South Asian Heritage Month – transforming diabetes care for patients in southwest London

When I started medical school at St George’s, University of London, I had no clear vision of where my career would lead. In fact, medicine was not originally part of the plan – I was expected to become an accountant before deciding to forge a different path.

Born and raised in west London by Indian parents, I studied locally before enrolling at St George’s. After completing my medical degree and early training rotations in southwest London, I entered specialist training in diabetes and endocrinology. At the time, my career trajectory seemed relatively conventional.

That changed when I was encouraged to apply for one of the first Darzi fellowships. It introduced me to a different side of healthcare: how systems work, how services are designed and how change happens across organisations. Working across hospital and primary care, I quickly realised that improving care depends not only on clinical expertise, but also on relationships, leadership and persistence.

It was also my first experience of professional setback. While I was passionate about driving improvements in diabetes care, I discovered that convincing organisations to work differently was rarely straightforward. Yet those early lessons proved invaluable and laid the foundations for much of what followed.

After gaining dual accreditation in general medicine and diabetes and endocrinology, I joined St George’s Hospital as a consultant in 2010. Over time, my role has evolved in response to changing patient needs, workforce challenges and opportunities to improve services. Today, my work spans acute medicine, specialist diabetes and endocrinology services, and integrated community care. One of the most rewarding aspects of my career has been helping to bring care closer to patients.

Working alongside primary care colleagues, I helped develop a community diabetes service that now delivers multidisciplinary team (MDT) clinics across the borough. We also run regular virtual MDT discussions for complex patients, supporting joined-up care between primary and secondary care teams. Alongside this, I continue to contribute to acute medicine through on-call work, same day emergency care and ward cover, while leading specialist clinics and a weekly diabetes foot MDT.

More recently, I was appointed secondary care clinical lead for diabetes and healthy weight across southwest London. This role reflects something I have become increasingly passionate about throughout my career: breaking down the traditional barriers between hospital services and the communities they serve.

Managing long-term conditions such as diabetes requires seamless care across organisational boundaries. As part of the integrated care system, I work with colleagues from across the region to improve outcomes, reduce variation and tackle health inequalities. The focus is twofold: ensuring people can access high-quality, evidence-based diabetes care wherever they live, while also addressing the factors that contribute to obesity and metabolic disease.

This work has included expanding access to prevention programmes, structured education and digital monitoring technologies, developing weight management pathways and community interventions, and helping to implement new NICE guidance so that more people living with type 1 diabetes can benefit from hybrid closed-loop insulin pump therapy.

It has also highlighted the realities of system leadership. Progress often depends on factors beyond our control, including political priorities, funding decisions and wider changes in the NHS. Balancing innovation with these challenges remains one of the most difficult – and important – aspects of the role.

Reflecting on my journey, I am conscious that many of the opportunities I have experienced did not exist as defined career pathways when I was training. Much of what I do today has developed through a combination of curiosity, circumstance and a willingness to step beyond traditional clinical roles. 

As healthcare continues to evolve, future physicians will need new skills alongside clinical expertise. Understanding digital transformation, population health, prevention and system leadership will become increasingly important. The RCP has an important role to play in helping shape training that prepares doctors for these emerging opportunities and challenges. 

My own journey, from west London medical student to consultant physician and system leader, has shown me that careers are rarely linear. Sometimes the most rewarding roles are the ones that are not advertised but created through recognising a need and being prepared to help meet it. 

Dr Roni Saha is a consultant in acute medicine, diabetes and endocrinology at St George's Hospital, London, and secondary care clinical lead for diabetes and healthy weight across southwest London.