Dr Andrew Greenland: 0:00

Welcome to helping this in the future of care guest is Dr. Karen Wallace, the GP and the Director of Clinical Partnerships at Maximus UK. Karen has built a career at the intersection of medicine, work and health, particularly in disability medicine, where she champions approaches that enable people to live healthier, more independent lives. Karen, welcome to the show. Thank you so much for your time this afternoon.

Dr Karen Wallace: 0:27

Thanks for having me. Very happy to be here.

Dr Andrew Greenland: 0:31

Wonderful. So maybe we could start a bit at the top. Could you perhaps talk a little bit about your journey from being a GP into your current role as Director of Clinical Partnerships at Maximus?

Dr Karen Wallace: 0:41

Yeah, absolutely. I've had a bit of a squiggly career to say the least. I think when I look back at my medical school career, I didn't think that I would have ended up where I where I am now. So I trained as a GP and then I sidestepped into disability medicine and learned about occupational health. And I've been with Maxwells now about seven years, and within that company, it's given me such a wider lens because we have national contracts for both work and health. So we see it from both sides of the coin. And that's really sparked a passion and interest. So that is my journey. And more recently now I'm moving into kind of trying to build tools looking at med and tech and the governance around it and the potential that we that um we could change the landscape. So very excited about the bright future that that might look like.

Dr Andrew Greenland: 1:53

Thank you. So could you tell us a little bit more about the nitty-gritty of what you actually do at Maximus?

Dr Karen Wallace: 1:59

Yeah, so I started off in a role um which is called a functional assessor. And um I had never heard, never actually heard of it, but um when I joined, Maximus was the second largest employer of healthcare professionals, which I also had hands up, never heard of Maxmas. Um so so what that role is is that we um see see customers or service users who've been signed off by their by their doctor with the fit note, and they have been deemed not fit for the workplace. If they've gone on to claim any sort of benefit, then they kind of come around um through our serve through our service, and we typically spend anywhere between 45 minutes and 60 minutes with them asking lots of questions just about their health problems, looking at their function, um, and then we uh look um and make a recommendation on their level of disability. Um, and that's and that and that is a job in a nutshell. So um we see roughly um six customers a day, which I thought was an absolute dream coming from general practice, but actually the um depth of the reports um is something that I had never really done. I think that we we kind of take a short history and we focus on the proper problem, whereas whereas this is really going into the nitty gritty of how the condition can impact their um their lives, and that's the part that I really, really like hearing, hearing that.

Dr Andrew Greenland: 3:49

Thank you. What sort of drew you into this field in the first place? Was there a sort of a moment of inspiration or something which triggered your direction in in this field?

Dr Karen Wallace: 3:59

Um it's a really good question. I think um when I was a GP, I um I was probably a bit of a perfectionist and I knew in myself that I couldn't do 30 odd years of caring this much and worrying. Um so there was a little there was definitely a bit of self-awareness there. Um, but I also really love the bigger picture thinking. And so when when I was in primary care, I was part of the CCG and the um health education leadership. And so Maximus was actually just a sidestep, it it was um just a filler role um to do what I thought bigger and better things. Um so so I kind of fell into it, and I think a lot of people who come into this job do fall into it, um, but then they but then they actually love it and they uh love the patient contact um and the actual time that you get with it. So came into it a bit of a mistake, but um, as I've gone through various kind of roles in the company, I've had the um had the had the opportunity to do kind of clo clinical governance and clinical um innovation and various l leadership stuff, which has led me on to my MBA. So very squiggly again.

Dr Andrew Greenland: 5:36

I think no, I think the most squiggly careers are the most interesting because it means people have used crafted a role for themselves, which is uh sometimes a little bit um not quite so common. And I think it's interesting how people end up where they do. I guess there must be a bit of oh, sorry, come on.

Dr Karen Wallace: 5:54

Oh, I was just what I say with the um career and a role piece, I suppose that has led on to probably how you find me. Um, so disability medicine is not very well recognized, nobody's really heard about it. Um, and so that is one of my passion pieces to um kind of raise the profile of our healthcare professionals and what they actually do because most of them go, you know, well, all of them go um through about two or three months of really intensive training to do this job after going through, you know, nursing school or middle school or physio. Um, so there's um so there's that piece, but uh trying to educate and get people to recognize that we are part of um an umbrella of Oki Health and trying to really kind of get a space for ourselves in the work and health journey journey and try and find our voice to help to help shape the system so we can help shape our people and get the right the right support in the right place at the right time, which we've got lots to work on in the um larger ecosystem there.

