GP Frontline - Issue 17, Spring 2020

M A GA ZI NE O F TH E R CGP  I SSU E 17  SPRIN G 2 0 20

1 | CONTENTS

CONTENTS 06

04 | COVID-19

04 – 05 Special feature on the RCGP response to COVID-19

06 | BIG INTERVIEW

06 – 08 Dr Roger Neighbour gets to the heart of the consultation

09 | NEWS 09

From survival to success: one surgery’s experience

11

Trialling the trainee portfolio

12 – 13 The GPs championing general practice early and later in their careers 15

Strong argument for specialist status

17 | OPINION 17

GPs and the smacking debate

18 | CLINICAL MATTERS 18

The map to cancer diagnosis

19 | GP LIVES

09

19 – 23 The champion of the homeless; A role model for black women GPs; The author whose recipes are reversing diabetes and The 47-year-old trainee!

24 | BACK PAGE 24

Access the COVID-19 Resource Hub

Staff Editors: Daniel Openshaw, Gillian Watson Reporters: Kristy Ebanks, Amy Boreham, Emily Brewer, Emma Wilkinson

Clinical Editors: Professor Martin Marshall, Dr Jake Hard; Professor Mike Holmes, Dr Jonathan Leach, Dr Steve Mowle, Dr Michael Mullholland; Dr Richard Roope Cover cartoon: Martin Rowson

Inside cartoon: Kipper Williams Design: Aura Creative Ltd

17 02 | CONTENTS

Feedback: Can be emailed to gpfrontline@rcgp.org.uk or tweeted using #gpfrontline. You can also write to us at GP Frontline, 30 Euston Square, London NW1 2FB

CHAIR’S WELCOME This certainly is not the column I was expecting to write for my first edition of GP Frontline as RCGP Chair. I planned to write about tackling workforce pressures and ‘undoable’ workload in general practice, and reinvigorating relationship-based care - my policy priorities during my tenure. But general practice, the wider NHS and indeed the whole of UK society is changing exponentially in a very short space of time as a result of the COVID crisis.

What hasn’t changed is the dedication of GPs and their teams to do their best for patients and we should all feel proud of our speciality but not surprised by how we have adapted so quickly and risen to the challenge of COVID-19. This health crisis will shape our generation and GPs are in the forefront of these changes – not only those of you currently practising, but the many retired GPs who are returning to help with the effort and the trainees who are plunging in at the deep end.

The College is here to support you.

We have developed practical resources to help you in your surgeries, for example, guidance on telephone triage, which will be new to many at this scale. We are lobbying on your behalf to Government and decision-makers both through the media and behind closed doors on issues such as PPE and testing for healthcare workers. We have produced a dedicated COVID-19 resource hub full of top tips, CPD and guidance to help you navigate these challenging times. We are supporting general practice-based research in order to find solutions to the pandemic.

The College, the profession, your patients and your communities need you, now more than ever.

Thank you for everything you are doing in these worrying times.

Martin Marshall

The College's new 'tech roadmap' highlights the ‘digital divide’ between urban and rural GP practices in their access to ultra-fast broadband in GP surgeries – and what needs to be done to avoid practices and patients being

left behind, wherever they are located.

Analysis shows that approximately 50% of practices across the UK currently have access to ultra-fast broadband (>=300Mbs).

However, of these practices, only 12% are rural.

NEW LGBT CARE RESOURCES The College, in partnership with the Government Equalities Office, has launched its first ever e-learning modules for GPs delivering care to Lesbian, Gay, Bisexual and Trans (LBGT) patients. The six new online modules aim to support further understanding of LGBT patients’ health

requirements and improve consultation experiences and outcomes.

Available on the RCGP website the resources also include screencasts and podcasts. All the new modules are fully referenced to additional learning for GPs who want to find out more.

COLLEGE ACTION ON COVID-19 The COVID-19 pandemic is the greatest challenge the NHS has ever faced, and GPs are at the front line of dealing with the crisis. The RCGP acted quickly to support members by assembling a group of emergency preparedness experts, including representatives from the BMA and Royal

College of Nursing, to oversee this vital work. Read more about the College’s lobbying and media work around COVID-19 – and the resources we have developed for primary care on p4-5; and for details of how to access our COVID-19 resource hub, see this edition’s back page.

COLLEGE RETAINS POSITION ON ASSISTED DYING The College will continue to oppose a change in the law on assisted dying. The decision comes following an independent consultation carried out by Savanta ComRes, to which 6,674 members from across the UK responded. The decision was ratified by the RCGP’s governing Council on 21 February.

The College last reviewed its position on assisted dying in 2014 although the different methodologies used mean the results cannot be directly compared. RCGP Council has decided it will not review the issue again for at least five years, unless there are significant developments on the issue.

NEWS IN BRIEF

| 03

COVID-19

THE RCGP RESPONSE COVID-19 has shook the world. It is certainly one of the greatest health crises of our time – and the biggest challenge the NHS has ever faced. This is how the RCGP is supporting members through the pandemic.

G

Photos: BBC News; Sky News; Bloomberg

Ps are on the frontline of dealing with COVID-19, and the RCGP has moved quickly to ensure they are receiving the necessary support to do their vital work safely and confidently, in order to provide patients with the best care possible in challenging and ever-changing circumstances.

“When we started hearing reports about this new virus that was having a terrible effect on patients in Wuhan province, across the rest of China and elsewhere in Asia, we quickly established our own version of a ‘COBRA’ committee to lead our response,” says Professor Martin Marshall, RCGP Chair.

The group was chaired by joint Honorary Secretary Dr Jonathan Leach and included former Chair Professor Maureen Baker and Dr Simon Stockley, who

04 | COVID-19

guided the College through the flu pandemic in 2009 and have vast experience in emergency preparedness, as well as representatives from the General Practitioners Committee of the BMA and the Royal College of Nursing. As the pandemic worsened, the group evolved into a clinical advisory group, still chaired by Jonathan with Honorary Treasurer Dr Steve Mowle as his deputy.

As a result, the College has already published a huge amount of guidance for GPs and the wider primary care team – all available on a dedicated COVID-19 page from the RCGP website – on topics, including, telephone and video triage, workload prioritisation, delivering care to vulnerable patients and using personal protective equipment.

The page also hosts blogs and vlogs from GP experts about pertinent issues, for example, how COVID-19 might impact patients who have an Advanced Decisions to Refuse Treatment, and a comprehensive FAQ section.

Furthermore, the College has developed a free COVID-19 resource hub available to all GPs and practices. This includes practical resources and bite-size-learning which summarises topics such as the epidemiology and symptoms of COVID-19 as well as

remote consultations, safeguarding and palliative care. A quick-reference top tips section on managing the virus in general practice is updated several times weekly.

“We’ve tried to prioritise issues that will impact on general practice most and soonest, but we’re developing new content all the time. We want to hear from members as to what they need,” says Martin. As such the College has set up a dedicated email address – covid19@ rcgp.org.uk – for members to feedback.

It has also introduced an online Members’ Forum – accessible via the website - for GPs to discuss the challenges they are facing and learn from each other.

“We also want to know about members’ experience from the coalface – what they have been finding particularly difficult, what they think needs to change, and any examples of best practice they want to share with colleagues.

