Trailblazer GP Blogs

Prison Medicine

Fascilitated By Spectrum, Wakefield 12th July 2019

prison pic.png

Spectrum community health comprises of:- 

  • prison healthcare
  • Sexual health
  • Community substance misuse 

Spectrum background:- 

  • Previously run by PCT
  • Runs up to north Tyneside down to Barnsley
  • UK registered charity – spectrum people
  • multiple partnerships all across north west – 
  • Good values based culture

Prison categories:- 

  • Range from Cat A to Cat D 
  • Cat A is closed, high risk crimes
  • Cat D is open low risk
  • Others in between 

Constraints of Prison

  • operational (medication timing, differences)
  • Access (so many other priorities eg. Education /work (even though low pay))
  • Other priorities (eg. Legal visits can take priority for some patients in cat A particularly or visits from family and gym is very important)
  • Security 
  • Escorts (some prisoners may need 6 officers before even opening the door, and going to hospital appt)
  • Bed watches (need 2 officers, therefore need to keep prison safe- staffing) 
  • Transfers
  • Prescribing (more acute medicine in cat A eg. Pcm overdose/ drug seeking/ can even manipulate use of nicotine patches)
  • All prisons on system one now
  • Ethical dilemma with prescribing psychoactive substances 
  • Breaking confidentiality with patient to prison officers eg.illicit substances, not allowed on the wings. 
  • Important for MDT approach 


  • Health promotion
  • Self esteem
  • Access to healthcare
  • Continuity
  • Healthy lifestyles

Ethical dilemmas

  • pressure to reduce hospital admission (due to the number of the staff it would require to do so) 
  • Confidentiality
  • Prescribing for pain vs substance misuse 
  • Every death in custody goes to coroner 
  • So many implications from actions 
  • Need good record keeping 
  • Some only have 7am-7pm health care cover 

Healthcare in prisons consist of:- 

  • Primary care providers
  • Substance misuse
  • Secondary care mental health eg. Psych ,palliative care
  • National Shortage of prison medicine drs
  • Can compromise services too 

Forensic psych beds

  • Difficult to issue
  • Hard to move those with severe psychosis for example to a forensic psych bed
  • Big pressure on the system and normally the pt is on a segregation unit not suitable


  • Morning urgent triage from 8am, then an evening triage 
  • Still have clinics and a waiting room, majority are consulted 1:1 (without police) 
  • 95% men 5% female in prison
    • women more smaller group and can be difficult behaviours 

Safeguarding in the secure environment 


  • Drug use in women is double the percentage of the number of female prisoners than the Male
  • This is most likely due to childhood traumas in women
  • Women are normally controlled with their drug use whereas men more likely to be independent and do drugs with their male peers
  • Also perinatal health/Street sex workers/pregnancy
  • Sometimes can keep baby on a mother and child unit 
  • Also mixed categories due to small number of women harder to keep all categories separate

Adult at risk vulnerable prisoner 

  • learning disabilities
  • Elderly/dementia/alcohol induced 
  • Poor access for wheelchair uses due to older facilities
  • Increasing age in prison due to historical crimes 
  • Elderly in prison >50 (as the prison process can add 10-15years)
  • Each year spent in prison can reduce the life expectancy by 2 years for every year spent

Learning disabilities

  • 7% of prisoners have learning disabilities compared to 2% of the general population
  • There’s no specialised provision in prisons 
  • 36% have a physical or mental disability
  • Literacy skills similar to 11 years old 

Other safeguarding:- 

  • Substance misuse
    • majority opiate use 
    • Spice use makes people more vulnerable 
    • High number of physical abuse/sexual abuse
  • Mate crime:- form of grooming 
  • Institutional abuse- just overall poor practices and behaviours of the team
  • important not to be judgemental
  • Unexplained injuries – just report through security systems 
  • Refer through safer custody department rather than adult social care
  • Complex cases can be sought from the local safeguarding board

Self harm

  • seen a lot in personality disorder
  • 87 suicides in 2018
  • Ingestion of batteries (problems as battery vapes) 

