A day in the life of: a medical director

 Just what exactly does a medical director do? Gareth Jarvis shared one day in his busy diary with BMJ Careers to illustrate what his role involves.

• 05.30   My alarm goes off. I’m up and head to the gym for an hour.
   
• 06.45   Back home, and first challenge of the day: getting my kids aged 8, 5 and 3 ready for schooI!
  
  My wife is a GP so has to get to work too, so we tackle this challenge together. We are lucky to share a nanny with my wife’s sister and today she took the kids to school
   
• 07.15   I leave home to catch the train to work. I work across four different sites but I’ll always get the train.
  
  I’m usually at Trust HQ on Mondays and Fridays and most Wednesdays I work from home. Every Thursday I work clinically — as a consultant adult psychiatrist in the community in Westminster.
  
  It was difficult to make that happen during my first year in this role because it was so busy and there were so many demands on my time. Plus I’d been working in a different trust for 10 years before this one and so the Trust was new to me, with a new team and there was a lot to learn.
  But I’ve now put a clinical day into my job plan. I find it very useful because you understand the demands and challenges of clinical areas and keep me grounded in what’s important.
   
• 08.00   I’m at my desk dealing with emails. I’ve made a cup of coffee and eat breakfast while I go through emails that have built up overnight – usually about 80. I triage them, dealing with the easy ones and using a system for managing those requiring more time or thought.
  
  I try to leave work on a Friday with all my emails processed so that I can enjoy downtime with my family over the weekend but sometimes this isn’t achieved and I’ll end up working some extra hours.
   
• 08.30   Meeting to discuss medical agency usage. Of all the Trusts in London that publish usage figures, we are outliers at the moment and we are working to get that under control. At this weekly meeting we review requests for additional staff and try to find other solutions to employing agencies off framework. 
   
• 09.00   Meeting with medical colleagues to discuss staffing and its impact on workload. At this catch-up we check that our services are safe and whether there is anything that we need to escalate. 
   
• 09.30   Trust wide bed call meeting with clinical colleagues. We discuss which patients came in overnight. I don’t always attend this meeting but today it feels important to join due to the industrial action and worries about patients building up in A+E. 
   
• 10.00   An hour to deal with emails, reading reports and various actions. We had a CQC inspection last week which took up a lot of my time and so I use this slot to catch-up.
   
• 11.00   Whole system meeting. This is a weekly meeting with clinical and borough directors. Here we look at patient flow data across the trust. This gives us a timely line of sight over patient flow and long stayers. We hold everyone to account.
   
• 12.00   Catch up meeting with my PA Gloria. We look ahead to the next 2-3 weeks to keep on top of all requests for my time – who I need to see and who I have to disappoint! I rely on Gloria to action many things on my behalf, for example to sign off on various documents that I’ve read and can be processed.  
   
• 12.30   Lunch. I rarely take a lunch break and often work through. Today there was no choice - I have a silver command meeting (Incident management protocol in the NHS).  All the key people involved attend, including HR and union representatives. We share intelligence and decide if there is anything we need to escalate. 
  
  I eat a chicken and roasted vegetable salad – something I made the night before. Last year I put on a stone in weight as I was turning to convenience food at lunch times. Making my own food is healthier and I’ve now lost that extra weight I was carrying.
   
• 13.00   Scoping meeting for our Quality Improvement ‘spreadathon’ — that’s what we are calling spreading best practice across the Trust. We have done very well in embedding QI across the organisation in pockets but now,  instead of trying to teach people to do small projects, we want to spread best practice across  whole teams.
   
• 14.00   1 to 1 meeting with a direct report – a consultant psychiatrist and the clinical director for Westminster services. We have a clinical director for each borough and I line-manage them all and have a monthly 1 to 1.
   
• These sessions are a mixture of clinical supervision. troubleshooting any problems they need my help to solve, and mentoring. I might go through how I would handle a particular situation, for example. There is personal development too, so we might discuss any training needs or courses they need or might want to do. I like to spend 50 minutes but today I have  to cut this time short - I’ll make up for it next time.
   
• 14.30   Gold meeting - a meeting with the chief executive and other executives to discuss whether there is any information from NHS England that we need to consider and discuss, and any information we need to feedback.
   
• 15.00   Divisional directors catch up. There are three of us who  each run a division (a director of nursing, a managing director and me) and we protect this time slot on a Wednesday afternoon to meet.
   
• It is always a good meeting as we can be honest, sound off and release a bit of pressure. I find it supportive plus we usually manage to have a laugh too, which is important. I feel lucky as they are the two best colleagues that I've ever had. We are flexible so we cover for each other when needed and, importantly, we are aligned in our vision, we trust each other, and we keep each other well informed.
   
• 16.00   Protected time to deal with admin and to make phone calls.
  
  Three to four years ago, I got some advice: identify one project that is important to you and keep that moving forward. I have employed this approach to work ever since – I always have something important on the agenda and, so long as there is progress every week, I am able to take the rough stuff. 
  
  For me, that project is a big pilot of ‘Open Dialogue’, a family friendly approach to managing mental health patients, which originated in Finland. We are trialling it and I am very hopeful about what that might achieve.
   
• 17.00   I always try to leave at 5pm but the nature of the job means that isn’t always possible. We are about to launch a public consultation about whether to reopen some acute care inpatient beds and in the run up to that I attend evening meetings with oversight and scrutiny panels. I have one of those tomorrow night but I’m focusing on the kids tonight!
   
• 17.15   On the way home I reflect on my job. I do feel I’m improving things and that is important to me. I definitely find the job very interesting and I know I have a really important purpose. I like to move things forward and I like the power to make decisions and get things done. But it is also very challenging at times, and exhausting. 
  
  My next step? It would be to become a Chief Medical Officer. I was a Clinical Director for two years before I took this job. As a Medical Director now, I think my next move would be a board level role.

Gareth Jarvis is a medical director for Central and North West London NHS Foundation Trust (CNWL). He has been in the role for two years and this diary entry is for 20th September 2023.