Harvir Braich had the absolute pleasure of chatting with Dr Andrew Snell,  a jack of all trades: A&E consultant and public health doctor. Andy and Harvir have a chat about the great work he has done abroad and his thoughts on how best to tackle health inequalities in this country. 

They had a brilliant conversation and discussed….. 

• What inspired Andy to dual train in public health and A&E (1 min) 
• The lessons we can learn from other health systems to reflect on our own (4.40mins) 
• Any atypical examples seen abroad that Andy found insightful (10mins) 
• The health inequality themes seen at policy level and at the front door of A&E (15 mins) 
• What work Andy has been helping with in Barnsley regarding health inequalities and the three tiers (22mins) 
•  What Andy would change if he had a magic wand in order to address health inequalities (31 mins) 
• What resources and books inspired Andy along his journey (33.30mins) 

References 

Copenhagen and cycling (13 mins): 

 Greenfield, John (9 December 2012). "Danish History: How Copenhagen became bike-friendly again". 

Foresight report on obesity (13.40 mins): 

Health foundation podcast (34mins) 

One Hundred Years of Solitude (35 mins)

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This episode has been hosted and edited by Dr Harvir Braich, GP leadership fellow in Health Equity, Future leaders Programme, Health Education England,

I had the absolute pleasure of chatting with Deborah Wilmot, a passionate GP with over 20 years' experience with the substance misuse service. She shares such a unique personal perspective that has really helped someone new to the arena such as myself. 

We had a brilliant conversation in the new year and discussed...

• Deborah's work as a GP and her amazing journey in working as a substance misuse lead in her region. (1.40mins)

• The changing pattern Deborah has seen of substances misused over her 20 years of experience (3mins)

• How Deborah started her journey into this area of work and what has motivated her to continue in this field (4mins)

• How Deborah has been able to keep such enthusiasm and passion for her work and prevented burnout (10mins)

• What Deborah finds the most rewarding part of her job (12mins)

• How we as clinicians and advocates can break down stigma and encourage patients to seek treatment and support (17mins)

• What advice Deborah would give to inexperienced clinicians or those wanting to better their practice with dealing with patients suffering from substance misuse (22mins)

• Being mindful of yourself and your current state of mind (27mins)

• What an ideal substance misuse service would look like in the eyes of Deborah (28 mins)

• The importance of lived experiences to develop ourselves (35mins)

Further resources:

Reduced mortality if in treatment compared to not in treatment (15mins)

Adult substance misuse treatment statistics 2020 to 2021: report

The "ripple effect" of substance misuse and hidden costs (16mins)

Benefit of peer support in substance misuse (29mins)

Doctors make mistakes (33mins)

Cautionary Tales (34 mins)

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In this episode we talk to Aarti Bansal, GP, founder of Greener Practice and now working as Net Zero clinical lead in North Yorkshire and Humber ISB. We hear Aarti’s experience of starting with a conversation in a pub in Sheffield and forming a small group of colleagues sharing similar values to a rapidly expanding network of GPs across the UK.

In this heartfelt and energising episode we discuss;

• Aarti’s current roles (2min)
• Where Aartis drive for Greener practice and sustainability comes from (3mins)
• What can we do as health professionals to minimise the impact of climate change (7mins)
• Four pillars of sustainability (8mins)
• Prevention and examples of this (10mins 30s)
• Sustainability as a social determinants of health (15mins)
• Greener practice and how it began (19 mins)
• Bringing new people onboard to a rapidly expanding network (28mins)
• What Aarti has learnt about herself in forming Greener Practice (29mins 30s) her thoughts on leadership (31mins)

And to finish…

• Aarti’s leader she most admires and why (34mins)
• Top tips as a leader (34mins 30 seconds)
• Top learning resource (35mins)- Active Hope - How to face the mess we're in with unexpected resilience and creative power by Joanna Macy and Chris Johnstone
• Aarti’s one magic genie wish to support equity and sustainability (36mins 30s)

Further resources

• Greener Practice
• First follower You tube video
• Nancy Kline –Time to think
• Next Generation GP and Next Gen Cast

Thank you Aarti for you time in recording this episode and her continued dedication to Greener and more sustainable General Practice.