“It’s through this feedback that we are able to effectively lobby on our members’ behalf to Government and decision makers right across the UK.” The College has seen lobbying successes: “We could tell early on that there were some more admin-based tasks GPs and our teams would have to stop doing to allow us to focus on

patient care,” explains Martin, “we lobbied for this, and subsequently routine CQC inspections, revalidation and appraisals were suspended.”

The College has also used the media to highlight key issues affecting members, such as prioritising COVID-19 testing for healthcare workers, so that those in self-isolation can return to work if they test negative; and calling for ‘urgent clarity’ around the safety

and effectiveness of personal protective equipment supplied to GPs, and how they should use it.

On the latter, a letter from Martin to Secretary of State for Health and Social Care, Matt Hancock, received substantial media coverage across BBC channels, as well as other national and local outlets – and quickly led to NHS England updating their guidance.

“GPs and their teams are putting themselves at risk every time they go to work during this crisis,” says Martin, “they are doing the best for their patients, and they deserve to be as safe as possible while they are doing so.

“It speaks to our standing amongst politicians and decision-makers at the highest levels that our influencing work has impact. Our relationships have been built up over many years, and it’s at crisis times like this that the importance of this really comes to the fore.”

As well as using the media for campaigning, Martin and other members of the RCGP Officer Team, have become daily fixtures in the national media since COVID-19 first started making headlines

TESTING FOR A TREATMENT – YOUR CHANCE TO JOIN THE EFFORT The RCGP’s Research and Surveillance Centre, in partnership with the University of Oxford and Public Health England (PHE), started testing for COVID-19 when the UK was in the ‘contain’ phase of tackling the virus. “We were testing people at 100 of our GP practices,” explains Professor Simon de Lusignan, the centre’s Medical Director, “PHE was doing a huge amount of work case-finding based on people who had tested positive for COVID-19. Our aim was to see if this was working, and to see if anyone who wasn’t expected to, tested positive.”

The initiative did find someone at the Haselmere Health Centre in Surrey – the first person in the UK to test positive without having visited any affected countries, or knowingly been in contact with anyone who had.

“It helped shape the next stage of the strategy,” says Simon, “it was the first indication that where people had travelled to would be an increasingly irrelevant criteria for diagnosing the virus. Now we are testing to see if current social distancing measures are working, or whether the Government needs to consider more stringent measures.”

The RCGP RSC is transforming itself into a trial platform and will be imminently testing a treatment for COVID-19 – but it needs more practices to sign up. “When practices join our network, they can sign up for three levels of involvement: they can simply share psuedonymised data for research and disease surveillance; they can be a virology sampling practice whereby they would collect swabs and

in late January, providing realistic but reassuring messages for patients among much hyperbole.

Some of Martin (and others’) media highlights have included BBC Radio 4’s Today Programme, Sky News’ Sophy Ridge on Sunday, BBC Breakfast, World at One, BBC Radio 5 Live, Channel 4 News, CNN, Sky’s All Out Politics, four episodes of ITV Tonight – and, in an RCGP first, Bloomberg TV. There has also been significant coverage in the print media. The College’s devolved nation chairs – Dr Laurence Dorman in Northern Ireland, Dr Peter Saul and Dr Mair Hopkin in Wales and Dr Carey Lunan in Scotland – have maintained similarly high profiles in their nations.

“As COVID-19 continues to test our members to their limits, the College is here for them to provide support and to reflect their concerns at the highest levels, so that issues can be rectified, and GPs can be reassured and confident in the incredibly important job they are doing for their patients and the wider NHS. “These are trying times for all of us, but together we will get through it,” says Martin.

blood tests from patients for serological surveillance; or they can be a ‘trial ready’ practice and help us test interventions,” Simon explains.

It is this third group that Simon is keen to expand – the RSC is already looking at trials for a treatment for COVID-19 but also wants to be ready to trial vaccines when they are produced, and there is some urgency in signing practices up. “If we don’t act now we won’t get the chance to have impact – without comprehensive clinical testing we won’t be able to treat people to keep them out of hospitals, and we won’t be able to vaccinate people to stop them getting sick in the first place,” says Simon.

If you’d like to support the cause and sign your practice up, visit www.rcgp.org.uk/rsc 

CANCELLATION OF COLLEGE EXAMS: The College made the difficult decision to cancel the Clinical Skills Assessment (CSA) and Applied Knowledge Test (AKT) components of the MRCGP examination in mid-March as the COVID-19 situation developed.

All candidates were contacted in advance of the announcement and examination fees will be carried over to rescheduled sittings.

Chief Examiner Dr Meiling Denney said: “At a time when the NHS needs GPs more than ever, we were committed to running the MRCGP for as long as we could, while it was still safe and responsible to do so.

“We will ensure that all examinations are rescheduled at a time when we can run them safely and reliably and thank trainees and examiners for their patience.” 

COVID-19

| 05

B IG I N TER VI EW

THE INNER LEGEND Former RCGP President Dr Roger Neighbour talks to Daniel Openshaw about his ‘Inner’ trilogy, the crossroads between arts and science, and his thoughts about the MRCGP exam.

R

oger Neighbour has a theory about the composer Franz Schubert.

“He was very, very short – only 4’11½”, a runt in his family. Secondly, he may or may not have been homosexual, probably wasn’t, but at any given time, he always had one very close male friend.

Third, there’s a dactyl rhythm that occurs in Schubert’s music time and time again.

It goes long, short-short, long, shortshort. People have written about it and don’t know what to make of it. Fourth, if you look at his face, he has the prominent forehead and small features that suggest a ‘growth-retarded baby’.

“Put it altogether, the short stature, his face, the one-two rhythm, his constant search for a best friend, and what I’ve come up with, which is completely wacky, is that he’s the single survivor of a twin pregnancy. In his life and his music, he was always searching for his missing ‘other half’.”

It’s this analytic, holistic approach to diagnosis (in this case without ever actually meeting Schubert, who died in 1828) that is central to why Roger has become prominent in general practice.

His ‘Inner’ trilogy - particularly The Inner Consultation, which has become a feature on any GP trainee’s bookcase since its publication in 1987 - has made the former College President a ‘legend’ of general practice (a moniker he describes as ‘really weird’).

“In a medical consultation that goes well, when you find yourself saying the right thing in the right way at the right time to the right person, it can be life-changing sometimes. It doesn’t need to be a random thing. It flows from a sense of structure and how you use language and communication,” he says. “[The Inner Consultation] was my attempt to codify the process that a successful consultation goes through,” explains Roger, “first you connect, make a rapport with the patient; next you summarise, that is you understand what the patient is telling you to the extent you can summarise it back to them; and third is handover, where you offer a management plan to a patient in a way they are pleased with it and understand it.”

06 | BIG INTERVIEW

Roger describes this, so far, as ‘standard stuff rehashed in my own language’, but he is ‘genuinely proud’ of the last two checkpoints: “Fourth is safety-netting, thinking one step ahead so that if [your original thinking] goes wrong, if the test comes back unexpectedly positive, or the drug doesn’t work, what’s the next move?

“The final one is what I call housekeeping. A consultation can be harrowing, upsetting, tiring, draining and frustrating and it doesn’t help patient B if you take whatever feelings you’ve got left over from patient A into the next consultation. So, to my mind, part of a successful consultation is getting yourself ready for the next one.

