Real-life story - Philip Monk

I completed my GP training and worked as a GP in a deprived area of Leicester where I became interested in how we could influence health on more of a population basis rather than at individual patient level. I made the decision to train in public health and then completed the four-year programme.

At that time, as a result of the Acheson Report, if you aspired to be a director of public health you had to be competent in communicable disease control, as that was seen to be extremely important. I entered that area of work and never left.

We have a responsibility to respond to acute incidents such as food poisoning, meningitis outbreaks, tuberculosis (TB) and the public health consequences of TB. 

For example, we had a case where a number of people had suffered from salmonella after eating at a particular pub restaurant chain. We brought the different agencies together to agree a plan of action to identify which food had caused the problem. This included putting together a questionnaire for the victims, testing out our theory of the possible causes, reviewing the data and making an action plan. We then put in place measures to control the outbreak and monitored the effect.  If there is a recurrence, we will review again and keep repeating that cycle until the issue is resolved. We work closely with Environmental Health colleagues who have the power to intervene if needed.

The other part of my role is more strategic, for example, ensuring that Leicestershire has robust TB and anti-microbial strategies in place, together with response policies that all relevant agencies are able to implement effectively. We work in partnership with a wide range of agencies including NHS England, NHS Immunisation and Screening, local authorities including Environmental Health, Clinical Commissioning Groups and NHS providers. We are part of the Local Resilience Forum and the Emergency Preparedness Forum chaired by the chief constable.

The thing I most enjoy about this job is its unpredictability; you just don’t know what you are going to have to deal with from day to day which means you really have to be able to think on your feet to respond to whichever challenge lands on your desk. 

For example, recently when I was duty consultant I had to deal with a cluster of cases of people with respiratory disease from one particular office environment. The team that I work with carried out  an investigation and discovered that it was due to pigeons roosting on the roof and droppings from pigeons getting into the ventilation causing a disease known as Parrot Fever or Psittacosis.

The approach fits with my GP training of diagnosing the issue and developing the solution.  I enjoy the detective work element and the satisfaction of solving a puzzle and closing a case.

The main challenge is that it is very much more difficult to do the strategic work than it used to be, as the overall responsibility for public health is split between a number of different agencies and no one body has responsibility for the delivery of health protection. 

Partnerships and multi-agency working are so important because we have to support other organisations to deliver health protection strategies and policies. This means we have to use influencing and negotiating skills to get health protection issues recognised as a significant priority alongside all the other priorities that local authorities and others are responsible for.  

I have the non-executive director role I mentioned earlier. We enjoy holidays and travel and have an active family life with children and grandchildren.  I am also active in our local church.

I am planning to reduce my hours and work more flexibly for two or three years as I approach retirement. I am a non-executive director for a social enterprise that provides healthcare for homeless people and I will continue in that role. I also act as a mentor for public health trainees and will probably continue with that.

Public health is an interesting and rewarding career. You have to be adaptable and flexible; don’t be put off entering a career in public health by the constant structural change that has always happened and always will. You need to focus on the causes and outcomes that you believe are important and learn how to prioritise them by negotiating with and influencing the political and other stakeholders.