Thank you also to Dr Nish Manek, Founder of Next Generation GP for this collaboration. If you are an early career GP please do visit their website here to find out if their is a leadership programme running near you and/or check out some of their amazing resources - blogs, podcasts, webinars and more!

If you would like to hear more from Aarti... Next Generation GP did a webinar with Aarti and colleagues on Leading in Greener Practice - Check it out here. Please also check out Nish's podcast the Next Gen Cast which has a rich catalogue of incredibly inspiring podcasts from leaders in and out of healthcare

We hope you enjoy the episode.

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What a privilege to be able to chat to the absolutely awesome Dom Maddocks. Street outreach worker in Leeds. He has buckets of experience of what works and doesn’t work in Street Outreach and bring this into a fascinating discussion.

We caught up back in the Spring and discussed…

·      Working for Bevan Healthcare and bringing together services and people to help others in the centre of Leeds (2mins)

·      What Dom does and what is so special about his role as a street outreach worker (2mins)

·      Challenges along the way – Covid, rolling into a post Covid world, and collaboration and funding of services and funding (5mins)

·      The beauty of being able to have a wrap around service and working with colleagues (9mins)

·      Experiences of patients in the system and rough sleeping (11mins) – Dom gives his ideas on how to communicate and how to meet patients in their reality of where they are (13mins)

·      Dom share’s his own personal story (19mins) and how this influences his role. As part of this, we explore stigma and navigating the health care service (23mins) to finally get the help he so needed (despite the barriers along the way)

·      Addiction (30mins) and consultation skills around this (32mins)

·      Adverse Childhood Experience (37mins) and the Self care (41mins 30s)

To finish…

Dom’s favourite resource- (46m 30s) The internet – get searching on the topic of inclusion health see what rabbit hole it takes you down

Dom’s Genie wish (47mins) 

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Finding fairhealth through integrated care systems

 I am going to be honest here and let you on to a bit of secret… I find it really hard to get my head round system level change when it comes to tackling health inequalities. Being a GP it is quite relatable when you hear and learn about stuff happening at grass route level and then all the big picture marmot stuff including funding and resources is talked abut all the time. It is the system level stuff that I wanted to learn more about. Sarah Smith, public health consultant in Wakefield has broken this all down for me. I found this conversation super helpful and hope you do too.

We talk about…

-         Different patient populations getting different outcomes and different access to services- What drives Sarah? (2mins)

-         Working across a large system and working out what we can all do to try to tackle HI (5mins)

-         Integrated care systems - what they are and what they aim to do? (7mins)

-         Three tests to try and identify what projects might work at scale in the system rather than being more locally focussed (9m 3s)

-         What data we might use to help us with this (11mins)

-         How governance might help or hinder her ambitions (13mins)

-         Brokering the gap between the national ask and what this means for the local population and being ‘servants of the local place’ (14mins)

-         What the CORE20PLUS5 means in Wakefield and giving a practical application of how this works at system level (15mins)

-         Having a public health team within the ICS and the challenges this sometimes raises (17mins)

-         Systems leadership (19mins)

-         Trying to include everyone in the system (21mins)

-         Practical steps (using frameworks, toolkits and pathways) to try reduce inequalities (26mins). Example of this – Access programme Bradford (28mins)

-         Social determinants of health (32mins)

-         Tips for emerging leaders wanting to find more about this (35mins)

To finish

-         Sarah’s best book (37m 30s) - Radical Help by Hilary Cottam

-         Sarah’s Genie wish (38m 30s)

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In this fascinating we episode talk about the important topic of ‘decolonising contraception’ with the determined Dr Annabel Sowemimo. I am joined by an amazing co- host too… Dr Juliana Duodu, GP at York Street Practice (part of Bevan Healthcare social enterprise) in Leeds.

