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Specialising in the Bigger Picture

DF

Specialising in the Bigger Picture

anna magnowska



Working as an A&E nurse Daniel Flecknoe often felt he was 'providing palliative care for societal problems' rather than searching for the cure. As a Speciality Registrar in Public Health he now has the opportunity to be part of something much bigger, and  he wants to let other nurses know how they can be part of the solution too. 

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Here’s an excerpt of what has become a fairly common email exchange for me:
Me – “… Lastly, just a minor clarification.  You addressed your email to me as ‘Dr Flecknoe’.  Although I am a Specialty Registrar, a title most commonly held by doctors, I’m not a doctor.  My background is in nursing and I don’t have a PhD or anything, so ‘Mr’ or ‘Daniel’ will do just fine.  Regards, Daniel
Them – “Dear Dr Flecknoe, thank you for your response…”


The automatic assumption of doctor status is something that most male nurses get used to dealing with early, as a result of outdated and sexist medical model stereotypes.  I’ve been apologetically explaining to patients that I’m actually not “the doctor” since I was a first year nursing student, although growing less apologetic with each passing year.  I was proud to be an A&E nurse, and enjoyed the relatively flat hierarchy between doctors and nurses in that environment.  So while I didn’t become a Specialty Registrar to sneak into GMC parties, it certainly has given people yet another reason to leap to the wrong conclusion.


Public Health is like any other medical specialty in some respects.  Doctors with a minimum of two years postgraduate medical experience are eligible to apply for it (completing their foundation training achieves this requirement), and will then spend approximately five years working and studying in the specialty before qualifying as a consultant.  The thing that makes public health training significantly different from other medical specialties is that a) its focus is on populations, not individuals, and b) it has a non-medical application pathway.  I personally think that this great opportunity deserves to be more widely known about within the nursing profession.

Targeting pregnant women and children with vaccination campaigns and nutritional supplements can take a whole range of horrible outcomes for them pretty much off the table.


I certainly knew nothing at all about it until I was doing my MSc in public health at Kings College London.  I had recently returned from working overseas with an aid organisation, which had really got me interested in population health.  We mainly did preventative medicine out in the field, because it’s the most cost-effective way to improve people’s health.  Targeting pregnant women and children with vaccination campaigns and nutritional supplements can take a whole range of horrible outcomes for them pretty much off the table.  And those interventions don’t cost all that much, especially when compared to the massively positive effects they can have on someone’s life.  Getting past the age of five without being crippled by polio, intellectually and physically stunted by malnutrition, or blinded by micronutrient deficiencies dramatically increases your chances of living a healthy and happy adult life.

I was providing palliative care for societal problems, and I was starting to wish that I could get involved in the search for a cure.


Then I came back to a London A&E department, and was struck by the difference in the nature of the job I had returned to.  No preventative medicine, but an endless parade of patients inadvertently demonstrating the health consequences of poor diets, drug & alcohol abuse, deprivation and violence.  And my role in all this was essentially to patch them up and send them back out into the world to be exposed to some more of the same.  I started to feel less like an emergency nurse and more like a hospice worker, soothing the symptoms of a disease whose root causes had been determined to be beyond the power of medicine to address.  I was providing palliative care for societal problems, in other words, and I was starting to wish that I could get involved in the search for a cure.


Hence the Master’s degree.  The MPH (Master of Public Health degree) was a great learning experience in itself, but in the course of doing it I discovered the possibility of entering the specialty training programme.  Of being a registrar.  No, hang on – I worked with registrars in A&E, and they were all doctors, without exception.  The one thing I did not consider a productive use of my time was spending five years at medical school in my mid-thirties.  No, I was told, you don’t have to be a doctor to apply for the training.  If you’re interested in population health, my tutors said, this could be a great career track for you.


This turned out to be true on both counts.  The requirement for non-medical applicants (referring to the 2015 person specification) is for at least five years full-time work experience, at least two years of which must be at Band 6 or higher (or an equivalent non-Agenda for Change post) and in an “area relevant to public health practice”.  If that last sentence sounds worryingly specific, I should mention that my work as a Band 6 A&E Charge Nurse was considered to be “relevant to public health practice” when I first applied.  There’s very little that nurses do which is not in some way relevant to public health.


The application process is hard work, no question about it.  There is an online application form which assesses whether or not you meet the basic criteria in terms of work experience.  For the 2016 intake this application stage is currently planned to run from 11th November to 3rd December 2015.  Candidates who meet the minimum requirements will then be invited to the Assessment Centre in early January, where they will take some standardised tests of numerical/verbal reasoning and situational judgement designed to assess other aspects of the person specification.  Those who achieve a passing grade will then be invited to the final stage of the process, the Selection Centre, in late February.  This is a half day of written tests, group exercises and short interviews.  Successful candidates, usually around sixty to seventy people nationally, will be notified in early March.

For the 2016 intake this application stage is currently planned to run from 11th November to 3rd December 2015.


This may all sound a bit daunting, and it is.  I prepared for it with a GCSE maths textbook, online practice versions of situational judgement tests, a one day interview skills course for specialty training posts, and by abusing the friendship of registrars I knew to drill me with practice interview questions every time we met.  The drinks were generally on me, to be fair.  See below for some helpful links if you’re thinking about applying.


As for the job itself, I can’t recommend it enough.  Right now I am working at Public Health England in Nottingham, and have been involved in projects including Ebola airport screening, reporting on prison health, participating in major incident exercises for chemical, biological and radioactive threats, conducting literature reviews on hepatitis, liver disease and violence prevention, and teaching medical students and junior doctors.  I’ve also spent time with the health protection team, investigating outbreaks of communicable diseases and working to protect the public by limiting their future spread.  The work interesting and challenging, and I feel more effective now than I did in my previous role.  I always loved the drama and the unpredictability of A&E, but I really enjoy the idea of being proactive rather than reactive and of helping people to avoid suffering from medical problems which are as painful as they are preventable.

Every nursing contact has a public health aspect, a wider perspective, whether we always recognise it or not.


Every nursing contact has a public health aspect, a wider perspective, whether we always recognise it or not.  Every patient’s experience of health, illness and healthcare services will be influenced by factors such as deprivation, ethnicity, social capital, cognitive biases, media portrayals, stigma and many others.  Health is social, psychological and very political.  If you think you might be interested in specialising in the big picture, check out the links below, or email me at daniel.flecknoe@nhs.net and I’d be very happy to discuss it with you.
Useful links:
The Faculty of Public Health (who advertise and oversee the recruitment process) 

The most recent person specification for public health registrars (unlikely to have changed much for 2016) 

ISC Medical (a useful resource for anyone applying for a Specialty Training post)  


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