That means having a variety of techniques up your sleeve to move on from one case and be ready for the next. That could be having a cup of tea or checking the post. I know some people who would do a quick meditation, or a moment of mindfulness.”

He admits ‘without wanting to sound immodest’ that he thought The Inner Consultation would be received well. “I do think I have a writing style that … well I like reading my writing anyway! It’s something I take pride in… also, it’s slightly gimmicky, you can represent the checkpoints on the fingers of a hand, so quite literally a handy way of doing it.”

The concept for the book was the culmination of Roger’s interests in medical education (he became a trainer very early in his career, having trained to be a trainer whilst he was a trainee); hypnosis (‘that by simply talking to somebody, you can induce profound-looking changes’); and Zen Buddhism.

“In the mid-60s I [learnt] transcendental meditation. I thought it was interesting, but I couldn’t quite see the point of it until I heard the founder of the London Buddhist Society, Christmas Humphreys, on the radio and it made tremendous sense.

Meditation is at the heart of Buddhism but it’s not a religious-type thing, it’s a training exercise…the whole Buddhist approach is to look within oneself for the origin of most of one’s problems.”

And so, his ‘Inner’ trilogy was born and Roger, still a practising Buddhist, followed The Inner Consultation with The Inner

Above: Dr Roger Neighbour in his study Right: Roger playing the violin as a child and now Main and bottom right photos: Simon Smith

“When you find yourself saying the right thing in the right way at the right time to the right person, it can be life-changing sometimes”

Apprentice in 1992 which explored ‘the idea of how, as a trainer, you can try to identify and latch on to an individual learner’s learning agenda’; and in 2016, his personal favourite of the series, The Inner Physician: “Every GP has their own personality and their own back story and their own emotions, their own hang-ups, their own blind spots. The patient doesn’t necessarily see it…the inner physician isn’t on public display, but it’s a profound part of what’s going on.”

Roger’s interest in the more psychological side of medicine stems back to his pre-clinical studies at King’s College, Cambridge, where he went against the grain by opting to read experimental psychology instead of biochemistry.

“It was terrific,” he explains, “we did everything from training rats to run through mazes to adolescent psychoanalysis and everything in between. If I hadn’t have done that, I’d have probably quit medicine and become a professional violinist instead” he says, referring to another of his passions (see right).

Cambridge was followed by medical school at St Thomas’ in London, which he chose ‘for no other reason than they turned me down when [he] first applied’ and then his first house job in Watford – his home town, where he remained for his whole career as a GP partner in the village of Abbots Langley nearby.

Now retired, Roger is sympathetic to the pressures currently facing GPs and worries continues



BIG INTERVIEW

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“People sometimes tell me 'we don't have time for the smartass stuff ' but we have to make time...if we don't, we de-skill ourselves.”

that the ten-minute consultation is forcing a more transactional, ‘medical model’ approach to general practice.

“Nobody dies if their doctor’s rude or isn’t nice to them. People do die if you miss their burst appendix. So, most important is clinical safety, but beyond that, it’s communication.

“People sometimes tell me ‘we don’t have time for the smartass stuff’ but we have to make time because if we don’t do the interpersonal stuff, we de-skill ourselves and our patients’ expectations are lowered. [Martin] Marshall is right to prioritise relationship-based care, because if we kiss goodbye to that, we haven’t got much else to offer,” he says.

Whilst Roger is most famous in general practice for his writing, prior to becoming President between 2003-2006 he was also the College’s Convenor of the Panel of Examiners (the equivalent of Chief Examiner today) for seven years between 1996-2002, at a time when the MRCGP was preparing to become the licensing exam for general practice.

“We thought, if it can make or break people’s careers, it’s got to be reliable, it’s got to have proper standards, it’s got to be defensible in law,” explains Roger.

Before 2004, the MRCGP included a video exam whereby candidates had to film 12 of their own consultations on VHS tape and examiners would look at 7 of them and mark the trainee according to competency-based criteria. “It was as reliable as you can make anything like that and the stats weren’t bad,” he says, “the drawback was that not everyone was able to make videos.”

08 | BIG INTERVIEW

To address this, a ‘simulated surgery’ was developed as an alternative to the video exam – and this has evolved into the Clinical Skills Assessment.

“The CSA was better because with videos, candidates could choose their own cases, so someone might choose 12 cases of a cold because they couldn’t go wrong – on the other hand they couldn’t fly, either,” he says.

Addressing the criticism that the CSA sometimes faces, particularly around differential attainment, he continues: “The CSA is inherently more reliable than a video, and easier to quality control. And the examiners are extremely scrupulous and fair.

“I think [the CSA] is pretty good as it is. I think what needs to change is not the exam, but the route to it and from it, as it were.”

Roger took some persuading to stand for the Presidency because he doesn’t ‘particularly like institution politics’. But he did enjoy the role and the thing he is most proud of during his tenure was introducing New Members Ceremonies.

“The way I chose to interpret the role of the President was to be the voice of the membership at the top table…All our Chairs of Council have been exceptional, but they are so close to the politics of it all, it’s sometimes hard for them to see the non-politics.”

Next for Roger, now 72: he’s working on a new medical book – ‘Consulting in a Nutshell’ – offering simplified and exam-focussed advice to improve consultations; he has another in the pipeline on ‘the habit of kindness’; and he’s working on his ‘great British novel’, the protagonist of which will be, of course, Schubert. 

Top left: Dr Roger Neighbour’s presidential portrait by Richard Keith Wolff

Croydon GP Agnelo Fernandes and his partners used drastic measures – and a positive attitude – to save their surgery from the brink of bankruptcy and transform it into an awardwinning practice. Kristy Ebanks reports…

S

ix years ago, Parchmore Medical Centre in Croydon was struggling financially and facing closure - today, it is an award-winning practice with 15,200 patients on its list and a full and thriving practice team.

Like many GP practices across the country, Parchmore’s biggest challenges were finances and recruitment.

In 2013/14 NHS England brought its PMS contract in line with the GMS contract as part of a review to reduce variation in funding per patient between practices.

Baseline funding shrunk by around £200,000 and the partners were unable to secure traditional bank loans because a recent building upgrade meant they already had a large loan on the books. The loss of three full time partners in a quick succession compounded the situation.

Senior practice partner Dr Agnelo Fernandes knew that radical measures were needed if the practice was to survive and continue taking care of its patients.

“If we made administrative staff redundant, it would be cutting off our nose to spite our face because we need-

Photos: Grainge Photography

RESCUE MISSION

ed them to run the practice – we had the demand,” he says.

To prevent the practice from going under, the partners resorted to other means of financing the practice, including putting up tens of thousands of pounds from their own pockets.

They also recognised it was time to diversify the team and, according to Agnelo, “transform the way we did things”.

The partners hired an operational manager with no specific practice management experience but transferable skills, which proved useful in developing social prescribing. They also hired two pharmacists, a nurse practitioner, a Physician’s Associate, additional practice nurses and health care assistants to support the GPs in the team.

Parchmore went through several lows in a short space of time but a ‘revolutionary culture change’, combined with the unswerving positivity of the team, meant that patients were able to continue receiving good quality care.

Things began to change for the better. The practice was now in a better fi-

Above: Agnelo and his team outside the Parchmore Medical Centre

nancial situation, with a thriving primary care team and NHSE had accepted their transformational recovery plan, meaning that the practice was able to remain open.