Episode breakdown

-         What is meant by the collective ‘Decolonising Contraception’ (1min 30s) what is the meaning by decolonising(4mins)

-         How the ideas of this have developed from the history of contraception (8mins)

-         How has knowing all this changed the way Annabel practices (10mins 30s)

-         Supporting patients to make decisions around contraception (14mins)

-         The importance of getting contraception consultations right (18mins)

-         Details of the events and workshops run by the Decolonising Contraception team (22mins)

-         Research around decolonising contraception (27mins)

-         Annabel’s insights into managing all the work she does (28mins)

-         Her book planned to be released next year (30mins)

-         Politicisation of medicine (32mins)

-         Advocacy (33mins30s)

Books (42mins)

Genie wish (44mins)

We hope you enjoy the episode!

Julie and Rachel

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In this episode we talk to Dr Najeeb Rahman, an emergency medicine doctor with years of experience working in humanitarian aid overseas. His years and breadth of experience gives a fascinating perspective on tackling health inequalities in the UK. I was so pleased he could join us for the episode.

Episode content

·      Why Najeeb gets excited about tackling health inequity (3mins)

·      Should secondary care and emergency care colleagues share Najeeb's drive to tackle health inequity? (5mins 30s)

·      Commonalities across primary and secondary care (8mins)

·      How hard it is to inform our interventions with data and evidencing what we are doing (11mins) and how we actually go about finding solutions to this (12mins) e.g. Core20Plus5, localising data.

·      Najeeb talks about developing teams to implement these interventions e.g. Emergency department youth navigator programme (15mins)

·      Building the evidence, case examples and sharing the learning (18mins)

·      Stakeholder engagement (20mins 30s) and who we get on board with the goal of tackling health inequalities... the power of evidence and patient stories.

·      Changes within secondary care to create more continuity of care (24mins)

·      Bringing people together to try and tackle health inequalities (28 mins)

·      Lessons and learning from other sectors (incl humanitarian aid sector) (32mins)

And to finish...

·      Najeeb's best authors and resources (44mins)

·      His Genie wish (47mins 30s)

Further resources

·      The Frontline Collaboration against COVID-19: Briefing to Health and Social Care Committee Introduction

·      The sphere handbook 2018

·      WHO – The cluster system

·      Classification and minimum standards for emergency medical teams

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Finding fairhealth through focus, traction and impact

We are so excited to be sharing this conversation. Why haven’t we made much progress in tackling health inequalities up to now? We hear from someone trying to change this at a national level. Someone who is leading a team to try to make a difference in tackling health inequalities at scale. Bola Olowabi has an abundance of energy and enthusiasm, and her team are setting the national direction and vision to help support making a difference on the ground. This is a not to miss episode…

Episode breakdown

-         Bola’s role in NHS England and improvement (2mins)

-         Core20Plus 5 – what is it about, why now and what’s different to previous national strategies to try to tackle health inequalities? (5mins)

-         What can we do at a primary care level to put Core20Plus5 into place? (10min 30seconds)

-         What Bola and her team are trying to do at a national level to tackle health inequalities (14mins 50seconds)

-         How to engage and work with stakeholders in tackling health inequalities(19mins 30s). Bola highlights the need for time, energy enthusiasm and humility.She talks shared purpose and shared action and emphasises the importance of investing in the quality of conversations rather than the number of conversations.

-         What does success look like for Core20Plus5 in five years’ time? (24mins) What challenges she sees in achieving this success? (26mins)

-         How can GPs support the Core20Plus5 effort? (29mins)

-         Bola shares how she feels about being a role model for tackling health inequalities for women, BAME groups and anyone wanting to tackle health inequalities (32min 30s)

Bola’s learning resources (35mins 30s):

Michael Marmot ‘Build back fairer’

‘Fair society, healthy lives’ – Marmot Report 2010

Marmot report ‘10 years on’

You can hear more about the ‘10 years on’ report in our Fairhealth podcast episode with Professor Michael Marmot

Bola’s genie wish (37mins)

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In this episode we have two amazing guests. Martin Rathfelder and Jess Drinkwater. Martin is a member of the public and Jess is a GP and is currently GP clinical lecturer at The University of Manchester. Both Jess and Martin have years of experience in patient participation in health research and services. 

