One the many advantages of being a freelance GP is having more time for conversations. At the time I resigned from my partnership, I’d been watching Breaking Bad and the value of our NHS hit me again. If Walter White hadn’t been cooking meth, he would have had to face the prospect of not being able to pay for treatment for his lung cancer. Without the NHS, stark life and death choices will have to be made.

Could I do even something small to help save my bit of the NHS? One of my plans was the pretty nebulous idea of ‘making a difference’, perhaps by helping practices who were struggling by suggesting some different ways of doing things. A pie in the sky idea, of course, but I was by necessity asking myself, ‘What else can a GP do except be a GP?’

I stumbled upon the massive, far-reaching and fascinating area of Improvement Science. Yeah, yeah, I know all that stuff: flip charts and Powerpoint presentations and Blue Sky Thinking business jargon?

I followed a link on NHS Networks to a site called and discovered wizard-cum-inventor character, Simon Dodds. Part-time NHS Consultant surgeon at Good Hope Hospital in Sutton Coldfield, he knows all the challenges of hospital medicine. However, as an undergraduate at Cambridge he also studied computer science and system design.

Simon described to me how he is met with disbelief and cynicism by clinicians: “If what you talk about were in fact possible then we would already know about it and be doing it because we are not stupid ... therefore it must be rubbish (and you must be a snake oil salesman)”.

Healthcare is a complex adaptive system and we can’t understand it. Our brains do not think in a non-linear way. We are good at recognising patterns but we cannot solve problems of system level complexity, even if we try really hard and we’re really clever.

Simon adds, “Doctors, nurses and managers are not formally taught about complex adaptive systems and how to design them to be safe, stable and capable. So we are emotionally challenged by the suggestion that the chaos we are experiencing is actually the result of our own well-intentioned but dangerous meddling”.

Our healthcare systems are chaotic and we have unwittingly designed them to be so. We need to design towards flows and outcomes but instead we throw resources at our queues. It’s a recipe for chaos.

Simon realises that we won’t believe him. He’s just quietly getting on with changing things on his own patch e.g. reducing his post-op wound infection rate to virtually zero, reducing his waiting times, improving quality and reducing costs.

I know that you can only have two of cheap, fast or good and not all three – so when Simon tried to persuade me otherwise I just could not believe him.

Luckily, he anticipated my cynicism and disbelief and has created an on-line course called FISH: Foundations of Improvement Science in Healthcare.

I took a leap of faith and trusted the wizard. I learnt how to create Gantt charts and to calculate waiting times and work-in-progress. These dry-sounding concepts translate into actual beneficial effects in clinics: better outcomes , reduced queuing and reduced costs . In an OOH GP call centre, after doing the FISH training , they reduced their mean call-back times and transformed the OOH experience for patients and doctors. I still don’t really believe it’s possible but the data are there and it is actually true. What I do know is that doctors need to know this stuff.

Would you like to go FISHing too?

Zoe Neill

Freelance general practitioner (family physician) Yorkshire, UK

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