Welcome to Transformational Thinking for Health Leaders. I'm Dr. Fiona Day, Master Practitioner Coach and Chartered Coaching Psychologist. This is a podcast that will help you meet your most complex leadership challenges and transform your perspectives, helping you to become a more effective and creative leader with a deeper understanding of yourself and your own world of work.

So Jamie Hayes is a Clinical Pharmacist by background and a Director in NHS Wales and also an Honorary Professor at Cardiff Metropolitan University School of Sport and Health Sciences. Jamie has a 30-year career in healthcare leadership, medical education and behavioural change. He served as an elected board member for the Royal Pharmaceutical Society for six years until 2022 and was awarded fellowship in 2021.

In 2017, Jamie founded his own coaching leadership and performance consultancy and has coached individuals and teams from startups to blue chips. And he coaches learners at Cardiff Business School. He's also co-host of the Oral Apothecary podcast, a podcast about medicines, people and stories, which is downloaded in over 60 countries around the world and frequently features in the Apple Top 10 for medical podcasts.

So that's something to aspire to. And welcome to Transformational Thinking for Health Leaders, Jamie. Thanks Fiona, thanks for the invite.

So Jamie, you've got a very rich kind of portfolio career, but tell us if you would about your kind of career to date and how you've got to this point in your career. Thanks Fiona. Yep, very rich portfolio.

I really enjoy it, which is the first thing. And for this is an exercise of looking back. So the first 10 years, Fiona started as a Clinical Pharmacist in a hospital setting in South Wales and a brief spell in New Zealand as well, which was great.

And that was the bedrock really for my career. I took a call and looking back, I realised that this has been punctuated by qualifications along the way as Fiona. So clinical diploma as a early careers pharmacist back in the early 90s.

Took a call from a general practitioner in the sort of mid to mid 90s, Dr. Carol Gibbs. She said, are you a clinical pharmacist? I said, yes. She says, are you any good? I said, I'd like to think so.

She said, we've lost control of medicines in this practice. And so that was one of the early adopters, if you like. And so hugely sort of forward thinking from Dr. Carol Gibbs.

And she asked if I would come and run and do sessions for her in her practice. So I did three, didn't even know what a session was in those days. I covered the phone piece to my mentor at the time.

And I said, I've got a GP on the line asking me to go and do medication reviews and anticoag clinic and things like that. And so I did that for a year and a half. And it was in an inner city practice in Cardiff.

It was one of the best experiences of my career. And then in 99, I took up first leadership and strategic job. Moved up to North Wales for four years as head of prescribing and medicines advice for two of our local health groups.

Four years in North Wales and then headed back to Cardiff and then took up a national role then with the director of the Welsh Medicines Resource Centre and director of the Welsh Medicines Partnership, which is now the All Wales Therapeutics and Toxicology Centre. And then along the way, so I did a medical education qualification when I was up in North Wales. That was a superb experience.

My brother phoned me. He's a dentist. He said, I'm on a medical education course.

He said, there's no pharmacist on this course. I think you should do it. That was enough for me.

I went to my boss and said, can I jump on that? And that was superb. Did an MBA then in 2010, 2011. Again, life changing experience really opens your mind.

And then following on from the MBA, you realise you've taken your eye off the therapeutics ball for a few years. And so jumped on a diploma in therapeutics just to refresh that. And that brings us up to about six or seven, eight years ago when I had the opportunity to do a coaching qualification as part of our host health board.

And again, that was another career defining moment really. So that brings us up to the current day. Along the way, and we might talk about this perhaps, there's been lots of people in trying to fix the NHS over those 30 years.

So I look down now, I've got oil and gas, nuclear, aviation, sport, military, Formula One, the automotive industry and lean thinking. And so I've been there with a black moleskin book, scribbling notes for the last 30 years. So I love all of that.

