1 year in NHS England & Improvement’s National Patient Safety team

Posted by: Nima Roy - Posted on:

As most of you will know, on the NHS Graduate Management Training Scheme we spend two years rotating around the NHS and occasionally external organisations. As some of you may know, graduates are sometimes placed in arms-length bodies (ALBs) rather than trusts or CCGs. My first placement has been spent doing policy and strategy work in the Patient Safety team at NHS England & Improvement. I recently wrote an article for my Directorate newsletter summing up my time here, and thought I’d share an adapted version to give an insight into the kind of work you can do as a grad in an ALB, and how to capitalise on opportunities in this environment.

Working in a national body means there are degrees of separation between you and patients, which results in key differences between working here and in a trust. In my experience, the positives have included being able to take a whole system view of the NHS and having the opportunity to understand how different organisations interact to fulfil the NHS’ objectives; having more time and resources to be able to critically analyse why things are done rather than just doing them; and being in a position to influence widespread changes to how the NHS operates. The challenges include systematically focussing on putting patients first in an environment where you’re more likely to see the Secretary of State wandering the corridors than a patient!

When I joined NHS Improvement (now NHS England & Improvement) it was the first year graduates had been placed at NHSI. This meant there were many opportunities to be creative as I was essentially working on a blank slate. One year on, here’s the advice I’d give any graduates starting their ALB placement (although it’s mostly transferable to any placement setting) and my experiences:


Advice: Focus on making the most of the opportunities available to you, and if you have ideas for the skills you want to develop and work you want to get involved in then don’t be afraid to ask – people are generally extremely willing to help. The first port of call for this should usually be your placement and programme managers, but if there are any issues then approach other colleagues and graduates for advice or contacts – there’ll usually be a group of you based in the same building so work together to collectively get the most out of your experiences. I’d also recommend going out of your way to meet new people – even if that means bonding over the broken kitchen tap or the gloomy weather – you pretty much always learn something new through it!

My experience: Being a General Management trainee based in a strategic arms-length body was initially a little complicated (we’re almost always based in a trust doing operational work) but from my first day everyone has been so supportive, friendly and engaging, both in the patient safety team and wider medical directorate. Having great relationships with my placement and programme managers and being good friends with the other graduates was key to navigating some of the natural ‘teething problems’ of being the first graduates placed here. Through having 1:1s, coffee roulette sessions and the (admittedly occasional…) hot-desking, it’s been great to get to know the people in the Directorate better. I’ve also become a pro at identifying people from their Skype photo, a valuable skill I’m sure!


Advice: There are so many varied work streams and projects you can contribute to in a national body. Take the first few weeks to understand your team’s work and the opportunities available, before trying to figure out what you want to gain and contribute. Because the work naturally lends itself to multidisciplinary inputs, there’s value in understanding how your direct work fits into other team’s and Directorate’s broader functions and exploring opportunities to work together. It may be challenging to get time in people’s diaries to do this but that’s generally just because they’re so busy; you can often overcome this by making everything as simple as possible for other people to understand and action. For example, develop a personal development plan (PDP) early on which outlines what you’re looking to get out of the placement, linking to your competencies as relevant (these are the specialism-specific core skills you are expected to develop on the Scheme). Commit to reviewing this with your line manager every month or so and consider using this strategically to structure your roles and responsibilities – also remember it’s a dynamic plan so you can add to it as your exposure and network increases.

My experience: I’ve been lucky enough to contribute to some incredible work, including hosting consultations on the new National Patient Safety Strategy across the country and getting to learn about different staff groups and organisations’ vision for the NHS; and on extending the National Learning from Deaths guidance to ambulance trusts which involved liaising with stakeholders from medical directors to patient representatives. Attending the National Quality Board meeting where this was approved was immensely rewarding, and the experience reinforced to me the huge potential to improve patient safety through policy change. Focussing on being involved in a diverse range of work and developing varied skills meant I naturally fulfilled the competencies without it ever becoming the be-all and end-all of my placement.


Advice: Being on the Scheme opens so many doors and in particular gives you access to senior people in the NHS (many of whom also started their NHS career on the GMTS). Don’t be shy approaching them – in person, via email or even on Twitter to mix it up! People tend to make time to talk to you about their roles and how they ended up there, and it can often lead to interesting shadowing or work opportunities; not many people say no to an enthusiastic grad! The Scheme can also give you a ‘free pass’ to shadow different parts of the NHS, from portering to ambulance ride-outs. More broadly, there are lots of conferences or talks that are free to NHS staff where you can learn about the health landscape more widely and build networks, e.g. Expo 2019, and on top of this you can attend a conference of your choice sponsored by the Scheme. 

My experience: In my first few months I accompanied Aidan Fowler, the National Director of Patient Safety, to Northumbria’s efficient and aesthetic Specialist Emergency Care hospital to witness best practice, and to AHSN meetings to better understand how their work is improving patient safety both locally and nationally. As part of the Scheme’s orientation period I visited Wandsworth prison to see how their healthcare services operate, shadowed porters to better understand patient flow and watched T&O surgeries on Christmas Eve (hearing ‘All I want for Christmas…’ blasting while a tibia lay exposed in front of me was a stand-out experience!)

Overall, It’s been a real privilege to have an insight into the interesting and valuable work of a national body, in particular to understand the NHS from a more holistic perspective, which I’m sure will be valuable in my operational trust-based placement. Attending Confed recently (the biggest Health and Social Care conference in the UK) made me simultaneously realise how much I’ve learned over my past year here – and how much further there is to go.

Thank you so much to everyone I’ve met and worked with over the past year, I couldn’t have asked for a better first placement – and I hope these tips can help someone else to capitalise on the incredible opportunities the Grad Scheme presents 🙂

As always – let me know if you have any questions @nimaroyNHS.

All the best,


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Alert: GMTS Scheme applications are now closed for 2024 entry