country so what was the biggest challenge you faced when you were setting it up?

NM:       On a personal note I’d say the biggest challenge for me was confidence if I’m being really honest.  It probably wasn’t anything structural, the structures and the, you know, that all was, not that difficult because people understood that this was important and people moved barriers out of my way to make it happen in a way that I couldn’t quite believe but on a personal level I really struggled with the, you know, we talk about it a lot but the imposter syndrome.  There was a lot of chats going on in my head of who am I to do this, I’m just a trainee, I look quite young (laughter) and I don’t really have any formal leadership qualifications and I was standing up in front of rooms of people who were much, you know, often much older than me and more senior than me with more leadership experience than me and trying to make this a reality so I think that’s where I really struggled. 

Oh, and mention a few things that helped if it’s useful because, I mean, even when you asked me to do this, to do this podcast I was paralysed under the weight of the imposter syndrome but I think I’ve come some way and the things that have helped me are I guess in a similar vein to what I said before, so talking to other people can be incredibly useful because other peoples’ belief in you cannot be underestimated and also the way you talk to yourself I think is quite important.  So, we can have really toxic conversations in our head, you know, really focusing on what you’re not and I did a lot of that, you know, I’m not older, I’m not qualified, I’m not experienced, I’ve not got any insight into how funding streams work or how to get this off the ground and you can really talk yourself out of things before you’ve even started and what I’m now trying to do is think about not what I’m not but what can I bring to this room, this project, this idea that no one else can bring. 

So it might be, okay, so I’m young and inexperienced but instead of thinking about it like that, I’m also quite creative, I’m probably not as weighed down by NHS bureaucracy as some people who are further ahead of me (laughter) so there are lots of things that I can bring because of the things that I am and the final thing I’d say is asking myself sort of key questions in the moment.  So, Sir David Haslam, he used to be Chair of NICE, told me once and he says this at Next Gen, he says, “Ask yourself would you regret this on your deathbed,” and that is quite a morbid question (laughter) but it’s also intentionally clarifying and the other question I ask myself is, which a GP called Martin McShane said to me which has stayed with me ever since which is, “How can you occupy the space that you’re given?”  So instead of expending energy thinking about why was I chosen for this or what is someone going to think about me if I go for this role, this is all wasted energy, why don’t you channel that energy into thinking I’ve been given this amazing, amazing opportunity, what can I do with the space that I’ve been given, and you know, Maya Angelou says this thing which I have on my mirror on a Post-It, she says, it’s something along the lines of, “How can I be on my own side?  How can I be an advocate for me and other people like me?”

So I say that to myself, you know, with this opportunity, how can I use it to help other people like me.  So the biggest challenge definitely has been confidence and maybe we don’t talk about it enough and I’m very happy to admit that I have had days where I’ve wanted to hide under my duvet (laughter) and thought why am I doing this.  I would add also that it’s not just me so it sounds, you know, we’ve got 2,000 people on this programme and 47 cohorts, I could never do this alone so I’ve got an amazing team that do this around the country in their own time and I really want to pay tribute to them because it’s very easy for me to sit here and say look, look at where we’ve come, but it’s not me, it’s about all these people that are doing this because they believe in it and they’re paying it forwards.

HM:       Thanks Nish, and as somebody who has a lot of negative self-talk in my head, I actually really appreciated those tips, I’ve written them down (laughter) and I’m going to be playing them out to myself so thank you.  So we sometimes hear a sense from health professionals, including from GPs sometimes that they feel they lack power in the system, that at times they feel more done to or a sort of sense of disempowerment rather than feeling as if they’re equal partners.  Is that something that chimes with you and what’s behind that kind of sense?

NM:       I think it is true.  I think there’s a lot of, there was a lot of negativity in general practice and some of it is borne out of facts so, you know, Simon Stevens often said, “We spend more on hospital outpatients than we do on the entire tier of general practice.”  You know, it’s no surprise that GPs can feel, general practice can feel a bit like being the poor sister of Cinderella sometimes, that’s how it feels, but I also think that it’s very easy to sit there and, to sit there in the negativity of it and not feel you can do anything about it and I think I’m trying to say to myself that if that is the case what can I do to change that.  So I’m not dismissing it because I think there is some truth in it but I think a more interesting way of approaching it is to think what could I actually do about it.

HM:       Yes, so flipping it on its head and tell us a bit about why in your view it’s so important that GPs are able to and are supported to step into those wider leadership roles and I guess acknowledging that they also already play very important clinical leadership roles in their own teams, you know, what’s the potential when GPs are able to step out into those wider leadership roles?