So I guess there's the combination of the learning, isn't there? The kind of putting yourself into non-traditional learning environments as well. And also that kind of innovation in terms of bringing pharmacy into primary care, which is now very routine, isn't it? So you have kind of right there, right back at the beginning. Funnily enough, I've just spent the weekend with a friend who's a GP partner, and she was telling me about how the pharmacist in the practice is just how valuable they are and how skilled they are and how much they really depend and value upon that.

So I guess that's all kind of comes back to you back in the day. Well, there's a few others, but again, you have to think that it was the GP at the time who picked up the phone and had the courage to say that they'd lost control, that medicines, you know, polypharmacy was just getting into its stride. I really enjoyed it because in the hospital, you didn't get to see, the patients never came back really, whereas in general practice, you started to see them, you know, weekly, monthly.

And again, you started to hear about their stories in and around their healthcare and the bit that I'm interested in was their medicines. So, yeah, thank you for sharing all of that. And I'm really curious about your Black Moleskine book, which I presume is several volumes long by this point in time.

They're the most precious thing in this study, Fiona. Okay, there's volumes of them there. And I often look at them and I shudder at the thought that if they were to, you know, if anything were to happen to them.

Yeah. Okay. Well, all of that cumulative learning.

So we'll pick your brains as we go along here about some of the insights that you've gained along the way. So in terms of kind of, you know, typical week for you, Jamie, how do you spend your time? What does that look like? Again, nice reflective question. No such thing as a typical week, which is, again, I've always enjoyed that.

So I've looked on what's coming up on the immediate horizon. So it's really varied. So I've got some team coaching workshops for our health boards in Wales and their medicines optimisation teams.

I've got a public workshop on medicines and shared decision making. So that's where members of the, not patients, members of the public come and we have a two hour conversation about how's healthcare going for them. And then we move on to shared decision making and the role that medicines play in their lives and the relationship that they have with medicines.

That's what we end up talking about. I'm in Sheffield then running a workshop, how to write a paper and get it published. That's another one of my strings on the bow.

And then I've got some team coaching sessions for some corporate clients. And then if I look at the second, so that's the first horizon. That's the, you know, the immediate.

Second horizon, trips to London, Glasgow, Copenhagen, and then Singapore a bit further down the track then as well. So it's really varied. No two weeks are the same.

I feel very fortunate. The side hustle, which we might talk about a bit later, feeds the day job and the day job feeds the side hustle. Yeah, that's amazing. 

And I suppose I'm curious. One thing about, you know, just your experience of team coaching and how that's different from one-to-one coaching, but also I suppose, you know, I was teaching motivational interviewing back to GPs kind of 25 years ago, but also kind of shared decision making and coaching skills and the overlap between those. Yeah. 

So if you could just comment on that, I'd be really interested. Yeah. So huge overlap.

So the shared decision making that we're doing with healthcare professionals now, I use with coaching clients, with corporate clients and with members of the public. I also use the, you know, the Atul Gawande stuff. I don't think it's his, but I think he made it popular.

You know, the what matters conversation. So just highlighting to even coaching clients when they come in with what is the matter. And it's quite a narrow focused conversation on the turmoil there and then.

And if you can just bring them back to what matters. Again, some real moments there. And then again, we might talk about this a little bit later because the motivational interviewing, I was involved in a piece of research, probably the same time as you were teaching GPs.

And it was with Steve Rolnick, the godfather of motivational interviewing and Professor Chris Butler from Oxford University on improving and influencing antimicrobial prescribing. And so we use motivational interviewing to roll out the STAR study to GPs across Wales in a randomised controlled trial. Again, another career highlight to work with those two giants.

I love how you really integrated that academic side into your work. You know, the kind of evidence base and the rigour that I'm sure underpins all of your work as well. And I suppose, you know, how do you keep up to date then as a clinician given the many different strings in your bow? And yeah, so how do you keep up to date and the changes that you've seen in clinical practice over the years? Jamie, what have you noticed around that? So a qualifier, I suppose.

I don't keep up to date as a clinician anymore because I don't see patients anymore. My coachees are the closest I get to patients. I do a CPD ward round with one of my consultant colleagues.