Workflow optimisation was a major part of the practices recovery.

“Our GPs were leaving the practice late, long after the cleaners were gone and that just wasn’t good enough, so admin staff took on the responsibility of the paper trail. They looked at letters and only gave GPs the ones that needed actioning before patient appointments. Our GPs went from looking at 30 to 40 letters a day to around 10.”

Following medical assistance training, the admin staff were able to take on more roles, such as dealing with reports and repeat prescriptions, further reducing GP paperwork.

“This means that our more complex patients get longer appointments. We do minor surgeries in-house and peer review all our referrals on a daily basis. This has seen an 18% dip in local emergency admissions and our hospital referral rate has dropped by 20%.”

Parchmore is now known for what Agnelo calls their social prescribing ‘revolution’. Patients’ high uptake of non-medical interventions, such as boxing and Bollywood dancing, even caught the attention of NHS Chief Executive Sir Simon Stevens and local government chiefs, and has led to the initiatives being rolled out across Croydon.

In the last two years alone, the team has won 10 national and regional awards, including HSJ, BMJ, and Parliamentary awards for primary care innovation, Rapid General Practice Transformation, and the General Practice Award for Managing Workload and Improving Access.

“Although still busy, the way we work now has given our GPs more time with patients, and a work life balance. When faced with closure it’s never easy – but piecemeal reforms just won’t do. You have got to be willing to be transformative to take control,” says Agnelo. 

NEWS

| 09

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WESSEX TRAINEES TEST OUT NEW TRAINEE PORTFOLIO Trainees and trainers in Wessex

Faculty are piloting the College’s new Trainee Portfolio before its rollout across the UK later this year.

D

eveloped in partnership with FourteenFish - an IT company that specialises in medical appraisals that was co-founded by former GP and GP trainer Dr Duncan Walling - the Trainee Portfolio promises a ‘faster, modern and more intuitive’ experience for trainees and trainers alike.

Dr Jonathan Rial is a GP trainer in Overton, Hampshire and clinical lead for the project. He said: “The current ePortfolio is now old in tech terms. It was re-designed in 2010 and programmed in language that is now incompatible with some of the new GMC-mandated functions we need it to perform, and the wider shift to mobile and tablet-based working.

“We know from member feedback that there are frustrations with usability – it’s a bit slow and clunky. There’s also an appetite to have it in app-form, which isn’t possible with the current system.”

The new Trainee Portfolio will look different and will include a range of

Photo: SiRastudio

features that aim to reduce the burden of assessment.

“A trainee or a trainer will be able to log on and know exactly what to do,” says Jonathan, “they’ll be able to gather data as they go and keep better track of what they need to do.

They’ll be able to use it offline via the app, something that will be particularly useful for people working in remote areas, and they’ll be able to dictate their reflections, which many trainees say they currently struggle to articulate in writing.”

Other key features include an inbuilt messaging system that will allow trainers and trainees to communicate directly with each other; an AI-enabled

function that will point out potentially identifiable names in entries; and email notifications for trainers, so they know when a trainee has submitted new information.

Jonathan’s own Faculty is Wessex, so he will be able to ‘keep a close eye on its progress and swiftly resolve any issues’, before the national launch to more than 25,000 trainees.

“It’s really exciting, and it’s going to have a huge, positive impact on everyone, so I hope it’s well received,” he says.  Above: From left: Dr Duncan Walling, CEO, FourteenFish; Dr Jonathan Rial, RCGP Clinical Lead for the Trainee Portfolio; Dr Mark Coombe, Education Director, FourteenFish.

OBSERVE GP: A TRAILBLAZING INITIATIVE FOR ASPIRING GPS School pupils who are interested in applying to medical school can find it difficult to gain work experience in a GP practice for various reasons.

Now, as part of its ‘Discover GP’ programme, the College has developed ‘Observe GP’, an interactive video platform aimed at aspiring medics aged 16+ who wish to learn more about general practice.

The platform is an innovative way of shadowing the primary care team, with interactive videos and learning activities providing a detailed insight that goes beyond what is possible to cover in a traditional work experience placement.

Launching next month (April 2020), the platform, filmed at Attenborough Practice in Bushey, Hertfordshire and Liberty Road Practice in Stratford, East London, will show GPs and members of the wider practice team providing care to patients, using real-life scenarios.

Aspiring medics will be invited to take part in activities and reflect on what they see. New videos and additional content will be added to the platform in the future, allowing the College to reflect the evolving general practice landscape. 

Photo: Raw LDN

Find out more about Observe GP: www.rcgp.org.uk/observegp Read more about the RCGP’s wider work experience programme: www.rcgp.org.uk/workexperience NEWS

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NEXT GEN GPs

Meet the trio who have been elected by their peers to represent the views of trainees and recentlyqualified GPs. Right: Anthony (left), Ian (right) Photo: SiRastudio

COMMITTEE TO COMMUNITY Around 13,000 members of the RCGP are trainee GPs, accounting for 25% of the College’s overall membership – ‘so our voice is incredibly important’, says Dr Anthony James, Chair of the College’s Associates in Training Committee.

Anthony, an ST3 GP practising in north London, is determined to make the College more relevant and inclusive for trainees.

“The first thing I want to do is change the word ‘committee’ to ‘community’.

GPs are part of the communities they care for and the word committee just sounds too formal.

“I want everyone to feel included and heard. I’m pushing for a culture of fairness and to do that we have to speak in modern language. Some trainees think the College is a bit of an Old Boys' Club and it’s not. It’s a wonderful opportunity to build and engage with a community of experienced GPs. “General practice is one of the few areas of medicine where you get to be a part of a community. As GPs we care for all different age groups at different

stages of their lives, at different stages of our lives, and you can really build meaningful relationships. That sense of community is one of the privileges of being a GP and I want trainees to feel this way about the College,” he says.

Since graduating from Barts and The London School of Medicine and Dentistry in 2014, Anthony - who champions LGBT issues in the NHS - has also taken on wider healthcare roles, such as Health Advisor at PinkNews and as an organiser for TEDxNHS. He will be AiT Chair until November 2020.

HEALTHY DOCTOR EQUALS HEALTHY PATIENTS “GPs get to know patients rather than problems – it’s one of the privileges of primary care,” says Dr Ian Wood, Chair of the First5 committee.

Ian, who is three years into his first five years as a fully qualified GP, practises in Buckinghamshire, and is acutely aware of the shift from trainee to GP. “The first five years are a very transitional time in your professional and personal lives. Often at this stage we’re starting families, moving into

new homes, and juggling this with new career options.”

He is using his two-year term as Chair to focus on GP wellbeing and wants to elect GP Mental Health Champions to raise awareness.

“We often work in isolation - it’s important that we create a working environment where GPs feel confident in the mental health support channels available to us. I want to encourage open discussions about our wellbeing and really push the message that a healthy doctor equals healthy patients,” he says.

“We’re often so busy taking care of others, we forget about ourselves and this can lead to burnout – it’s imperative we tackle this from the start of our careers so that the role is sustainable and we can enjoy long careers.”

Ian, who graduated from Bristol Medical School in 2012, is also a Clinical Director for EMIS Group and a Clinical Lead for Big Health and wants to ensure the College further develops its digital arm to enhance membership benefits.