Concerns about children

  • Male a disclosure about children on the outside

Personality disorders

  • Around 50% prisoners/offenders 
  • Problematic/persistent/pervasive 
  • Normally onset’s in adolescence, with issues around attachment and security 
  • Borderline commonly seen with unstable relationships
  • Paranoid PD linked to offending, easily provoked into feeling unfairly treated and attacked
  • Obsessive compulsive struggle more in prison given lack of control 

Trade-able medications 

  • Understanding pain 
  • Use the acronym PADABIT for reviewing records 


  • Use prison formulary- can be slightly different mental health and pain medication
  • Try to give longer acting preps, need an ECG, don’t use liquids. 
  • Mirtazipine – Suicide risk 10x higher than ssri
    • the sedative effect wears off after a few weeks 
    • Buscopan- psychoactive if smoked 
  • Venlafaxine- give a high like amphetamine
  • Opiate- good to write morphine equivalent 
    • not effective for chronic pain 
    • Be objective eg. If hip pain stopping you from up the stairs, with the morphine now you should get up the stairs
    • Unlikely to respond to different opiates 

Managing intoxication

  • Alcohol, do breathalyse and can tell the level, can speak to hepatology if concerned, lactulose use
  • Spice, cannabinoid agonist, sprayed onto letters normally, normally smoked. Increases risk of serotonin syndrome , long term use can cause withdrawal.
  • Opiate overdose can affect 45% of opiate users 
  • Naloxone given to pt, being used a lot to reduce overdose. 
  • Methadone/buprenorphine/suboxone
  • Depot injection of buvidal- steady dose, not lots of information on polypharmacy, going into hospitals and needing further analgesia.
  • Espranor- dissolving wafers of buprenorphine, not easily removed after 15sec.

Preparing for Coroner’s court

  • Palliative care don’t need jury 
  • Good report, get indemnifier to read it
  • Full name, qualifications (bachelor of medicine not MB) status (GP for 1 year salaried)
  • Factual account, explain medical terminology, seen alone, nhs reason, report should be standalone, wrote in first person and be specific, don’t just quote what the pt said, interpretation of your examination into context, say what you found and what you failed to find. But explain why you didn’t do it. 
  • If you cannot recall the case, then state what your usual or normal practice will be. Specify what you can remember from memory.
  • Read the records prior, know your report, speak to mps, 
  • Remember confidentiality, confirmation
  • “I don’t recall this can I review?”
  • Can watch on YouTube cross examination 
  • Ask for clarification 
  • MDU website

Blog by Dr Saira Khan

Trailblazer GP Blogs

Migrant health at Bevan

3rd May 2019

Migrant Health – session by Dr Andrew Lephard, GP at Bevan Healthcare.

This week we had a session on Migrant Health by Andy Lephard, a senior GP at Bevan Healthcare who has been working in this sector for over 10 years and has often done teaching sessions on this subject due to his experience of this type of general practice.

Andy talked about the different ways that people can arrive in the UK – through refugee resettlement programmes, asylum seeking, being trafficked into the country. He told us about the asylum process and where patients tend to struggle – and why. They go through an initial interview, then later on a substantive interview which can last many hours. Then they receive a decision about their asylum application (it can take many months, although is only supposed to be a maximum of 6 months), and at that point they have 28 days to get themselves sorted with “normal” benefits and amenities (housing, universal credit, bank account etc) before their asylum support is stopped. Many people hit a crisis at this point as they may still not speak English and may have mental health problems, not know the area and not be in a good place psychologically or financially to get all these things sorted. Housing takes money and time – after living on asylum seeker benefits of £35 per week it is going to be quite hard to afford a deposit.

Asylum seekers are usually not allowed to work and are given approx. £35 per week to live with. Their accommodation and heating/bills are paid for but are often in areas of the country with low rents and the standard of accommodation is often low. They are moved around the country with little notice and have to sign in frequently at the home office so are not free to move around. During the process of travelling from their home country, many families are separated. Once someone has been accepted as refugee they have the right to family reunion (1st degree family members only and there are some stipulations) so many families might consider sending only one family member (paying to get across the world is expensive) and then reunite later. However also in other cases families may get shipped to different countries and some be claiming asylum in different parts of the world. Andy talked about the effects this has on people and the frustration and powerlessness that seems prevalent in many people stuck in this situation. The feeling that they have escaped the danger but life is harder than it used to be. 