Every quarter, just to see things haven't changed. But I don't consider myself a clinician anymore. Again, looking at the question of keeping up to date, I read a lot and I've always have since I qualified.

And then when I started working with the National Prescribing Centre, I was running critical appraisal workshops back in the day. And you remember those, Fiona, and evidence-based medicine workshops. And I was introduced to the concept of information mastery.

It was by two colleagues in the States, Dr. Dave Slawson and Professor Alan Shaughnessy. And they pointed out to us that, you know, if you think you're going to keep up to date by reading everything, then you're going to struggle. And so went to Boston in the States to learn from them.

And they pointed out that information mastery was about having confidence in not knowing. They highlighted that actually we need to get rid of the bedside stack. That, you know, you think, oh, I'll read that one day.

I'll rip that out back in the day when we had paper journals. I'll read that. And, you know, we talked to audiences about people carrying around the bedside stack, which becomes a problem for them because they never get through it, you know, with the best intentions.

So, you know, if you think you're going to be able to keep up to date, you'll be out to date by the time we finish this podcast. And so some of the learning, and so I started delivering information mastery workshops then as part of the critical appraisal and the evidence-based medicine. You know, we explored clinical decision-making and realized that we didn't have much of an angle on human decision-making before we were even broaching clinical decision-making with medical undergrads and pharmacy undergrads and postgrads.

And so the headlines from information mastery were be selective about what you read, which a lot of people get this one. The next one really stuck with me was be selective about who influences you verbally. So you can have conversations, can't you? And you come away from a conversation and you think, oh, right.

And I've seen it and I've played with it over the years just to show people I've got up in front of audiences and I've said something to them and they've just scribbled it down, you know, just and taken it. I thought, all right. And so we summarized in our busy, chaotic lives, look, we rely on a trusted network of colleagues.

And I think that's come up a few times on your pod from some of your previous guests. And we rely on those shortcuts, those heuristics and mind lines. And so I try to implement.

So I try to have confidence in not knowing. You know, I love reading, but I'm selective about it. And I try not to jump down too many rabbit holes.

And I certainly have a trusted network around me of people whose opinion I value and I trust. Yeah, thank you. And I love the idea of you doing that, that kind of ward round once a quarter just to just touch base and keep up to date and see what's happening or changing.

Or I heard you say, you know, what's not changing perhaps. Can I add one other in there that I wanted to mention, really? Well, I'm a member of the Royal College of GPs over-diagnosis group. So it's an email discussion group.

But, you know, the learning that comes on that, and I'm a quiet member on there, but that's not to say I don't read and digest, you know, so much of what the discussions are. And again, you have to be selective. Sometimes they do go down a rabbit hole themselves sometimes.

But, you know, shared decision-making, over-diagnosis, de-prescribing, a lot of conversations now about the time needed to treat. Busy clinicians just don't have the time to implement these guidelines that we're coming up with. And so I would put that down as one of my CPD and keeping up to date tools as well.

So a kind of professional forum, even if it's kind of email or WhatsApp or whatever base, but the learning that you get from that shared collaborative space. Yeah, really important. Thank you.

And, you know, your interest, Amy, in the interface between medicines, therapeutics and behaviour change, what are the differences there between each of these medicines, therapeutics, pharmacy? Yeah, it's interesting. So I do say to my pharmacy colleagues, don't be talking about pharmacy. And I would say the same to my general practice colleagues as well, because that's not so exciting.

But people are fascinated by healthcare and medicines. So talk about medicines and you have people immediately, is my experience. It doesn't take long, I don't think, for you to be in a public or a private place and then you hear a conversation, don't you, about somebody's healthcare.

And again, in my world, my cognitive bias trips me into, I tune into as soon as I hear a medicine mentioned. And I use this in lots of my talks and conversations over the years around medicines. It's a Royal College of Physicians report from 2011, N equals one, why people matter in medicines.