“Members need a central digital space to connect and collaborate and the College should be every GPs first port of call.”

PRIMARY CARE ON THE INTERNATIONAL STAGE

“The education you gain watching primary care being delivered in low-resource settings is just as valuable as learning opportunities in high-income settings,” says Dr Aya Ayoub the new Chair of the Junior International Committee (JIC).

Aya graduated from UCL in 2013 and is two years into her First5 in general practice, working as a locum based in Vauxhall, south London.

She recently spent some time on an observation placement in Egypt and feels that the international aspect of general practice is important for GP trainees and First5s with an interest in understanding the importance of the social and economic factors that influence patients.

“Working in multicultural London, it’s important that I understand other cultures, appreciate the resources NHS GPs are privileged to have, and learn to deliver care in a way my patients will appreciate,” she says. She will be JIC Chair until November 2022. 

12 | NEWS

PREPARING FOR A NEW CHAPTER

Retirement from general practice has opened up new opportunities for Mona Aquilina - here she discusses life after practice and her work with refugees.

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hen Mona Aquilina approached the RCGP stand at the annual conference in Harrogate four years ago to ask what the College was doing for retired GPs, she had no idea she was sparking a movement.

She was encouraged to join the Retired Doctors working group, which led to the creation of a ‘wonderful initiative’ and she is now chair of a new College group to help later career and re-tired GPs adjust to the next phase of their lives.

“As you approach retirement, you might get some help with financial planning, but there is no transition planning on wellbeing and life changes,” says Mona, 62.

“Your GP skills don’t stop, and you don’t lose your interest in primary care, just because you’re no longer laying hands on patients.”

As well as offering peer support, the Later Career and Retired Members (LCARM) group aims to deliver practical advice and is setting up its own dedicated part of the College website to signpost tips on how to stay on the performers list and retaining your licence.

There are also vignettes about the experiences of ‘older’ GPs and ways of using transferable skills within primary care after retirement from clinical care.

Mona explains: “It’s about sharing best practice, not reinventing the wheel.

Above: Mona at the Refugees Welcome march in London, September 2016

ways been pressurised. If you were a partner you had no option but to work 10 sessions and it could be very intense and overwhelming; it was difficult to have a work life balance,” she says.

“I admire today’s younger generations of GPs as they have an emphasis on wellbeing and wellness from the outset.

It’s no longer about showing how tough you are”.

Mona started her medical training in her home country of Malta, inspired by an uncle and great uncle who were GPs, but came to England to escape the political turmoil in the 1970s.

Whilst taking part in a Refugee March in 2016, she noticed a Refugee Council banner and approached the organisation to offer her skills and experience, not least her 13 years as a GP trainer.

She now works with refugee doctors on the Building Bridges Programme helping them prepare for their English language exam and introducing them into the culture of the NHS. “We help them with their communication and language skills, supporting them with interview skills for clinical attachments, shadowing opportunities and consultation skills”she says.

“ Your GP skills don’t stop, and you don’t lose interest in primary care, just because you’re no longer laying hands on patients” I’ve written to all College Faculties and some have appointed their own leads and are already organising social and networking events.

“We also need to look at creating better career opportunities for retired GPs. Many GPs would like to continue to contribute to non-clinical primary care work but many roles still require a licence to practise and we can’t be revalidated without a patient satisfaction survey. We’re the first generation of GPs who’ve got this problem – we need to break down barriers, especially when there’s a shortage of GPs.” Mona worked as a full-time partner for more than 30 years in South London.

“The pressures were very different back then, but general practice has al

She got a place at a ‘brilliant’ medical school at the Royal Free Hospital in London, founded for women’s education.

“It was a big deal to leave your homeland and go to a strange country. I was horribly home-sick but knew I’d made the right decision. It was self-funded and my parents weren’t rich. They spent their life savings on me.”

She tried six months in psychiatry but found it ‘too far removed from the ground’, and qualified as a GP in 1985, taking up her partnership a year later.

When she officially stepped down as a partner, she had a short break then did some sessional work, including looking after homeless people in Westminster.

“I think people presumed I was retiring for good, but I wanted flexibility and to keep my hand in,” she says.

Mona is enjoying her involvement in the new College LCARM group and would encourage anyone who is interested in joining to email lcarm@rcgp.org.uk.

“Feeling connected is such an important part of healthy ageing, and we also link up with medical students to share our experiences with the younger generation.

“It’s like having the enthusiasm you had years ago mirrored back at you, and you realise why you became a GP in the first place.”

Mona is one of the many RCGP retired members who have responded to the call to return to practice in the wake of COVID-19. The College is very grateful to them.

NEWS

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GIVING GENERAL PRACTICE THE STATUS IT DESERVES

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DR HOLLY HARDY

Photos: Backlash Photography

GP in Bristol, GP educator and RCGP nationally-elected Council Member.

WHY DID YOU CHOOSE TO BE A GP?

At medical school, I did an attachment with a GP and her family in North Yorkshire, living with them as the practice was attached to the house. It was my first flavour of how being a GP puts you at the heart of a community. I was fascinated at how she solved problems, and how curious she was about people.

Dr Mary McCarthy’s campaign for UK GPs to be recognised as

specialists in their own right started in Budapest, Hungary in 2014 when she was a GPC representative to UEMO (European Union of General Practitioners).

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ix years later, she remains driven by the hope that the recognition of the speciality and the increased status it confers will encourage more medical students to make general practice a ‘first choice’ career path.

General practitioners are considered specialists in general practice/family medicine in 24 European nations and several international countries - and Mary has many reasons for wanting the same status for the profession she is proud of.

As well as raising the profile of general practice among junior doctors and giving more prestige to the role of a GP, she says it will acknowledge the skills and expertise needed to deal with undifferentiated disease and with patients who present with complex and multiple diagnoses.

“The idea that general practice isn’t a speciality is outdated and unhelpful – the title ‘generalists’ comes with stereotypical views that make the role seem less prestigious than other disciplines,” she says.

“We are specialists, we take part in specialist training and have to pass rigorous exit examinations. It’s discriminatory not to recognise us as specialists in general practice.”

Mary and others brought an emergency motion to the 2016 British Medical Association representative body meeting, asking it to support the recognition of the speciality. It was passed overwhelmingly, becoming BMA policy.

Through the College’s Midland Faculty, the motion was brought to RCGP Council at the end of 2016, where it was similarly supported. This led to the RCGP and BMA signing up to a joint statement in autumn 2017, calling on the General Medical Council to recognise GPs as specialists in general practice and family medicine.

This statement was reiterated by the College and the BMA in late 2018, and in 2019 the GMC issued a Joint Statement with the College and BMA acknowledging that GPs were Specialists in General Practice.

Legislative change is now needed to amend the Medical Act. Mary, who still does three sessions a week at Belvidere Medical Practice in Shrewsbury, where she was previously a partner, said: “It is an anachronistic anomaly that GPs are waiting for politicians to decide that they are specialists”.

“I want to see fairness across the globe. GPs worldwide should have equal status and feel proud. We’re currently dealing with a workforce crisis and raising the status of general practice will, we hope, encourage more people to become GPs and therefore have a positive impact on patient care.” 

WHAT’S THE BEST THING ABOUT BEING A GP?