We learned about VPRS and GPP refugee resettlement schemes – a lot of people at Bevan have arrived through these means and they run new arrivals clinics for these people to discuss immunisations, general check ups and to introduce people to UK healthcare systems. These people do not have to go through the asylum system as they are already accepted as refugees. They are supported fully for a year after arrival and the difference in the way they are treated compared to asylum seekers who have arrived in the UK off their own back is quite huge. 

People arriving on the VPRS (vulnerable person refugee scheme) will have come from UN refugee camps and be identified as particularly vulnerable – often with children who have serious health conditions that cannot be managed in a refugee camp. The GPP scheme is similar but is for any refugee from certain conflicts only, and they do not have to be particularly vulnerable. It does make the mind boggle a bit to wonder just how people would be chosen for these schemes, given the millions of people across the world still stuck in refugee camps. 

After this session I felt that I understood these common migration methods much better and understood more about how healthcare needs to adapt to fit the difficulties that people in this situation can experience. Particularly mental health and orientation to the NHS. It stressed the importance of knowledge of charities that can help support people in need, and of non-medical support services (e.g. social prescribing) in helping new arrivals to integrate into their new local community. 

Dr Helen Barclay

Trailblazer GP Blogs

Trauma Informed Care

Session by Jonathan Tomlinson

Blog post by Dr Katie Burgass


Trauma is an issue that has been raised at many of the sessions we have covered through

the Trailblazer scheme so it was extremely useful to have a session solely focussed on this


We started by discussing examples of complex and difficult to manage patients we have

encountered, those that can present with many and often difficult to explain medical

symptoms. Jonathon spoke about how he had identified common problems between these

patients such as pain, fatigue, IBS, palpitations, dyspnoea, dyspepsia and incontinence.

These symptoms all are associated with sympathetic (arousal) or parasympathetic

(reduction) activity.

We discussed the theory of “Hypervigilance”. The limbic system (that controls our emotion,

motivation, learning and memory) is linked to the brainstem which controls the vagus nerve

in charge of our parasympathetic and sympathetic drives. If there is trauma in early life,

people often struggle with self-regulation between “arousal” and “reduction” states. As a

result they can develop symptoms through the parasympathetic or sympathetic drive, that

could therefore be interpreted as symptoms of undischarged traumatic stress. In addition to

this the limbic system and brainstem have no link to the prefrontal lobe (involved in

decision making, planning and behaviour) so any actions coming from it are reflexes. The

patient has no control over these symptoms.

Patients suffering with symptoms of hypervigilance often use methods that result in

dissociation and disconnection to try and regain a level of control. Examples are self-

harming, using drugs or isolating themselves. It is also worth noting the impact of trauma

can be variable between different individuals. Trauma is the symptom, not the event.

We also discussed the impact of childhood trauma as well as resulting in physical and

mental health difficulties, can often result in shame. “Unlike guilt which is the fear of doing

something wrong, shame is the guilt of feeling you are a bad person”. This can be crippling

to a person.

So how best to approach a consultation if you feel someone has suffered from this in the

past? And when you have, where do you go next with it? Recovery is all about reconnection.

The 5 areas Jonathon suggested focussing on were:

1. Relationships – building a meaningful connection with another human being, this

could be done using social prescribers to access voluntary or support groups.

2. Biology – encouraging healthy behaviours, addressing diet and weight, smoking

cessation and drug use, rationalisation of medications.

3. Body – encouraging physical and mental exercise, creative activities, using outdoor

spaces and connecting with nature.

4. Mind – dealing with emotions, accessing support through talking therapies and

mental health teams

5. Social security – without this 5 th element it is very difficult to start addressing the

other 4. Having financial security and appropriate, safe accommodation is a priority.