And I still use it to this day. And it says, it points out that people's belief about medicines have an enormous and underestimated impact on the use of them in practice. Time after time, we heard from witnesses and saw in our visits that the context of people's daily lives was more important in effective use of medicines than merely prescribing the right medicine and exploring how to take it.

And so that's 15 years ago, but that has stuck with me ever since. And that's where it's taken my area of interest, having conversations with the public and the patients, because we know that patients, when you lift the lid, and it is true, we have a relationship with our medicines because it's a relationship, it's a proxy for a relationship with our disease condition, perhaps. And so when you ask people how they manage their medicines at home, we all do some very strange things.

And I've got some lovely quotes from former GPs that I've worked with. We can't help but add a flare to our medicine-taking behavior. So that's one.

And another one is a quote that I use often. I've probably poisoned more patients than I've cured. And then I ask the audience, well, what's the word that jumps out at you in that sentence? And most people jump to the word poisoned because it's not really a great word you want to see in healthcare circles.

But then when I've given them a bit of time to think, they realize it's the word probably and that there's not a huge amount of, you know, we're trying to improve it, but there's not a huge amount of learning in our prescribing and medicine systems. And for so long, we've worked on the outcome that, well, the patient didn't come back, did they? As our outcome measure. So yeah, so the behavior change piece is, you know, I'm fascinated by what goes on behind the public front door around their medicines.

And we know that they do strange, strange things. They collect them, they store them, they sell them, they prescribe them for their neighbors, a whole raft of things. So, yeah, that was that.

And then I suppose in behavioral change considerations, the one thing I've seen from a healthcare system perspective is that we've often thrown more medics, more nurses, more pharmacists at some of these issues. Whereas for the last 15 years, I've been champion in health psychologists. And, you know, when you engage with the health psychology community, I wish we were employing more health psychologists to work with us on some of these things because that's where the expertise lies.

Yeah, as part of the health psychology department in Cardiff Met, then that's a real pleasure to work with learners studying for masters in health psychology. And they just come with a completely different way of thinking. Yeah, there's something about the rigor of that psychology background and psychology training when it comes to behavior change that is really, really important, isn't it? And, you know, like you were saying, in terms of patients and prescribing and the kind of the end of one and the world that the patient inhabits and the kind of principle of starting where people are at, but you've got to actually really understand where people are at.

And often they're quite confused, perhaps, as well, in terms of what matters. And I suppose just in terms of behavior change in clinicians, I know you're an expert in that field, and I'm curious. I wrote all the individual funding request policies for Leeds for a 10-year period, served on the panels for drugs, therapeutics, and procedures, and I'm imagining you've done a lot of that yourself too.

And I'm just kind of curious about behavior change in clinicians and what you have observed over the years. Yeah, yeah, it's very similar, Fiona. My MBA dissertation was using the theory of planned behavior, so that was an introduction with GPs in Wales.

The reason I came to be working with Cardiff Met was I read a paper, and it was why don't doctors follow guidelines, and it was around asthma and antibiotics, and I was introduced to this concept called the theory of planned behavior, and I thought, well, how have I been in this game for so long and never come across this theory? And I've done this a few times in my career, and it always goes well. I contacted the author. I said, I love your work. 

I just read it. And she said, oh, it was my PhD. Thank you very much.

I'm in Oxford. She said, I'm moving to Cardiff in three months. And so that was a start of me working with a lady called Dr. Caroline Limbert, who was the author of the paper, and then the introduction to the health psychology team at Cardiff Met.

And so that really sort of put me on my way with understanding, fresh off the back of working with Professor Rolnick and Chris Butler. So we had our motivational interview training, so this was before I'd done any coaching, and our role was to deliver the training component or the motivational interviewing component of the intervention. So it's a randomized controlled trial.

We had 65 or 63 practices in Wales. Half of them had the intervention. Half of them had the control, and the intervention involved, it was multifaceted, which was one of the first studies to show that, look, tackling prescribing and influencing prescribing is tough because it's so nuanced, and it's not just a simple act, is it? And so it was multifaceted, and it involved using data that was relevant for the practice, that meant something to them.