Dr Andrew Greenland: 7:13

Thank you. Um what shifts are you seeing in disability medicine and the way health and work intersect at the moment?

Dr Karen Wallace: 7:20

Uh yeah, really good question. Um the disability rise is going up, so COVID was a real turning point for it. Um, and and you know, gone up by millions of people not in the workplace, where um say we are seeing trends in younger people not being able to um to um work and longer spells of being out. And I think for me coming from GP land, there's a real frustration of who should be that person who, when people might be falling out of the workplace or need some help and support, who should be giving that help and advice that they don't fall out of the workplace, have to wait months to see us, and then if they are deemed not fit for any type of work, um then you know, months and months roll, and then their chances of getting back into the workplace um can actually be really, really slim. And what we know from the many white papers, green papers, um is that work is a key social determinant of health. So good work is good for health, and um, and I think that is a message that's not fully out there.

Dr Andrew Greenland: 8:45

I'm guess there must be some tension between the work that you do and the clients that you're seeing and assessing. How do you kind of navigate that?

Dr Karen Wallace: 8:54

Um well, I suppose it's it's important to say that we aren't the decision makers, um, but I think you touch on the fact that the system's quite misunderstood. So um, and actually as a G as a GP, once I signed the fit note, I'll hold my hat, I'll hold my hands up. I didn't really know the process or the system that my patients might be going through and the further assessments. Um, so I think there's a mis there's a misunderstanding that if patients are signed off by their um by their their their doctor, one of our most common questions asked is, but I've been signed off, so why am I here? Um and what we say is that the doctors typically signed you off um for a certain type of role, whereas we're looking at kind of your function as an overall, not just if you're fit for your building work and do you have a bad back or things like that, not to oversimplify it, but um yeah.

Dr Andrew Greenland: 10:07

Okay, so they can often come out with a positive outcome, even though there may be some apprehension as to what the process is going to involve for them.

Dr Karen Wallace: 10:14

Yeah, and actually one of our biggest feedbacks is that they can't rem they can't remember the last time that they spent a full hour with uh health with um somebody from healthcare, um, which is really, really nice because I do think that they feel listened to in in that space of time.

Dr Andrew Greenland: 10:38

Thank you. Um how do you say the role of healthcare professionals has changed in this area, especially for those um in traditional diagnosing or treatment roles? And I appreciate you've come from the world of general practice, but I guess I'm thinking a little bit more wider in the in the space.

Dr Karen Wallace: 10:53

Yeah. Yeah, I and I think it's probably been a topic for for a long time. Lots of people think maybe it's not the best use of a clinician's time. Um, so that is something that is brought up. Um my view on it is that we um we need clinical expertise, but we need it at the right time. And and I think one thing that I that I see a gap in is is that we don't have enough people with a dual lens who are trained in clinical and health, but also trained in trying to get people back into the workplace. So the VOC, you know, the VOC rehabs, the Yocki Health, there's so many people and um anecdotals who we all work in silos now. Um, and even within Maximus, we delivered the contracts, but because of the wide the um wide the wider ecosystem, we cannot join that pathway. Um, and so what I would love to see is kind of a tiered work and health journey journey. So so you know, patient patients are getting the right support, the access to health, and and and a joint up work and health co um work and health conversation at the right level. And if that intervention hasn't helped, then the next year, the next year, and then you'll eventually see a clinical person or have clinical oh oh oh oh clinical oversight um um of what that looks like. So that's my dream. So bring it all forward and um get different people trained in different ways because I don't think that it's all clinical. There's it's very complex why people aren't in the workplace, and and I think if we flip it from our reactive nature of the tiered approach, that's actually when you know when when somebody's probably fallen out of the workplace. And and um there was the Mayfield review in March this year that be that be basically said that as a government we need to help our employers re um re reduce the bar barriers and um really help people stay in long-term good work and not focus on kind of short-term short-term sickness. So um, so I think a lot has to change. Um, and I'm not sure that we have the capabilities within the UK at the minute. Um I read some fact about 92% of large firms have Oki Health resource, whereas I think it's about either eight or eighteen percent of small businesses do, which who you know, who's there to actually help support them, keep that person in the workplace. Um, and so there's a big gap that we probably have to fill and think about going forward.