Once someone feels secure in the environment can they start addressing changes

within themselves.

As doctors we often strive to find the “science” behind our patients presentations, so

hearing a theory around the impact of trauma on physical health based within a

neuroscientific context was extremely interesting.

Practical tips I picked up from the session:

– Look at the problems list and consolidate.

– Acknowledge when things have become chronic. Looks for symptoms of

“hypervigilance” as explained above.

– If you feel a patient may have suffered from trauma in the past allow time to build

rapport and a relationship before addressing this. “Where do you think your anxiety

comes from?” is often a helpful question to ask as an opener.

– Acknowledge the cause of the symptoms, this will empower patients.

– Look at the 5 areas to be focussed on for recovery. Make a plan together, addressing

things at a pace the patient in comfortable with.

– Make a crisis plan for if things were to go wrong, involve family / friends and other

professionals. Focus on triggers and coping mechanisms as well as sources of

support. Write the plan down. Review it after each crisis. Don’t change medication

during a crisis.

There are many patients I encounter at work that I am sure have experienced trauma in

their past. I now feel more equipped to address this with them, the difficulty, as always in

general practice, is finding adequate amounts of time and space to spend with these

vulnerable patients within the busy day.

Trailblazer GP Blogs

Action Learning Sets and Professional Coaching

There were some incredible opportunities to connect with other like-minded GP’s on an action learning set. It allowed some thinking time to explore problematic areas of practice within our new jobs at newly qualified GP’s and solve ‘wicked’ issues, where the concept of the problem is often difficult to comprehend and understand and the answers often lie in nuanced collective agreement rather than reactionary approaches. The theory is that this approach by sharing problems with like-minded peers with similar professional experience is more likely to result in making meaningful behavioural change and positive action. My session of coaching was almost a well-earned and useful time for reflection on the path I was headed in my early stages as GP.


The Action learning set in Sheffield really provided me with the head space to reflect on my learning as a newly qualified GP. Other GP’s who attended brought other difficulties they were having in practice. These included inter-professional difficulties with the managing partner, perceived workload inequity, payscale differences with another newly qualified GP who had negotiated a higher wage, difficulties in considering how to request more admin time to perform a job description and how to deal with the feeling of not being able to meet the demands of the administrative side of the job with the time made available to do so. I left feeling more able to understand the common difficulties we all face as newly qualified practitioners working in a primary care system under strain from under-funding and from being over-subscribed. I also felt the comfort in understanding the problems others face on a daily basis and how we were able to tackle these as a collective has changed my practice in the way that I am now committed to using this learning style to help solve future ‘wicked’ problems, or tease out problems that I find it difficult to articulate. I will also be able to apply this method of problem solving when working within practice teams and partnerships to work more collaboratively and achieve greater shared understanding.

My coaching session was nothing short of a revelation as it provided insight into my career that I had never really had before. The beauty of the coaching was that little advice was actually offered and in the two hours offered of self reflection and learning I was able to address some of the nagging issues that had previously been concerning me. This was mainly in relation to the feeling I had of inertia within my early career and that I hadn’t set the ‘new’ challenge.

My coaching allowed me to identify what I was feeling was a lack of validation in my new job and a lack of openness with my new practice management team as to how I was settling in and what opportunities I might be able to get involved with. I quickly made assertions to make contact with my mentor to make a mid-year progress meeting to ascertain how the practice thought I was doing (it was better than I thought!) and also to ascertain what opportunities the practice may hold in store for me and my scope of experience. This has taught me the importance personally of ensuring I not only consider my own performance, but I obtain the feedback of others as to how I am getting on to obtain some kind of objective measure which in turn helps drive motivation. As a potential future employer, this is something I have really taken on board and it will change my practice of giving regular feedback to others in my team.