It was their own data for one of the first times we were using a practice's own data, because up until that had been aggregated at healthcare economy level or health board level. They had two motivational interviewing sessions with me and a few colleagues, and then in between that, there was an online learning, an introduction to an online learning platform where they were able to view consultation skills and consultation skills techniques. And again, antimicrobial prescribing is so much to do with consultation skills.

But I realized the power of motivational interviewing and being taught by Steve, you know, don't be offering advice, wait. And I use wait now, why am I talking? Yeah, it's a great one. And I try to bring these skills into the coaching, the leadership and exec coaching I'm delivering today as well.

So fond memories, still having great conversations with the public, and they still share with me their stories. And again, that relationship they have with their medicines, and it's still fascinating and still, you know, never fails to impress me. Thank you for sharing that.

And I really just love that openness that you have to listening and learning and then kind of integrating that into the next thing that you're doing. Yeah, there's something there for you on the listening and learning. Learning has been a constant through my career, a real constant.

The listening, I'm a talker. I'm a talker. I spend a lot of time up in front of people running sessions.

And it was the coaching, you know, in 2014, that I realized the power of listening. So I have to give myself all sorts of behavioral cues when I'm delivering a coaching session to be quiet, to listen deeply and actively. It drains my battery like you, you know, because to do a coaching session, as you know, for an hour, hour and a half with somebody, and to really listen takes a lot of effort.

And I'm drained at the end of a successful, you know, I know that I've listened well. And so flippantly over the years, Fiona, I've shared with audiences that I would suggest that coaching is more effective than most of the medicines we dish out, which is a flippant comment, I know. But, you know, you get what I mean.

I think to listen to somebody in this day and age for an hour, hour and a half, and we know that a lot of general practitioners and healthcare professionals listening to this would love to be able to spend that amount of time with some of their patients. And they probably know they wouldn't be reaching for a prescription pad quite as quickly as they perhaps are forced to. There's a systematic review of health coaching by Jonathan Plasmore.

I hope I'm allowed to say that. I believe it's in press and coming out soon. So that would be really interesting, I think, in terms of, you know, synthesis of the literature around this and the potential for that overlap between coaching, coaching psychology and health and health psychology.

So it's a particular interest of mine. Perhaps you can help me with this one. And this is one that I'm sort of fumbling around with.

And I have been for a while. Spent a lot of my time work, as you will have as well, of Fiona with numbers needed to treat and numbers needed to harm. And now we've got, you know, time needed to treat.

And so in response to them, I sort of, you know, I think coaching has more impact than many of the medicines we give out. I'm trying to fiddle around with a number needed to coach. Yeah.

And, you know, the number needed to coach to have a positive impact, whatever that might be for the coachee, is low, isn't it? Let's get together and talk about that because, you know, then it's one over the attributable risk reduction fraction, isn't it? It's the NMT. Yeah. So we need to have some outcome, you know, enough outcome data to be able to do that.

But yeah, let's talk about that outside of this conversation. Sounds really exciting. So tell us about your side hustle then as a coach and as a podcast host with the Oral Apothecary, which, you know, I've listened to and actually was very amusing as well as being very informative too.

So you founded JMH Collaborations back in the day. And so how do you fit it all in? So I read a book and the book was The 10% Entrepreneur. And it said, Living your dream without quitting your day job.

And I read it and I'm not sure I recommend the book to... I enjoyed it and there was a couple of sections in the book that really resonated with me. And it asked, you know, what does it look like if you use 10% of your time, 10% of your networks, 10% of 10? And I started just asking myself that question and people had always suggested that I should take some of this stuff and do something sort of bigger and wider with it. So I inquired about buying annual leave from the NHS.

They were more than happy to sell it to me. And I, you know, took little footsteps to start with, bought a week's annual leave to start with. But those days went quickly.

And so it's, you know, it's... I describe it as boutique and it is genuinely boutique. But when I say boutique, it's small, it's selective and prosperous. That's the nice thing about it.

