Portfolio careers in healthcare allow clinicians to improve patient care and shape the NHS locally and nationally, writes Nikita Kanani

“Unless somebody like you cares a whole awful lot, nothing is going to get better. It’s not.” this was the message from The Lorax by Dr Seuss.

It may seem odd to relate portfolio working to a bedtime story, but I think it encapsulates the social values that make it worth getting involved in a number of roles in healthcare.

My portfolio career works well with being a mother of two small children. Recently my son said to me: “Mummy, you don’t work, do you?” and I (eventually) took that as it was intended, as a compliment. What he was trying to say is that I am present for him − at breakfast, for the school run and at bedtime.

I first became interested in portfolio working as a senior house officer in a medical department and noticed that I was getting more and more frustrated about people’s experience of care and bothered by the rotas and the working lives of colleagues.

Grab opportunities

Having expressed my concerns, I was given the opportunity to improve services around me and work as a service redesign lead. I was hooked − I really enjoyed talking to health professionals in the hospital, understanding what patients and staff found valuable and leading on a number of large scale redesign projects.

‘Taking on different roles allows me to see where something has been done well elsewhere and apply it locally’

As a GP training in Bexley, south east London, I was given lots of opportunities to develop my skills, ranging from being the clinical lead for winter planning, for screening assurance and for older people’s services within the primary care trust − the lead roles continued upon completing my training.

I also use my insight to help me in my role on NHS Bexley Clinical Commissioning Group’s board and as the lead for integrated care. I get to follow up the frustrations I find in general practice and seek solutions to them. In turn, I am able to use some of those relationships across the CCG to improve the care my patients experience when I have my GP hat on.

As the quality lead for the Faculty of Medical Leadership and Management, I have the opportunity to develop and deliver a national strategy, building quality improvement capacity and capability throughout our membership. Delivering the keynote address (see video, above) at the faculty’s annual conference last year was a real moment of pride.

Influence policy

There are many benefits of taking on a non-clinical role; it adds variety to the week, and allows you to be more flexible around things such as children or other interests. It is also remunerated; something that I have tried to drive through any of the organisations I have worked for is to value time, it has to be developmental and reimbursed and that is how you develop your succession plan as an organisation.

At Bexley CCG, we are very proud of being a clinically led organisation and are developing our talent pipeline. We have a number of clinical leads for the different areas of commissioning but we are finding that they need more support and development.

‘When you are wearing a number of different hats, it can become difficult to prioritise what is important’

We need more of them too, because they really are the strength and knowledge and bring a different skill set to the organisation. When talking to our sessional GP population about becoming clinical leads, there is a hesitation about the impact it would have on people’s private lives and clinical work.

Taking on different roles allows me to see where something has been done well elsewhere and apply it locally. If not at the CCG, then at least at practice level, or even something I can do with my patients to improve their experience and the quality of care they receive. As an executive member of the National Association of Primary Care, I can help to shape and influence health policy nationally and understand how to implement it locally.

The best thing about a portfolio career is to experience a new chance of working and new ways of thinking. For example, this month I am travelling to Harvard University in Boston to attend Michael Porter’s value based healthcare seminar. This is something I would never have had the opportunity to attend had I not taken on a range of roles and developed the networks I have.

Make portfolio working a success

When you are wearing a number of different hats, it can become difficult to prioritise what is important and more importantly, make each role a success.

It is important to recognise where your boundaries are. For me, my weekends are family time and I have had to turn down opportunities that I would otherwise have leapt at.

Ensure you have a good work/life balance. I have a mentor who is a high profile GP, nationally very influential and also a family man. He has provided me with a number of opportunities but also shown me how to ensure I get a good work/life balance. 

‘It is acceptable to do other things, as long as you can assure yourself, patients and colleagues that you will be still an excellent clinician’

One of my mentors once looked at my CV and said it looked like “crazy paving”, but that is okay. For clinicians, I think this is more difficult to accept because we are very vocational; we are trained to become a GP or consultant. It is acceptable to do other things, as long as you can assure yourself, patients and colleagues that you will be still an excellent clinician; only then can you expand your portfolio.

My sister and I have co-founded a social enterprise that gives opportunities to young people from disadvantaged communities to access the experiences and support we have had.

You must set professional values. I have left roles where I feel I have been professionally compromised − my values drive me, and I want the opportunity to leave a legacy where a population will be healthier.

People sometimes say nothing is going to change or improve, but if you take the opportunity to be like the Lorax, you really can make a difference.

How to expand a portfolio career

  • Understand what is important to you − what is your value set personally and professionally? What do you want to achieve? Not in five years but in say, one week. What would you like your week to look like? What sort of people do you want to work with?
  • Identify the skill sets and experiences of the people around you. Tap into their knowledge by asking them to mentor or sponsor you – it is just a case of asking. Portfolio working can appear dysfunctional and fragmented, so having a set of people who are a source of information, advice and support is crucial.
  • Join or create a network. I am co-chair of The Network − an online community with more than 3,000 healthcare professional members, focused on the idea of connectivity − but a local group of people with similar ideals works too. Networks enable people to connect with others and share experiences.

Dr Nikita Kanani is a GP in Bexley and a member of Bexley CCG’s governing body

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