NM:       It’s probably better thinking about the kind of system that we want going forwards.  It’s often quoted 90% of patient contact happens in general practice.  We know going forwards that the biggest usage of healthcare is going to come from an aging population, chronic disease, multimorbidity and most of that is dealt with by generalists in the community and we also know and hear time and time again that across the world evidence shows that investment in general practice is associated with better health outcomes and better health system efficiency and improved health equity.  So all of that is, I think, quite a persuasive argument that whatever system we design going forwards is going to need a strong foundation in general practice so the logical conclusion from that to me is that we need GPs in these wider leadership roles.  I don’t know who said this but, “Every system is perfectly designed to get the results that it gets.”  So without that, that’s not what we’ll get and the other thing about general practice I think, we occupy a pretty unique in the system so the way that we sit inside patient stories over time we see all the factors that influence their health, all of those things that are quite unique and I think those insights are really important to shaping and delivering services going forwards.

HM:       So we’ve talked a bit about your leadership journey but I also wanted to talk about your personal approach and your own leadership style and I noted that you once wrote a letter to your younger self as part of a series of articles on health and care in The Guardian, where you described how each GP has personal traits that patients value and for you they were your capacity to listen, your knack for connecting with strangers and your sense of humour.  Do you see those as being the same characteristics that help you as a leader or would they be different?

NM:       Gosh, you’ve really done your research haven’t you (laughter) that was quite a long time ago, I’d forgotten I’d written that.  That’s a great observation yes, probably true so all those things are really important, listening to people, having a sense of humour, being able to connect with people, absolutely.  In fact, so many of the skills that I’ve developed as a GP I use in leadership roles and being kind really and people talk about kindness as the soft stuff but it’s not at all in my opinion.  I think being kind when things are really, really hard is difficult. 

I was thinking about my surgery on Monday and how busy it was and how tired I was and how I got to the end of the day and I came home and I reflected but I probably if I’m being honest wasn’t my kindest self to the last patient of the day as I was with my first and I was reflecting that I need to do that better because when you feel like you’re just holding this weight of uncertainty and risk and when your thoughts are slowing down and you’re in a bit of a brain fog, staying kind is probably the most important thing you can do and yet not always the easiest so I’d add that to my list of leadership values and I’m lucky, I have an amazing role model in my life of someone who is just the epitome of kindness and that’s my mum and she is just, I find myself welling up a bit (laughter), sorry, she’s just in, it doesn’t matter how hard things get or how, you know who else is pulling on her time, she is just this core of kindness in our family and I think if I can be even 1% of that to my patients as a, you know, to the people that I lead, to my own family then that would be a good starting point (laughter).

HM:       Well, I’m hoping that your mum listens to this, Nish and -

NM:       She probably -

HM:       - she does.

NM:       - (laughter) my mum is probably my only fan.  My biggest fan and my only fan so she was (laughter) -

HM:       (Laughter) that’s not true, The Kings Fund is too (laughter).  So yes, hello Nish’s mum, and you seem very kind of values driven but what are the things that really drive you as a leader?

NM:       A value that I really try to live by is contribution and this might sound a bit cheesy but I think about all of the things that I’ve been given as a kind of torch to carry on and I mean things I’ve been given because lots of what I have done and achieved, I’ve not earnt, I’ve been given them so just the fact that I grew up in this country in a democracy, you know, my parents were immigrants to this country and had very little but they made sure me and my brother had a good education.  We had enough money that we could go on holiday and all the other things that come with it.  We had the opportunity to go to university.  I’ve had all these incredible leadership opportunities given to me.  I think about all of that as a torch that represents all the people that have come before me and I think in the course of my lifetime, how can I take that torch as far as I can possibly take it before I have to hand it on.  That may not be very far at all but I have to take it some distance and what can I do with what I’ve been given to take it as far as I possibly can. 

That’s a responsibility I have so that value of contribution is really important to me and I think the reason it’s come into focus if I’m being honest is life is short and I haven’t talked about this publicly but when I got married, the day before I got married my husband discovered a lump in his neck and he ended up having thyroid cancer and we had a really, a really difficult and quite unexpected start to our marriage for two years and he’s fine now thankfully and we’re incredibly blessed to have had the care that he’s had but things were pretty bad in that time and I think before that, I was sort of going round with this quite naïve youthful immortality not really thinking, you know, life is for living and it’s such long lives and that experience, as difficult as it was, we both are quite glad we went through it because I think it taught us both that life is short.  So going back to the idea of the torch, I guess I think how far can I take it and the time I have to do that may be shorter than I think so keeping that in mind every day is really important.