I get to say, because it's not the day job, I get to say no to lots of people and clients in a nice way, in a nice way, in a helpful way, I hope. And so, yeah, coaching, leadership and performance consultancy. And it's a combination of one-to-one exec leadership coaching and then leadership and some team coaching the last couple of years and then some leadership and performance days as well then.

And it's a real mix. And as I said earlier, one feeds the other. I, you know, continually learn from the clients, from all those industries that have been in to try and fix the NHS and those black moleskin books.

It translates into the legal sector, the insurance sector, banking, retail. And the overriding thing, Fiona, is with these people, there's dysfunction of some sort, isn't there? You know, and the complexities that we're faced with. Yeah, really enjoy it, really enjoy it.

I wouldn't want to do it full time. That's, you know, I still love the day job. I love the world of medicines and medicines optimization and the things that that throws at me, but really enjoy it.

And your clients are mainly in the corporate sector, aren't they? So I'm just kind of curious about what you've learnt about leadership from the corporate sector that might be relevant to healthcare. There's a different, what's, how to describe it? You know, you have performance, and maybe it's our colleagues talking to GP. The GPs tell us, don't talk to me about personal resilience.

You know, this system, we need systems resilience, and I get it completely. And lots of friends and colleagues, I absolutely get it. So you have a different level of performance conversation.

It might be the NHS, which is down on its luck. The staff are, that discretionary effort that we've relied upon for, you know, years and years is probably getting less just because of the physical capabilities. And it's, so I start conversations with, you know, a performance triangle.

Do we have a skillset issue here? Do we have a mindset issue or do we have a systems issue? And that's a lovely way to open a conversation. And so I would say the corporate clients are just, the people I'm dealing with are on message and interested in that next level of performance. Yeah, that's the bit I, that I note.

And they're future orientated, which obviously helps with a coaching conversation. Whereas, you know, healthcare is, we're struggling and still looking at what's gone, you know, what's just happened. So something about being future focused and keeping an eye on the horizon and open to, I mean, I'm getting here, but open to kind of innovation and horizon scanning and thinking about the bigger system.

I use the Don Berwick quote a lot from the IHI, you know, when he says, oh, you know, I get it. We've, and he was talking to a nursing colleague, I think, when she said, I get it, I've got two jobs. I've got doing my job and improving my job.

And we have those types of conversations a lot with people. If you're waiting around for somebody to come and improve your job, you could be waiting a long time. And I'd add there's a third, doing your job, improving your job and helping other people to improve their own jobs too, yeah.

Yeah, and it's interesting, the team coaching, you end up having a conversation about what does it look like to be a good teammate? That's a nice conversation. It slightly changes the focus. Yeah, so what does, you know, we talk about high performance teams and high value creating teams, but down to it, what does it look like to be a good teammate here? Sounds like you're having a lot of fun as well as interesting discussions in a range of contexts here.

Yeah, yeah. And the fun bit brings me onto the podcast, Fiona. So it was a lockdown project, you know, together with two close friends.

And, you know, we've recorded over 80 episodes now. We've done six live shows. Guests come on from the world of healthcare.

They're asked to share a desert island drug. Well, they were before the BBC wrote to us with a cease and desist letter, a career anthem and a book for the library. And then we top and tail it with a topical pub-based CPD discussion.

And coming back to the how do you keep up to date in CPD, you know, producing 80 episodes, that's 80 lots of planning, 80 lots of reading, 80 guests, learning from the guests. So, you know, that has provided an interesting... We record on a Thursday evening, so that provides a natural cadence to all the other stuff going on. The Thursday evening is protected and that provides a really nice natural cadence to... And I'm reading stuff I probably, you know, I wouldn't have been reading if we weren't having a, you know, a particular guest on.

So we just recorded with a clinical pharmacologist from Liverpool on clinical trials and some of the interesting stuff around there. And then we're just planning now next week we have a deep dive on the inverse care law and two deep end GPs joining us. And it's, again, pub-based CPD.