Dr Mathew Fortnam (Trailblazer 2018/19)

Trailblazer GP Blogs


Session ran by Dr Lucy Chiddick, Leeds

May 3rd 2019

This was a morning session with Lucy Chiddick (Health Inequalities lead in Hull CCG). I have found commissioning an intimidating topic which I find difficult to understand. The session was valuable in demystifying this topic and giving practical examples of how new ideas and changes can be made (the example used being the pathways project in Hull)

Below are my notes and key learning points from the session

– Changes in structures common and confusing for everyone! Currently CCGs – commissioning and provider arms (wide spectrum of community services). Regarding commissioning more collaboration (health sector, local authority, mental health), over bigger area, was STPs then healthcare partnerships now ICS (integrated commissioning systems)

– Population health – aim to target services to specific populations

– GP networks developing – practices with similar populations and needs – more likely to know what intervention will help for that population (30 to 50 thousand in total). Mentioned in GP forward view (developing workforce, working at scale, networks). Long term plan pushed forward networks (and now in new GP contract)

– Translating ideas into practice can be tricky

– GP contract/NHS plan; bringing more secondary care into the community (ca, resp, MH, stroke, CHD), workforce and diversifying workforce (inc looking after staff), IT, Indemnity, QOF changing. ??how to measure health inequality

– GPs in CCGs – read papers, advocate (eg for vulnerable groups) – comment on specs for stuff coming in (but ?not really changing or adding new things)

– Working in CCGs – build relationships with people and get people on side. Look everywhere for funding, along with the political climate. Also new roles can be created eg health inequalities lead. Example being pathways and resources and services for homeless people. Homeless strategy 2018 from gov helped as was in political view at that time, persuading people that this was a good idea, putting healthcare for homeless in the housing strategy for the city, need to make business case and finance – ask business analysis people for stats.

– Practicalities of this work – self directed and set own agenda. time management important (freedom to get to meet people and know what is happening). Different work to clinical – goal is long term – changes take long time

– Things to consider, does the PCN need sub-clinical lead eg in health inequality.

How the above has developed my understanding of commissioning – the most important part for me was demystifying this topic – knowing the structures are changing and confusing even to those involved makes it less intimidating – it would take time for anyone to understand when working in these roles. The change to Primary care networks is something I had heard about, but it is more clear now.

This has given me more confidence on how I could be involved if an opportunity came up to have some involvement (before I would feel under-qualified and intimidated by this area, but I do have experience and skills coming from my practice and also the teaching I have been having on Fridays)

Dr Sam Wild

Trailblazer GP Blogs

New Wortley Community Centre and Practice visit

Learning points: The day encompassed a practice visit to New Wortley, a deprived region in South East Leeds, which bordered Armley to the West, and Holbeck to the East. The work of the former GP partner, Dr Andy Sixsmith had focused on the importance of the GP practice in the community, as a safe place to go to obtain advice, help and treatment. With funding obtained, a new community centre was built next to the medical practice with the idea that residents of the community could benefit from the symbiotic relationship between the GP practice and the community centre, with the sense that if the overall wellbeing of the community could be improved, this would have a positive impact on the health of the community as a whole and thus even reduce GP attendance and workload. The notion of the popularity of social prescribing is a newer construct, but in reality, attempts like these to connect health to the heartbeat of the community have been commonplace in pockets of the country for a number of years. We first met the community link worker and social worker, who helped staff the community centre, and John Battle, a retired MP for Armley who ran the men’s walking club, a permanent Friday fixture for men suffering mental health problems or isolation. This then led to meeting the practice community link worker and the PEP worker (Patient empowerment Project) who worked for the local practice federation as a type of social prescriber. These highlighted the large scope of her work for those requiring extra support with finance, housing or mental wellbeing, with 90 minute appointments and two follow up appointments being offered. We also met two members off the executive board from Community Links, a mental health charity commission by the CCG with a brief of providing support via social prescribing, who are now opening wellbeing cafés as a drop in service for people experiencing mental health problems to talk about their problems. The day as a whole was a really rewarding experience, and demonstrated the power and importance of community activation within a patient population to help improve long term health outcomes.