How do we involve our patients in tackling health inequalities? Such an important question and fundamental in thinking about how we work better with our patients and communities.

Jess and Martin start off by telling us what got them interested in patient participation (3mins) and then what patient participation means to them. We hear from them both as to why patient participation doesn’t always happen and why it might not be a priority at the moment (9min 30s). We also discuss what good patient participation can achieve and why it’s important to do it (12min 30s). We then go on to talk about whether a patient participation group (PPG) needs to be representative of a practice’s patient population (14mins), the value of what different patients can bring to a PPG (15min 30s), and who might join a PPG (17min 30s). The conversation highlights the importance of acknowledging the power dynamic between health professionals and members of the public and the importance of simple things like meeting around food or in an accessible, non-threatening place in the community.

Jess works in a deprived part of Bradford and tells us her insights of what is different about patient participation in her practice area compared to more affluent settings (19min 30s). We discuss lack of trust, hope and confidence in her practice population and how this effects engagement in her PPG (22mins).

Jess and Martin give their insights into different ways patients can participate within the system, what this might involve (26min 10s) and where participation should sit in the system (28mins). Patient participation can often feel quite daunting and it can be difficult to know where to start so Jess and Martin give their advice on how to get started (29min 30s). Jess talks about trying to find someone who can facilitate and provide challenge (not just listen and be defensive) (30min 30s). We discuss who can and should participate in patient participation (33mins) and how this might not always be obvious. Before moving on to our final questions, Jess gives us her golden top tips when getting started with a PPG (35mins).

As always, we finish with books and Genies…

-         Jess’s Book (39mins) Purpose of power- Alicia Garza

-         Martin’s book – (40min 20s)- A radical practice in Liverpool – Katy Gardener and Susanna Graham-James

- Genie wishes (40min 40s)

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Funding, workforce, policy, politics... big picture stuff with the pragmatic and articulate GP Dr Becks Fisher. This episode will hit the spot if you want to know more about what’s happening now and what might be coming next at a system level to try and tackle health inequalities in primary care.

We discuss loads including;

• The Inverse Care Law (3mins) - what it is and why we should be interested in this in primary care. Becks’ work at The Health Foundation has shown that once you adjust for the extra need in areas of deprivation there is less funding, fewer GPs and the quality of care suffers in areas of deprivation.
• Funding of General Practice - Becks tells us about The Car-Hill Formula (10mins) and why funding isn’t currently and hasn’t been previously distributed to where it is needed most. Becks gives us her insights into possible future funding solutions in General Practice to try and shift the inverse care law (16mins). We discuss personal values and how we bring our colleagues and policy makers with us in trying to support (and fund) health equity (19mins).
• Recent politics and government priorities - We ponder potential optimism (23mins) in trying to demonstrate the persistence of the Inverse Care Law at a national level.
• Banging a health inequality drum (26mins) - Becks gives her insights into rationale and strategies for making reversing the inverse care law a bigger priority.
• Becks' personal interest in health inequality - We dig deeper into why Becks feels so strongly on this topic. (28m 30s)
• Juggling two roles and what each role brings to the other- What Becks brings to her policy role from her work as a GP (30mins 30s) but also what she brings to her role as a GP from her work at the health foundation (33mins).

And of course, we finish with:

• Becks’ resource/book recommendation (35m 30) – Julian Tudor Heart – Inverse Care Law
• Becks’ genie wish (37mins) 

Want to find out more...

• The (very recent) Health foundation Report- Tackling the inverse care law. Analysis of policies to improve general practice in deprived areas since 1990
• Also..Comparing General practice in high and low socioeconomic deprivation in England

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