The continuity and relationships we build with patients. Having changed practice and initially losing that continuity, it made me realise how much it mattered. It’s something we must hang on to.

WHAT’S THE MOST FRUSTRATING THING ABOUT BEING A GP?

Paperwork and admin can take me half the day.

My time would be better spent doing clinical work.

WHAT ARE YOU MOST PROUD ABOUT IN YOUR CAREER?

It’s actually something that came out of failure. I was a partner in a small practice when my two senior partners both retired, leaving me and another parttime partner to keep things running. We did this for about a year, but it became unsustainable. However, we were able to secure a merger with a nearby practice, which meant our staff could keep their jobs and our patients their GPs – I’m proud of that.

WHAT HAS BEEN THE MOST IMPORTANT LESSON YOU’VE LEARNT DURING YOUR CAREER?

You can always see a patient again. When I started, I thought you had to solve a patient’s problem all in one go, as is often the case in hospital, but I’ve realised you can ask a patient to come back.

It’s about living with uncertainty and feeling ok about it - it’s hard.

WHY IS IT IMPORTANT TO BE A COLLEGE MEMBER?

I’ve always been a member but until my practice merger, I wasn’t hugely engaged. I stood for RCGP Council and got elected. It made me realise that my situation with workload and recruitment issues was reflective of GPs on the ground – and that all GPs can contribute to policy discussions and be listened to through their Council representatives.

WHAT WOULD YOU BE IF YOU WEREN’T A GP?

I love being a GP but I’d consider being a postal worker. It wouldn’t pay the bills as well, but I’d still be connecting with people in the community, and it would get me outdoors more.

WELCOME NEWS

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Rowena Christmas

THE SMACKING DEBATE...

A GP's VIEW Dr Rowena Christmas, a GP in Trellech, Monmouthshire put forward a Motion to UK Council last November, calling on the RCGP to adopt a position to enhance support for parents to use non-physical disciplinary methods and to support legislative measures across the UK to prohibit the defence of reasonable punishment in children. The Motion was carried.

Here she explains why she felt it was necessary to take action.

"Our professional duty is to advocate for the most vulnerable members of society and this will be easier for us if the law is clear that all physical punishment is wrong."

Children who are smacked are more likely to be bullied and to display delinquent behaviour, with a reduced ability to manage situations verbally. As adults there is an increased incidence of criminality.

No replicated peer-reviewed research can demonstrate physical punishment has any positive effect on long-term developmental outcomes. Furthermore, there is no benefit that cannot be gained from other methods such as timeout or withdrawal of privileges.

Studies indicate that when smacking fails, parents who rely on this method of discipline tend to intensify its use rather than change strategies. They smack harder. Studies also suggest that 85% of parents express moderate to high levels of anger when physically disciplining their children. If a parent smacks a child in anger there is a great potential for emotional and physical harm before they regain composure.

This is an emotive topic, provoking strongly held and polarised viewpoints.

The majority of parents from both sides of the debate agree that they want to raise

children who are secure, loving and confident, with a clear internal moral compass and that loving, responsive parenting is essential to achieve this.

The debate about parental physical punishment is often driven, at least in part, by value judgments about how children should or should not be raised, rather than by empirical evidence. There is evidence that in the UK the prevalence of physical punishment is decreasing and that public attitudes are changing.

It is essential to emphasise that this position is about supporting parents not criminalising them. There is extensive evidence from countries such as Sweden, who took this position 30 years ago, that Our professional duty is to advocate for following the ban fewer children were rethe most vulnerable members of society moved from their families and there was and this will be easier for us if the law is no increase in the number of prosecutions clear that all physical punishment is wrong. for assault. A change in the law must be The College, as the membership oraccompanied by a wide ranging awareganisation representing family practitionness campaign, along with support to ers, has the influence to encourage high help families with the inevitable challenglevel political commitment to enacting es that parenting brings. and implementing legislation, coupled It is reasonable to ask why the RCGP with ensuring necessary initiatives are in should adopt a formal position on this isplace to support families. sue when there are so many competing priorities for our time.

Our charitable purpose is to encourage, "It is essential to emphasise that this position is about supporting foster and maintain the highest possible parents not criminalising them." standards in general medical practice.

GPs frequently see patients with This will address the issue that parenchildren and offer advice on a broad range tal physical punishment is a violation of of issues. A recognised presentation is the children’s rights according to the UN Conoverwhelmed, desperate parent, who has smacked their child in frustration and pre- vention ratified by the UK and will ensure children have the same legal protection sents to the GP full of remorse. from physical punishment as adults. It will Parents who use physical punishment also reduce ambiguity when defining the may well also have been hit as children and need trauma-informed care them- boundary between reasonable and unreaselves. We can offer help and support, sonable force.

Adopting this position sends a clear explaining the harms associated with message from the College that physical physical punishment, while discussing violence towards children is wrong on alternative parenting techniques and signposting to further supportive services. any level. ď Ž Photo: Pradip Kotecha of PK Photo Art

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became interested in this issue when asked to give evidence to the Welsh Government, which is proposing to outlaw smacking children. Scotland has already introduced this law. In preparation I read many papers and discovered compelling evidence of a broad range of harms associated with parents physically disciplining their children. These risks include an impaired relationship with their parents and a negative impact on mental health both as children and into adulthood.

OPINION

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MIND MAPPING CANCER SYMPTOMS

Photo: Page One Photography

Dr Ben Noble is an RCGP ‘Bright Ideas’ award winner for The Cancer Maps, a referral algorithm that supports the recommendations in the NICE guideline on recognition and referral for suspected cancer.

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ICE’s guidance for suspected cancer is absolutely invaluable but also 80 pages long. I know of a GP who had a patient that presented with raised platelet levels – the GP used The Cancer Maps to search ‘thrombocytosis’ along with the patient’s age and gender. At the click of a mouse he was able to see NICE guidance that suggested he referred the patient for an urgent chest x-ray, and

the results showed that the patient had lung cancer. If GPs can use this tool to swiftly recognise and refer suspected cancer patients, within a matter of seconds, then its impact will be life-changing,” says Ben Noble.

“I’ve always used mind maps. Even when I was at university, I used to mind map lectures. When NICE released new guidance for suspected cancer I instantly mind mapped it. Mind maps are usually personal but once I started I thought, this guidance lends itself really well to the mind map way of thinking.”

Ben’s father, Patrick Noble, had recently retired after a long career in computers and software development so Ben took this idea to him. “He had the computer expertise so we worked together to produce The Cancer Maps online.”

Patrick developed a website; programmed in search results based on patient symptoms, such as raised blood platelet levels; and put together a tutorial in the form of a screencast to help demonstrate and teach health professionals how to use the tool.

“It became a self-contained package,” says Ben. “I want it to reach the desktops of as many healthcare professionals as possible. No subscriptions or memberships required, simply visit the website and anyone can have access to NICE and RCGP endorsed cancer guidance.”

PRISON HEALTHCARE COMMUNICATION Dr Richard Kirk, Northern Ireland’s Clinical Director of Prison Healthcare, was awarded for his Bright Idea of developing a communication pathway to ensure continuity of care is maintained – on the way in and out of custody.

As prison GPs, Richard Kirk and colleagues were finding it difficult to care for patients without any medical history. It was also proving an issue for community GPs who noticed the information gap once these patients returned home.