Dr Andrew Greenland: 14:16

Interesting. Um you found your calling in this work, but do you think there are more clinicians are starting to see opportunities like this as part of their professional path?

Dr Karen Wallace: 14:26

Yeah, um I think yes. Um it depends on their motivator, right? Really, like, and again, I don't think anyone goes into medical school to think that they'll become a functional assessor. Um, but I think that my motivator as a doctor was patience and time and quality with them, so that's probably why I've enjoyed the jobs so much more. Um it I think can be a really nice portfolio career for somebody who still wants to be clinical because what we don't do is we don't treat and we don't diet diagnose. Um, and so some people do miss that. So I wouldn't say that it's for all clinical people, but we do have a really wide, wide range in workforce. So we've got mental health nurses and par paramedics and OTs and physios and nurses and doctors, so a whole range. Um, and that is really, really, really, really, really, really, really nice to see an MDT that isn't in the usual places. So, yeah.

Dr Andrew Greenland: 15:54

Thank you. Um, I guess we're still post-COVID and we probably always be post-COVID. Um, I'm trying to get some sense. Are there still people that you're seeing that have not been able to return to work through you know long COVID or some of the associated conditions? And what are you doing with these patients?

Dr Karen Wallace: 16:12

Do you know it's a really interesting question because I think that there's a real misconception that everyone works from home now. So if you do have a physical health problem or something like that, there should be work that they can do because everyone works from home. But actually, a lot of these um jobs that are whether it's the entry level level or whichever sector, they they are manual jobs, they are face-to-face jobs, they're in shops, they're in construction. And um, so I don't think that we've actually seen a massive labour market shift in what in like what jobs are still available um for people. And I think that's an issue. Um, what are we doing about it? So we are independent, so we cannot signpost or um treat, which is probably a frustration of a lot of our workforce that we that we're in a prime spot, but yet we have to stay very um objective. Uh so I think that's probably a wider question, and probably not for me to answer. Um, is there support there? I think from from what we're see seeing and a caring, and you you will hear this too, in your role, is that they're on a waiting list, but it's two, three years down the line. Um, and if it and if they aren't having the right intervention, then then um then they're usually coming through us, then.

Dr Andrew Greenland: 17:59

And are there any um misconceptions about disability medicine or work-related health that you'd love to see challenged publicly? Obviously, you've talked a little bit about the COVID thing and the working from home. Is there anything else out there that you'd like to see challenged just so people have a better understanding of what goes on?

Dr Karen Wallace: 18:15

Yeah, I th I think one of the things um and one of the reasons reasons why I didn't want to join the um that sector originally was that I I read and understood a lot about, you know, there's targets to the kits, so we have to say that there's X amount that um that are fit or aren't fit for um for um for um work. We we don't make that choice if somebody's fit or not for work is the first thing to say, and there are no such target targets. Um so that's so that's something that I that I was very wary of that that it seemed to be that you have to fit people into boxes, um, and that that's not the case, it's your clinical judgment, um, and that then um compared with the policy and legislation. Um so so I think that's that that that that is definitely one uh myth to bust. Um if there's any clinical people listening to this, um another myth is that the 113s and the forms that get that get sent as a consultant or a G or a GP, um we do read them, they're incredibly useful, and the more that you write on them um really really helps us um make a judgment on the pathway that a patient might go might go down with whether whether it's a uh paper-based full assessment or a phone call or a fate or or an actual face two, face one. So um if there are any healthcare professionals who never really get that closed loop um back, they're incredibly useful. So and I never thought that as a GP. I didn't really know what the forum wanted, and I wondered if anyone actually read it.

Dr Andrew Greenland: 20:22

So thank you. So, what are the things that are working really well for you right now in your work or the broader um mission of Maximus?