It's if we bumped into you in a pub, we know there would be socialization of learning going on. Yeah, some people don't notice it, but it's really rich and it's been... Of all the things I've done, Fiona, and I've published stuff and strategies and all that stuff that you went through earlier, the podcast has been one of the highlights, without a doubt, and continues to be. Yeah, I guess where you kind of bring it all together and it's a different form of communication, isn't it? And then, I suppose, Julian Tudor Hart and the inverse care law.

He was a Welsh GP, wasn't he, back in the 60s? So it's nice that you've got that link as well. Well, he was indeed. And in terms of storytelling, I had a day with him.

I've just bumped into him as a random stranger and so I've never told the story and it's been a constant thread through the 80 episodes. So it might be time to tell the full story next time on the podcast. But yeah, you wouldn't realize that his work in the Welsh... He was one of the first... Well, he was the first GP to recognize blood pressure as a thing that we should be keeping an eye on.

And then he stayed in touch with me then after our meeting. So yeah, that's a big part of it. Oh gosh, well, how amazing, Jamie.

What a wonderful experience that sounds like. And in terms of the future of medicines and how pharmacy professionals can contribute to the health of the whole population, what do you see ahead here? Yeah, so it's an interesting... The future of medicines, I'm a cynic on this, really, in that we'll continue to overestimate the benefits and underestimate the harms, I think, as new medicines come through. And the way that we're fed this diet of... And it's interesting.

It's happening at the moment with the GLP-1, you know, the Weger Vs of this world. And they all follow a similar pattern in the press. And I've been interested in how medicines are portrayed in the press for years.

And so they follow a pattern of, here's a great new innovation. Oh, but you can't afford it and you can't have it. So there's that scarcity, you know, demand.

Nowadays, we've got celebrity endorsement that just spikes the demand even more. And then somewhere down the line in the future, we'll have a, you know, innovation made my life a living nightmare stories. And I've watched that.

And then the drug will get withdrawn, you know, not suggesting the GLP-1s will, but that's a familiar story. And we seem to fall for it every time, that, you know, the whole place is getting so excited about, you know, these... But there's lots of uncertainty still about, you know, the new preparations. I did a project with the Institute of Welsh Affairs a few years ago on, and it was called, Let's Talk About Cancer.

And it was a conversation with the public. And the public told us that they didn't want bright new shiny things. Yeah, they wanted decent healthcare.

They wanted the basics done really well. And they wanted to be communicated with really well. And some of these new innovations that may add one or two months to life or... And I get that from an industry perspective, you have to have some of these marginal gains because they end up in being a bigger gain somewhere down the line.

But we often get the science and health sort of mixed up, I think. So, yeah, so the conversation with the public, they said, you know, do the basics well for us. And rather than, you know... And on the over-diagnosis group, their conversations are often focused on, you know, what are we trying to do here? And I've got a book recommendation for you, Fiona, and for your listeners.

And it's by a colleague of mine and a friend, Professor Neil Maskry, a GP of many years, retired a few years ago now. And he's just written Rebalancing Medicine. So not only is it a great read, it's also a great title.

And I'd love to think that we continue to try and rebalance, which is something that seems to be, you know, that would be a nice direction to go in. Thank you for that recommendation. I'll make sure all of these links and things we've talked about are in the show notes.

And I guess we could have a whole other conversation about rebalancing medicine and value in healthcare and all the health economics and all the kind of, you know, what people, patients want. But let's draw this to a close. It's been fantastic talking with you, Jamie.

Thank you. I really enjoyed the stimulation from your very acute brain and all the kind of, like I said earlier, all the kind of the rigor that underpins all of your many and varied different practices and things that you're involved in. So thank you for taking the time to meet with me today and wishing you all the best for the next chapter.

My pleasure. If you've enjoyed this podcast and would like to find out more, head over to www.fionadayconsulting.co.uk and you'll receive three hours of free CPD, the Health Career Success Program, when you sign up to my newsletter. And there's loads of other resources to support you as a medical or public health leader on my website too.

Thanks for listening.