“Around 4000 people a year enter prison in Northern Ireland. Previously on arrival most prisoners didn’t de-register from their GPs and when leaving they didn’t tell GPs they’d been in prison,“ he says.

Richard developed a letter to be sent to all the prisoners’ GPs. The letter informs community GPs that a patient is in prison; provides them with a medical record code; lets them know that they no longer need to issue prescriptions; and requests the front page of each prisoner’s medical history.

“When a patient leaves prison, we upload a detailed discharge letter to their electronic care record so community GPs are informed that this patient has left prison along with details regarding medication that has started, changed or stopped.”

In the future, Richard hopes to increase the amount of detail included in discharge letters to cover hospital and clinic appointments, as well as use of mental health services. 

18 | CLINICAL MATTERS

“I want to reach the desktops of as many healthcare professionals as possible - no subscriptions or memberships required.”

Dr Ben Noble

“Securing endorsements involved a lot of work, it was laboursome – I had to make edits to ensure the content was robust but actually that’s given it credibility and reassurance that everything is correct.

“I use it with patients. A lot of patients come in worried about cancer and together we explore their concerns. The Cancer Maps reassure and educate patients at the same time.”

Ben hopes to visually improve the tool, getting the balance between simple and accessible while being upto-date and comparative with other modern online tools. He also wants to de-jargonise the platform to make it more patient friendly.

“I want more people to use it. I know it works.” 

Access it here

GP LIVES 20

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AUSTIN O'CARROLL

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CLARE BAILEY

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OMON IMOHI

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GRAHAM MCKENZIE GP LIVES

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Photo: SiRastudio

MEDICINE ON THE MARGINS

Dr Austin O’Carroll is pushing general practice to rethink care for homeless patients

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Working with homeless people you see all the chronic conditions, coughs, colds and chest infections as well as mental health problems you see in routine general practice, but how you manage them in people who may be rough sleeping or living in a hostel is very different, he explains.

“I love working with these people; there are lots of things you can’t solve but there’s a hell of a lot you can and you are making a difference at a level where you are saving lives. You often get people into housing or off the street. We are often the first link and when you achieve something it’s big.”

To ensure sustainability of the work he was doing, he founded the North Dublin City GP Training programme – the first of its kind specifically designed to train young medics to work in areas with high levels of deprivation and with marginalised groups.

Photo: High McAlveen

ffected by thalidomide, which caused disabilities in his hands and legs, 57-yearold Dr Austin O’Carroll was told he would not be able to do medicine. Instead he opted to study law where for two years he did outreach work in the inner city as well as working with organisations supporting disability rights.

When he did qualify as a GP in 1992 and started working in his inner city practice, his previous experience taught him to make sure that his services were accessible to all regardless of their background.

The first homeless clinic he was involved with began with a chance encounter. “A nurse rang me and said, 'I have a patient who has had a psychotic episode and I can’t get anyone to commit them', so I did it. Then after that she cornered me and said she was starting a clinic but couldn’t get a doctor.”

By 2007 he had founded Safetynet which has now grown to be the umbrella organisation for primary care services for homeless people and other vulnerable groups. The services, which include a Mobile Health Unit, are provided at hostels and drop in centres across Dublin, Limerick and Cork. He is currently the organisation’s medical director.

Austin also did a doctorate exploring the behaviour of homeless people in using health services. What he found, as he explains in a TedX talk, is that health services have often got their thinking wrong when it comes to homeless patients. “My research for my doctorate showed homeless people only present when their position is overwhelming. People are outside the margins and health services have not been devised to meet their needs,” he says.

He gives the example of two patients, a man and woman, who had been living rough in the park for years.

One Sunday, when they were losing consciousness from hypothermia, they turned up at hospital only to be given a lecture about what a state they were in, further cementing their insistence to never engage with any services.

But through the Safetynet service,

they got treatment for drug and alcohol addiction and somewhere to live.

Sadly, the man could not cope, started to panic and ended up back on drugs before taking his life earlier this year.

The woman is now back at college doing psychology, Austin explains.

“It is a story that shows you what you’re up against – years of abuse, difficult childhoods, really vulnerable patients – but it also shows what you can do.” He does get frustrated he says, but the way he deals with that is to battle to figure out solutions.

“At the moment I’m really annoyed about hospital outpatient appointments which don’t work for homeless people but we’re trying to work out a way to solve that.”

Above: Austin conducting ethnographic research in Dublin Top Left: Austin speaking at the RCGP Annual Conference 2019

“When I first set up the scheme I was told 'no one will apply' but we have been in the top three [for applications] every year so that tells me that it’s inspirational and young people do want to make a difference.”

He adds: “Around 95% of our graduates are now working in areas of deprivation and many part time or full time with homeless or migrant communities. I do think having a GP training scheme makes a difference because there are a group of people coming in behind you who can build on the work you have done.” 

THE DIET GURU Dr Clare Bailey has a radical new approach to diabetes management in general practice

t seems odd, looking back now, that Dr Clare Bailey was never really interested in diet other than wanting to understand more about motivation and behaviour change, but her advice to patients was the same as everyone else’s – eat less, move more.

Then her husband, Dr Michael Mosley, explored the benefits, as part of a BBC Horizon documentary, of intermittent fasting and reversed his type 2 diabetes in the process. It led to the development of the 5:2 diet.

His experience, and seeing the same effects among her patients, prompted her to write a series of companion recipe books including The Clever Guts Diet Recipe Book, The 8-week blood sugar diet recipe book and The Fast 800 Recipe Book.

The last two books are based on, initially, following a rapid weight loss diet (800 calories a day for up to 12 weeks).

“There is a lot of research going on, such as Professor Roy Taylor’s 800 calorie diet to reverse diabetes. The NHS takes time to change, but it feels like the message is filtering through.

“It was seeing that weight loss was achievable. What really made a difference was when you started offering it to patients as an option and seeing how incredibly well they were doing.

It has been a grassroots change.”

The 58-year old has recently retired from the Buckinghamshire practice where she first saw such impressive results among her newly diagnosed diabetic patients. “The other GPs were supportive while being appropriately cautious at first, but they could see the dramatic changes too. I would stick a graph up in the common room of someone newly diagnosed with diabetes who had got their blood sugar right down to normal within weeks or months.”

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What patients were telling her was that they were not hungry, could quickly see the benefits of the low carb Mediterranean diet, and for most of them who did not want to rely on medication, it was a real revelation.

“Over the past couple of years, it has felt like pushing on an open door because there has been so much publicity about weight and diabetes and people know they really don’t want to get it. I work in an area with a high Asian population and they get it younger, and many of their parents are diabetic, so people are keen to take control of their health.

Photos: Jacqueline Ferguson, Penn Road Studio

“One of the most striking things was seeing the impact on other conditions as well – blood pressure, cholesterol, and fatty liver disease improved and PCOS settled. I had patients who had been trying for months or years finally getting pregnant.”

What needs to happen now, she says, is more focus on how this can be implemented in general practice.

Hence, the DIAMOND study, by a team at Oxford University, which she co-authored. It took 33 people with type 2 diabetes, a third getting usual care including standard advice on a healthy diet, and two thirds a low carb Mediterranean diet of 800-1000 calories a day for up to eight weeks.