Reflection The impact of the day shaped my thinking of how in the future I would like to be involved in shaping services to reflect meaningful wellbeing provision to the local community. It built on my previous meetings with social prescribing hubs to realise the importance of not just working with supplementary services, but utilising them within teams. At future practice meetings and pending involvement at partnership level, my vision would be one of utilising link workers directly employed by a practice group or federation to cover a patient population, rather than as a separate organisation. The day also invigorated my sense of serving a local population as a community practitioner and allowed me to think of ways I could do something on a local level – for instance, setting up walking groups. Following the day, I have signposted more patients to social prescribing groups and projects than I previously had done in the past so I think the day has impacted my practice and will continue to do so.

Date of visit- 5th April 2019

Dr Mathew Fortnam

Trailblazer GP Blogs

Social Prescribing Visit- Connect Well

Learning points As part of my trailblazer role, I met with the local operations manager of the local social prescribing service, Connect Well. The purpose of the meeting was to forge a good working relationship which may benefit us mutually in the future. This would hopefully improve my understanding and knowledge of the service and also to help inform the service of potential areas for service improvement regarding increasing their visibility in primary care and maximising utility. I learnt primarily about the scope of the service locally which enabled me to consider how I may be able to incorporate their service into my management. I commonly encounter patients where medical problems exist, but their overriding difficulties may well be based within a social problem or context.

From experience trying to separate interpersonal and social problems from a patient’s presentation is rarely productive and I increasingly viewing patients through a different lens of establishing their presentation on a continuum of wellbeing  and fulfilment and explaining their routes to recovery, rather than focusing on curative outcomes. I learnt specifically that the service not only exists to help patients with difficulties with housing, finances, benefits and support but provides a holistic service to help patients with specific interests and to engage them back into social interaction to improve their mental wellbeing. Specific examples included tailored groups which were available in the Hull area, such as Andy’s Man Club, a group for men with mental health problems to meet once a week and share stories to gain collective strength, or Men in Sheds, a group for isolated males who want to reconnect and learn new skills, walking groups, park runs, new mum groups, breastfeeding support, community centres, voluntary groups to help people back into work, groups tailored to particular ethnic minorities to find friends and support and lots more.

We then talked about how me may be able to help improve the utilisation of the service with the consideration of how to increase referral rates when GP time is pressed.

I agreed that i would help organise educational meetings at the practice to widen the knowledge base and understanding of the service, whilst I have also help organise the team to perform sessions for the local VTS scheme to increase understanding of the registrars of the services the social prescribing team offer and how to access their services.

Reflection The meeting has not only reinforced my knowledge and understanding of the positive benefits of social prescribing but has allowed me to think about patient care in a different way and I have since been more open in talking about the possible options for patients which don’t necessarily involve medical investigation or treatment. Recently I have been able to signpost myself to some of the above services and groups but I also was able to refer a patient to the service who was increasingly lonely and nervous about getting out of the house unaccompanied. We were able to sort a visiting service which meant he could go for a walk with a regular visitor and have a friendly chat over a coffee which really improved his symptoms of anxiety.

Date of visit: 22 March 2019
Dr Mathew Fortnam

Trailblazer GP Blogs

Social Prescribing Visit

Bassetlaw Community and Voluntary Services

I met with Allison Palmer, the partnership officer and one of the community advisors at Bassetlaw Community and Voluntary Services (BCVS). She told me about the service that had been running for the last 45 years and was seen as a “hub” for voluntary services in the local area. In the last 3-4 years they have developed the social prescribing and community advisor roles with funding from the Bassetlaw CCG.

The social prescribing role is for those aged 65 years and over that are felt to need  more social input, most commonly due to loneliness and lack of community involvement. They are required to be referred by healthcare professionals and start with an initial 2 hour visit at home where their needs are assessed. Following this they are supported for 12 weeks in accessing the services they have been signposted to, they are given transport costs and chaperoned for their first 1-2 visits to help build confidence. They are then followed up 12 weeks after the input has ended and assessed in terms of ongoing engagement but also impact on GP/A&E attendances. On evaluation 2/3rds of those who have gone through the program have remained engaged with the services they were encouraged to attend.