Dr Karen Wallace: 20:33

Yeah, I think one of the um Maximus missions at the minute is is to kind of have some thought leadership around that work and health um journey journey. Um we are a company who who do it from both sides and really see what improvements can be done if we if we weave in both sides of that journey journey. I think a lot of um on the wider landscape we are hearing from commissioners that they uh that they want tech, that they want a digital journey. Um so we're really looking at at our systems and and our interactions and and our tech and a front door um and kind of building our strategy and plan um off the 10-year plan from which has been recently released, um which I think everyone's doing now. We're gonna go looking looking at how tech can make it easier and more accessible for people to find out the information, to have assessments, to um share some of their data. And it's just about doing that in a kind of safe, um a safe and fair, safe and fair way. And that's probably something that I'm I'm most passionate about now, um in how we build in triage tools and how we look at artificial intelligence and make it safe. So um looking at the regulations and the governance around that, um, and also and I'm sure our workforce will be the same as um many. We have a very wide-ranging um set of digital literacy, and so that's that's something that I'm really passionate about um trying to help and empower people to play safely in a sat in a sandbox and use those tools and um and so then they'll be better equipped for the future to um change our journey for the best way best way possible.

Dr Andrew Greenland: 23:05

And is there any particular um ongoing frustrations or challenges or bottlenecks in the work that you do that you would like to see overcome to make your life easier?

Dr Karen Wallace: 23:15

Ooh, bottlenecks. Um I think you know our frustration is shared with the rest of the world, and um we want to do things as quickly as possible, and um I think everyone has great ideas, it's just moving at the pace that we want to um to like help serve and shape our um customers at the four at the forefront. Um, you know, we we have green papers and white papers and things like that, and the Mayfield review that did come out earlier in earlier in the year is just a discovery phase, and then the recommendations are out near Christmas time, and you know, I think that when when you're in the sector and you're waiting for those key um key mo key key moments, it can feel like a long time. Um maybe I'm just very impatient, but um, but we would like to kind of move a bit quicker.

Dr Andrew Greenland: 24:23

So and think about the next sort of six to twelve months or so, where would you like to be or where would you like to see Maximus and the broader um landscape of disability medicine?

Dr Karen Wallace: 24:34

Yeah, um six to twelve months. Um what would I like to see? I I I would love to see some technology built into our systems. Um we are similar to the National Health Um Service, we um work on on quite old systems, and um we don't have all of the functions that we would like to like to to make our job quicker and easier, so then we can spend more time with our customers or me um making an impact in a better way. So my dream would be to actually see you know scribes in our workplace. Um we type reports um each each of our re each of our um reports are hundreds and hundreds and hundreds of words, and and we do that multiple times a day. So sim simple tech could make a huge, huge difference. Um, so that is that is what I would love to see in the next six to twelve months, in the next one, two, three years. I would love to see a combined work and health journey journey and trying to break down those silos of just seeing it um work and getting people into work, or if they have any sort of health problems, they go down a different path. Really, kind of it should be the same path with a network around them to help support them. So that would be my dream.

Dr Andrew Greenland: 26:11

Thank you. Um finally, if you were um starting your career again tomorrow with all the experiences that you've gained, what might you do differently, if anything?

Dr Karen Wallace: 26:23

Oh, um, that's a really good question. I uh what would I do differently? I would be more vulnerable more quickly when I left the um more clinical front lines, so um GP land, I kind of left with my perceived head held high and I was tough, but I just wanted a change in um a change in in like my career, and that was in 2018, and only in COVID when when I looked to go back and help support, um, did I write about my my time and the real reason that I left, like my main trigger um was about being called to an inquest, which was absolutely fine and for my care, but that kind of knocking confidence really, really knocked me. Um, and I couldn't really get it back. And I wish that I had spoken about that earlier, um, because when I have shared, it seems to have reached so so many, and so that that's that's a regret. Um, and yeah, I would probably be more vulnerable sooner and lead better earlier. Yeah.

Dr Andrew Greenland: 27:52

Karen, thank you so much for your time and joining me on this conversation. It's been really fascinating and thought provoking. I think our listeners will really appreciate your clarity on how healthcare and work overlap and the vital role that clinicians like yourself can play beyond the traditional consulting room. So thank you so much.

Dr Karen Wallace: 28:08

Thank you.