Those on the diet plan lost 9.5kg compared to 2.5kg in the control group and had an average of 15.7mmol reduction in HbA1C. One reason for the trial was to look at whether this could be delivered routinely in general practice, in this case by practice nurses. “It is difficult to incorporate diet advice into general practice given the workload for most GPs. What was really interesting about the DIAMOND study was that it was done in four different general practices led by the nurses through five extended consultations. It was very doable without specialist intervention.”

So, what now for Dr Bailey? After 30 years in general practice she is focusing more on diet and the need for evidence-based weight loss, diabetes remission and prevention programmes.

“I have really enjoyed writing the diet books and I wouldn’t have expected to go down that route. It’s a real privilege to be doing something that really does change people’s lives. It’s incredibly rewarding.” 

“Clare and Michael have now developed an online programme.

Find out more at www.thefast800.com”

GP LIVES

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EMPOWERING BLACK FEMALE DOCTORS Dr Omon Imohi is making connections with the Black Women in Health Initiative

hen Dr Omon Imohi arrived to train as an F1 in Warrington, coming straight from St Kitts in the Caribbean where she went to medical school, what she wanted more than anything was a mentor who could help her with the challenges that were unique to her situation.

As a teen it was a book by neurosurgeon Dr Ben Carson which inspired her into medicine. Here was someone like her who was saving lives. Working long hours as a junior doctor in a new country was the start of her vision for a group which would provide help and support to black female doctors.

She has now made this vision a reality, setting up the Black Women in Health Initiative, building on what she had learned from developing a small group of friends from similar backgrounds during her GP training who would offer support and advice and “bounce ideas off each other”.

Officially launched in January 2019, the group has 125 members formally registered, there are several mentee-mentor relationships established, and there have been a handful of events to work out how to best provide support and advocacy for their members and help them “achieve professional excellence”.

“As a trainee doctor, there was a lot of support from the deanery but they couldn’t really relate to what I was going through,” says Omon. “I really needed a mentor to understand my challenges. I needed someone who had made that change and could understand my struggles. Things like understanding the lingo, what certain things meant, cultural differences. I needed someone in the medical profession who could relate and I couldn’t find anyone like this.”

Most importantly, at that point, she couldn’t find any other women who would understand her background and who could mentor her. “I grew up in a

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home of only girls so I knew how important that support could be,” she says.

BWIH is the only black women in medicine organisation outside the US, Omon believes. “I’m passionate about advocating for diversity and inclusion and I hope we can provide a unique network for black women in health. We can provide practical help to members going through struggles and dealing with complaints but it is also a platform for women in health to connect and engage and empower each other.”

The response has been amazing, she says, with members saying they always wanted a group like this but didn’t know how to make it happen. “Last year we were able to meet with the RCGP president and it was well received. We also met with the BMA to talk about how we can work together. That was very successful and they’re coming to one of our events to talk about supporting us further.”

At 37 years old, having been a GP for five years, Oman is now lead clinical GP in her practice in Leigh, Greater Manchester and last year she won the RCGP North West Faculty GP of the Year. With two young children, it can be hard to manage the extra workload that has come with setting up the group but she is very good at delegating, she says.

And the group has many more plans, including doing work in African-Caribbean communities around vital health

Top Left: Omon receives the GP of the Year award from the RCGP North West Faculty Above: Omon (centre) at a recent BWIH meeting

messages and giving inspirational talks to young students who may never have considered medicine or science as an option.

“Over the next 12 months, my hope is that the mentorship will be very effective and running smoothly and that we also are doing a lot more with outreach programmes. For example, there is very low uptake for screening tests and proactive health in the African-Caribbean community. So we want to do some more awareness raising and changing health seeking mentality and behaviour.”

In the summer she is hoping to have a health fair with games and stalls and is currently trying to get the local council and some companies on board to see if it is possible. But to date, the members have found some of the biggest support through the BWIH online groups.

“It can be anything from people struggling with exams or contracts or going through complaints.

“The advice or signposting from other members has already proven to be invaluable,” she adds. 

THE LATE CAREER SWAP Dr Graham Mackenzie is loving every minute training for his second career as a GP

r Graham Mackenzie has certainly not taken a conventional route into GP training. At 49, he is not the oldest junior doctor he has come across but most of the peers he meets on his hospital rotations are a good two decades younger.

Perhaps the most surprising aspect of his late switch into general practice is that he gave up a well-earned senior position to do it. Having spent more than decade as a public health consultant, he took a leap of faith to do the front line clinical work he had always craved.

“I had actually applied 11 years ago and went for a job interview without doing much preparation and I realised during the written and practical test that general practice is a much broader field than I thought. I didn’t get offered a job in Scotland where we lived and I had three young children, so I just kept following the public health route,” he says.

Then in Spring 2018, a threemonth sabbatical enabled the Edinburgh-based doctor to put his plan into action. He spent that time getting his foundation competencies up to scratch, speaking with GPs, reading and doing practice papers.

“It was a long gestation, it took a lot of planning and it was a considerable risk because I was in a good job in a permanent post and I gave everything up to go back to being the most junior person on the rota.”

Graham started out pretty conventionally, going to medical school at 18, doing the 100-hour weeks as a young medic. But he realised that the route he was on – interventional cardiology – was not one for him. While spending time managing acutely unwell

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patients, he was more interested in prevention and the reasons for premature ill health.

He is now in the first year of three years of rotations which has been fascinating, he says, allowing him to learn about areas of medicine he’d never worked in before including obstetrics and gynaecology and paediatrics.

Being an older trainee has its pros and cons, he admits. “On one side there is the tendency to overcomplicate things because you’re looking at the bigger picture rather than just the task in front of you,” he says.

“In a single week you might identify a new cancer, see someone with mental health issues, see people to who you can offer reassurance. There is so much diversity and I have had no second thoughts about this career choice.”

“But in terms of resilience and keeping on top of the work, the experience has been invaluable. I’ve supervised dozens of people and that experience helps me understand what is needed.”

Graham has also been able to see some of the policies he was working on in public health from a different perspective. “It’s been fascinating working in areas I used to cover such as vaccination, screening, and maternal ill health. There’s lots of things you don’t really understand fully until you do them on the front line.”

For his family it has been an interesting time, not least for his third-year

medical student daughter, who can chat with her dad about their experiences from a unique perspective. “My wife and I met when I was a junior doctor first time round and she tells me it’s a bit like being back in our mid-20s because of the pressure and intensity. It is a question of putting yourself back in those shoes and not being arrogant about it.”

His unusual career switch has attracted a fair bit of attention. “Some of my colleagues knew I’d applied before so they weren’t surprised, some people were gobsmacked and thought I was mad going back to junior doctor rotas.

“I have now met people who have moved from another specialty.

One person on my rotation at the moment is ten years older than me,” he continues. “I’ve met others in their 30s and 40s wanting a career change and looking at general practice.”

He says that in his early 20s, when he first considered GP training, his view was that it was a bit mundane or repetitive but that could not be further from the truth. “In a single week you might identify a new cancer, see someone with mental health issues, see people to who you can offer reassurance. There is so much diversity and I have had no second thoughts about this career choice.” 

Top Left: Graham against the Edinburgh skyline Photo: John Need Photography

GP LIVES

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