In contrast the community advisor role is for anyone under the age of 65 years and can accept self-referrals. They can do assessments on the phone or meet for a face to face appointment and run a morning drop in session at a number of our surgeries. They are mostly involved in signposting to groups but can help make the initial email / phone call to encourage engagement. The level of support isn’t as great as the social prescribing group but they feel the age cut off will drop due to the governments new 10 year plan.

BCVS also runs Bassetlaw health, a website with information on 75 voluntary sector groups in the local area. They monitor which subjects are searched for to tailor the service to the community’s needs.

A few weeks after my initial trip to BCVS I attended 2 visits with Sarah, one of the social prescribers, to see how they performed their initial assessments. She enquired about subjects such as mental and physical health, finances, social support and engagement and safety in the home. During the two visits she was able to offer a wide range of different support recommendations including bereavement counselling, a car service, support with benefits, gym membership, silver line (a telephone service for older people) and a support group for those with reduced vision. It was really helpful to accompany a visit and see the broad range of services that could be offered. 

I found it really useful going to speak to Allison and her team about what BCVS do. I have often given out the leaflet for using the community advisor service for patients but often wondered whether they would actually engage with the service. Now I know more about it I feel I could “sell” the service better to patients. I wasn’t aware of the social prescribing or Bassetlaw health website which are two really useful resources I will definitely use within practice. It was also interesting comparing what services we have here to those in other areas e.g. the Hope Citadel Focussed care workers. Alison discussed her vision of integrating a well-being centre into the hospital to try and engage those requiring help at secondary care level also which I thought was a brilliant idea.

I presented this information to the Trailblazers at a later session where we discussed and compared the different ranges of social prescribing that was available in out different areas. It was interesting comparing what was available and there was significant variation in who was able to access what depending on where you lived. We discussed the importance of linking the voluntary sector with the health sector as it is often the communication channels that are lacking, and how the new primary care networks may be able to help with this in the future.

Date of visit: 15th March 2019

Dr Katie Burgass

Trailblazer GP Blogs

Hope Citadel Visit – Hill Top Surgery

I found our visit to Hope Citadel very inspiring. We met with Dr James Matheson, Dr Jon Patterson, 2 of the GPs working within the practice, and Dr Laura Neilson the CEO of the group (who had initially set up the foundation as a medical student) along with Lisa, a focussed care worker. They shared their experiences of how they set up the group and how they approached and developed their ideas about caring for patients in a very deprived setting. We also discussed the role of the focused care worker, the difference in their role between a social prescriber/community advisor and the impact they have had on patients in the practice. We learnt about the Manchester GP training scheme and how they are integrating opportunities to learn about health inequalities into training from medical school to post CCT. We were also treated to some delicious home-made soup for lunch, made from the produce from the practice’s vegetable garden that is run by their patients.

It was really helpful to speak to Lisa, the focussed care worker, about her job. Having watched “Frontline Care: Saving the NHS?” a program shown earlier in the year on ITV covering what work they do, and having heard about their role at the Health Inequalities conference in Glasgow, it was interesting to hear about practical aspects of how the role works such as what training they have and how they are supported. There seems to be a  number of advantages of this role compared to the role of a social prescriber. Social prescribing seems very concentrated on supporting through signposting whereas focussed care seems to have the scope to go one step further than this e.g. taking patients to appointments, filling in forms, organising transport, attending and running community projects within the practice for patients to get involved in. I can think of many patients I see in surgery with complex physical and social problems that I feel could benefit from a member like this in the practice team.

The discussion from the GPs who had developed the group was also very interesting. Having heard Laura speak at a Next Generation GP lecture previously I was aware of the amazing story of how they started and developed. We learnt more about the difficulties they had faced and how they had approached tackling them. Focussing on the right staff in the practice seemed critical. They demonstrated an increase in smear uptake by 50% over 5 years through improving access to appointments, ensuring all members of clinical staff were trained in smears and the encouragement of opportunistic smears. We have a lower percentage uptake of screening in our more deprived branch surgeries and the discussion offered some interesting ideas as how we could approach this as a practice that I will feed back.

