Trailblazer GP Blogs

Health Inequalities

21st December 2018

This was a great introductory session to Health Inequalities and the research and theories behind some of the great work that is done in Deep End GP practices across the country.

We started by discussing the social determinants of health, and how it is harder to be healthy when someone lives in a deprived area, with fewer resources and more social challenges throughout life. These might include living conditions, financial security, employment conditions, social exclusion, gender, early child development, addiction, family support, and many other factors. We looked at Maslow’s hierarchy of need, and also at the difference between equity and equality.

We discussed the politico-social determinants of health as well – the Inverse Care Law and the importance of the GP’s role as an advocate for patients who are suffering due to social conditions and exclusion.

As it was the session before Christmas, Rachel had us playing a game of Health Inequalities Pictionary Team Relay – I can’t really describe this but it was an absolutely inspired idea!

The session reinforced to me that as GPs we have a unique opportunity to advocate for these patients and to strive to provide the right sort of care to patients whose health is adversely affected by social factors. Hospital colleagues do not have the continuity of care or the link to community organisations that it is possible to develop as a GP, and by working specifically in one community as we do GPs, we can develop community links that will affect the health outcomes of our patients in the long term, through social means rather than medical.

I don’t think at any point through medical training did we have such a clear lecture or seminar on the social determinants of health – this session really made me think about our goal as doctors – we need to treat medical conditions as they arise but when such huge disparities exist in rates of disease between the richest and poorest in society, it makes far more sense to reduce these inequalities so that a huge proportion of health problems do not occur in the first place. Prevention is always better than cure – we should be encouraging policymakers to look at the facts and to make policies for health and social care which address this enormously important issue.  

However you could take this to mean that all doctors should give up and go into politics or public health – I don’t think that! By treating patients and getting to know our local populations, we can gather our own evidence of what social policies do to health outcomes. And by being aware of this, we can tailor our treatment to the individual patient and communities, so that we can influence change this way as well as advocating on a national level or through organisations that we support (e.g. the RCGP has some activity on the subject of health inequality).

I found this session incredibly useful and inspiring – and I would encourage anybody who is interested to know further to look at the learning modules on the Fairhealth website as they cover a lot of this material very concisely. Unfortunately you can’t play “Health Inequalities Pictionary Team Relay” on the website, but I would encourage Rachel to make this game commercially available one day…

Dr Helen Barclay

Location: The Hepworth, Wakefield

Session facilitator: Rachel Steen

Trailblazer GP Blogs

Effective Meetings

This was a useful day as meetings and involvement in meetings is something I feel I can struggle with and find participation in meetings is not something which comes naturally to me.

As my career progresses I am more likely to have an increased involvement in meeting/teaching and so this day gave helpful pointers in how to make meetings more valuable.

Key learning points:

– Consider place – tidy/clean environment, maybe drinks/food and be well prepared. This will make people feel more valued and more likely to engage

– Attention – the attention you pay to someone in aim to enhance there thinking (demonstrated and practiced in thinking pairs, while listening paying attention to content, response, environment. Not interjecting often, remain more neutral, allowing silences)

– Equality – aiming to allow everyone to have there say/give their ideas. Especially when chairing asking those are not as involved what they think (ok for them to agree with previous points/have no different thoughts)

– Issues to questions – think what’s the issue, what is the outcome wanted and what is the question, that if we could answer it, would get us closest to our outcome. Have an agenda of questions, this will help people have ideas on solutions.

– Send details around the agenda questions out in advance so the details do not need discussing in detail first

– Giving a minute for people to jot down their thoughts on the question before starting the discussion I found was helpful to structure discussions and responses.

– Consider using rounds – everyone getting a chance to discuss, then asking next person what they think. Can go around again after initial thoughts if this has changed any opinions or prompted new points

– Thinking council; presenter presents issue, then questions to clarify questions, then in a round everyone gets a change to respond to the question, no interruptions

– Appreciation – should do this more in general, and in meetings. Sincere, succinct, specific

Following on from this teaching I have had opportunity to put this teaching into practice. I organised and run a mental health MDT meeting with secondary care and IAPT to discuss difficult mental health cases which we were not sure needed referral or how to manage best.

I found this intimidating, but the above knowledge helped me greatly in structuring the meeting and making it run smoothly
In particular, sending out information in advance and ensuring the cases we were discussing had specific questions to answer was very beneficial.

I didn’t formally use rounds in the discussion, but I more actively tried to involve everyone in the discussions and give good attention to all

I also ensured I was familiar with the room being used and that tea and biscuits were available (although the take up for these was surprisingly poor!)

My confidence in running meetings have developed greatly, this is something that I still find less natural and less comfortable with, but the above learning has really helped and I will be using further in future.

Dr Sam Wild

Date of teaching 23rd November 2018