HM:       I’m so glad that your husband is okay now and thank you for sharing it, Nish.  So, I also wanted to ask you, you’ve said before in the past that it can seem as if leaders are born rather than made when in reality obviously as you’ve kind of shown in some of what you’ve said today that’s not the case.  Do you think it’s important for leaders to be open about their own leadership journey and the challenges they faced and particularly given what you’ve just shared, how important is it?

NM:       Yes, I mean absolutely and I was just thinking, I wasn’t really planning to say what I said just then and why did I do it and it’s probably because, so I’ve seen so many other leaders admit when things have been really hard and if you ask them, you know, where has your learning come from they will always talk about the things that are difficult, mistakes that they’ve made, personal family issues, failures, they’re so important to talk about because from the outside you can genuinely think that these people have just been tapped on the shoulder and had this really smooth trajectory to the top and nothing goes wrong. 

You know you can admire them for that but it also makes it feel completely unrelatable and completely inaccessible and it’s a bit like being in a reality TV show (laughter).  We look at celebrities and think oh you’re just amazing but you’re also a different species but actually if you go behind the scenes, frankly, these are normal people who have had really difficult journeys often and part of the reason they’ve got to where they have got to is because they’ve had tough stuff happen to them and they’ve taken it and used it as growth and learning opportunities.  That’s why they’ve got to where they’ve got to.  I 100% think the more that we can talk about the tough stuff, the more open we can be about it, the more vulnerable we can be about it, the more people are going to trust leaders and they’re more that they’re going to be able to realise that these people are not that different from us.

HM:       So final question for you, I’d like to know, and I’m sure our listeners would like to know, what’s next for Doctor Nish Manek? 

NM:       A glass of wine I think (laughter).  No, I shouldn’t say that (laughter).  It’s a good question.  I get asked this quite a lot and I don’t have a grand plan.  If I’m being really truthful, if I could, if I could achieve three things in the next chapter of my life I would be quite happy and probably in this order.  So I really want to be a good mum, first and foremost, and maybe there’s no definition of what a good mum looks like but I know part of it for me is being around and being present.  So I’ve got an 18-month-old, that means I want to work part time and I want to be around for her, I want to drop her to nursery and pick her up and be there for when she really needs me. 

So that means everything else is going to be squeezed into a shorter time maybe so that is really important to me and I’m happy to sort of admit that freely and then after that, I want to be a good GP.  You know that’s, this leadership stuff is amazing and I love it but the essence of me is a general practitioner.  I haven’t even qualified yet and I really need to make sure that I focus on that.  I think becoming a good GP is a lot about pattern recognition and you just need to be around and see a lot of patients in order to recognise those patterns so I need to make sure that I’m seeing plenty of patients so I’m getting clinical exposure and I am, I think being a good GP is a life-long lesson but I definitely want to focus on that and then alongside those two things, if I can keep Next Generation GP alive and I can keep paying forward the opportunities that I’ve had then I’ll be very happy.  So that’s it (laughter), there’s no grand plan, you know, be a mum, be a GP and be a leader.

HM:       It’s still a pretty clear plan though, I’m still impressed.

NM:       Yes (laughter).

HM:       It’s a three-pronged approach, Nish, I don’t have one of those so I’m very impressed (laughter) so thank you so much, Doctor Nish Manek, for joining me today.  Actually for me personally, just listening to you feels like it’s been transformative and I’ve really appreciated your honesty and you’ve inspired me personally and I imagine many others listening so thank you so much for sharing your experiences and your time with us today.

NM:       No, thank you so much, Helen.  Honestly, it’s a real privilege to have spoken to you.  I’m really humbled that you asked me.

HM:       Well that’s it from us.  You can find the show notes for this episode and all our previous episodes at www.kingsfund.org.uk/kfpodcast.  We’d love you to subscribe, rate and review us on Apple podcasts or wherever you get your podcasts as it helps others to find us and also helps us to improve the show.  So an extra special plea from me today, please, please, if you have time do take a moment to rate the episode and leave a review as it would mean a lot to me and the team here.  You can also get in touch with us via Twitter either @TheKingsFund account or my account @HelenaMacarena and finally, thank you as always to you for listening but also to our podcast team for this episode; producer Sarah Murphy, researcher Johnathan Holmes and also huge thanks to our colleagues Becky Baird, Aamena Bharmal and Tricia Boyle for their advice and assistance.  We very much hope you can join us next time.

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