Date of visit – 22nd February 2019

Dr Katie Burgass

Trailblazer GP Blogs

The Exceptional Potential of General Practice Conference- Glasgow- 14-15th February 2019- Dr Helen Barclay

This conference had a collection of truly inspiring speakers and I learned a lot. I’m not sure that this is reflected in the notes I made, as I was often too engrossed to really write down that much – but below are the things that I did jot down about the two days. The first day was more theoretical, talking about the potential of GP to effect change, and also about the life and work of Julian Tudor-Hart, who was a dedicated GP to a practice in rural Wales, a very deprived area, and whose work contributed enormously to the body of evidence about health inequalities and about the benefits of continuity of care, and who is most celebrated for his work on the Inverse Care Law.

Day 1 Learning points:

The life of Julian Tudor Hart and his development of GP mixing research and patient care in rural Wales.
The inverse care law is inextricably linked to the marketisation of healthcare.
Deep End GP as an evolving concept and the development of the subspeciality in Glasgow.
The history of socialism in medicine. The development of the NHS and the GP role in shaping it over the last 60 years. Late to agree to it but soon took it on. Partnerships, CCGs, alternative models of GP provision. Encroaching privatisation, marketisation of healthcare, bringing technology into GP.
Talking informally to retired GPs and academic GPs about activism and advocacy, service development and effecting change – focussing on preparing for the future.

Reflections from Day 1:

GPs are uniquely placed to effect change in patients’ lives and improve health and social inequalities.
It is a privilege to do our job and advocating for our patients is essential part of this. Looking to develop practical services is something that actually any GP can do, effecting change is possible if you take the opportunity and just “have a go”, but it’s vital to plan for the future and engage younger generations with this.
I will try to observe patterns in my patients and look for areas that I can improve options available for reducing inequality and improving long term health outcomes (taking inspiration from Julian Tudor Hart’s longitudinal study of CVD risk factors in his community).
This session also cemented for me the importance of continuity, for patient and doctor satisfaction and for clinical efficacy. The doctor-patient relationship can be therapeutic and this is actually a really important aspect, expecially working in inclusion healthcare. Trust is a vital part of this and cannot always be transferred between doctors, it may be personal to the individual doctor.

Learning points from day 2:


The Exceptional Potential of GP Conference day 2 (915am – 430pm) This day focussed on what different areas are doing to try to encourage people to work in deep end GP and to give them ideas on how to improve health inequalities.
Northern Dublin training scheme – Austin O Carroll – the most popular GP training scheme in Ireland. GPs tend to stay in the areas that they trained – so we need more trainers in deprived areas.
Yorkshire – the Trailblazer scheme!
Pioneer scheme in Scotland- more structured development time than in the Trailblazer scheme but it’s also longer – 2 years rather than 1 year. Good feedback.
Govan SHIP – excellent multifaceted project with really good outcomes.
Hilltop Surgery in Oldham – Focussed Care workers and the importance of trying to achieve QOF vs making your patients invisible.
Gent, Belgium – the importance of family medicine the community and looking at community assets e.g playgrounds – huge social effect.
The importance of continuity of care, being alongside our patients rather than above them.

Reflection from day 2:

This day focussed on different approaches to realising the exceptional potential of GP rather than the academic background and was inspiring. As a result I’m hoping to become a GP trainer (in a few years) and I have seen the importance of GP networks in pushing for better services, achieving better outcomes and innovative solutions to problems that you just don’t get in posher areas! Coming together and sharing ideas makes a huge difference and seeing how much has been achieved since I last went to a deep end conference a few years ago is incredible. I left the conference inspired and motivated to make changes wherever I can, and to try to help make a West Yorkshire Deep End group this year to share ideas and meet people doing the same kind of thing as us.

Overall it was a very informative conference, the opportunity to hear experts from so many different areas of excellence was incredible and inspiring, and I have taken home with me a renewed enthusiasm and passion for my work – and a recognition that the way many people can achieve such great results is through making the most of connections, networks, peer support and sharing ideas, so that we can inspire each other to keep our passion for the job and make a difference to our patients.

Dr Helen Barclay