Happy New Year everyone and welcome to episode 17 of Finding Fairhealth!

After hearing from Ollie you can’t help but feel full of enthusiasm and I couldn't wait to share his energy with you all.

Ollie fills us in with his journey he has been on leading to managing patients using person centred care (2mins). We discuss what person centred care actually means for both the doctor and the patient (4mins 30). We talk about the practical application of person centred care as a GP (5mins 50s) and he gives an example of how this has worked specifically for one of his patients (8mins 30s). Ollie tells us about patient activation (10mins) and how important knowing a patient's level of activation is in supporting them to decide the next steps in their care. We discuss how we manage patients with a lower level of activation particularly in the context of complexity, deprivation and tackling health inequalities (12mins 30s). Ollie highlights the importance of building trust and rapport and avoiding blame (14m 30s). We discuss managing the GP consultation in respect to a patients's individual context and the social determinants of health(16mins 30s). Ollie also mentions the importance of building relationships with his patients over time (19mins) and we also discuss how it makes us feel as clinicians when managing patients who are lower in activation (21mins).

Ollie works in leadership roles locally and nationally and he explains how he brings in his experience as a health coach (24mins 30seconds) into these roles. He also explains how the health coaching approach can take the pressure off clinicians, boost staff morale and help us in looking after ourselves as health professionals (28mins). Before moving on to his best book and genie wish, Ollie gives us his run down of the challenges going forward in 2021 (30mins 30s). He stresses the importance of involving communities and acknowledging different patient contexts in how we weave in tackling health inequalities in everything that we do. 

Ollie’s best books and resources (35mins 40s) 

• Realising the value- Nesta and The Health Foundation
• Good help bad help- Nesta
• Book- Why we revolt- Victor Montouri
• Film- Educating Rita
• Development as Freedom - Amartya Sen

Ollie’s genie wish (39mins 30 seconds)

Further resources

• Peak Health Coaching
• More resources on the Peak Health Coaching resource page here
• Patient activation measure

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Finding Fairhealth through silver linings

The amazing and inspiring Dr Farzana Hussain fills us in on her busy year in General Practice in one of the hardest hit areas for Covid-19 in the country (2mins). We discuss the silver linings in a challenging year (3mins) and why she loves working as a GP in Newham (7mins30). We talk about the challenges she finds working in an area of deprivation but also the feeling of meaningful work and achievement that she feels she wouldn’t get elsewhere. She champions human-to-human interaction and seeing each of her patients as the individuals that they are (10mins).

Farzana has created something very special with her team at The Project Surgery in Newham. We discuss practice culture (18mins 30s), community and how she has created the amazing team she works so closely with today. We discuss the importance of autonomy (21m 30s) for her in managing her busy week and how still manages to make time for herself and her family.

Farzana explains her experience as prominent BAME woman working in General Practice at the moment (23m 40s). We discuss her role as primary care network (PCN) lead locally and co-chair of the PCN federation at NHS confederation. We discuss getting the balance right between making a difference at a national and local level (25mins) and an insight into the communication channels and challenges for her across the system. We also discuss some of the opportunities going forward to tackle health inequalities that PCNs can bring (29mins).

As always on the podcast we finish with Farzana’s magic genie wish (37mins) and her book/resource (38mins) recommendation.

Farzana’s Resources

The Marmot Report 10 years on

RCGP Annual General Conference 2019

Further resources

NHS confederation

Farzana's session with the Trailblazer GP fellows in Oct 2020

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Finding Fairhealth through making Black Lives Matter

In this episode we talk to Dr Julie Duodu and Dr Lucy Carter. I can’t stress enough how incredible these two ladies are and what a pleasure it was to be (a small) part of their conversation. Julie is a GP in Leeds working at York Street practice, a large inner city practice in Leeds serving the homeless population. Lucy is a GP in the culturally diverse borough of Hackney in London.

As much as I try to make some of these episodes short and a quick listen, I can't do that for them all...This is a longer episode than usual, but I think you’ll understand why. We hope you enjoy hearing the experiences of these amazing women.

We kick off with Lucy and Julie filling us in with how they are both doing in this challenging time (3mins). We discuss the opportunity the events of recent months have given to talk more about race (6mins). We cover the challenges with talking about race (6mins) and becoming more comfortable with being uncomfortable (8mins). Julie and Lucy share a mutual feeling of being proud of their heritage but feeling a pressure to fit in (12m20s). We discuss how society’s attitudes have impacted on the journey to where they both are now as GPs (18m40s).

Lucy and Julie share their experiences of attitudes to race in the workplace (23mins 20s).We discuss being labelled as ‘the black doctor’ (27mins) and having to negotiate racism in their everyday work (29m30s). We go on to discuss the importance of good leadership in having a unified stance on anti-racism (34m 40s). We also talk about the importance of representation and diversity in leadership and how inspiring and impactful this can be early in a career and beyond (37mins)

I ask Lucy and Julie how race impacts on health inequalities amongst their patient population (39mins). We discuss COVID-19 and how race and ethnicity impacts their (40mins).

We discuss Lucy and Julie’s views on some of the solutions to dealing with race and health inequalities for our patients (46m 35s) including:

• Recognising that health inequalities exist and that race plays a huge part in this; 
• Opening up spaces in the workplace to explore biases;
• Decolonising medical curriculums, defaulting from the white standard;
• Increasing the diversity of race and ethnicity in leadership roles;
• Keeping the conversation about race going into the future (53m 10s);

As always we finish with further resources and magic genie wishes (60m).

Lucy’s resources

• Brit-ish: Race Identity and belonging by Afua Hirsch
• Robin DiAngela White Fragility: Why is is so hard for white people to talk about racism

Julie’s recourses

• Natives by Akala 
• Superior by Angela Saini 
• Colour brave rather than colour blind TEDTalk by Mellody Hobson  

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In this episode we catch up with Dr Jonathon Tomlinson, an amazing GP in Hackney. Jonathan fills us in with how he is getting on during the coronavirus crisis. He shares his experience working in a practice in one of the hardest hit areas for coronavirus in the UK (1min 40). He tells me how his team has acted quickly to manage the acute situation but also continues to support the long term conditions for many of his patients in the community. 

We talk about some of the many changes in primary care over the last few weeks (5min 40s). These include; phone and video consultations; losing the GP waiting room; sharing clinical decisions and talking more with colleagues. We discuss the effects of coronavirus on those people living in deprivation (10mins 10s) and Jonathon shares some experiences from his practice and his patients (11mins). Jonathan talks about the social determinants of health and the importance of prevention along with all the stuff we are seeing in the media at the moment like PPE (14mins 50s) . 

One of the things that GPs can do is advocacy and Jonathon was keen to discuss the work of Dr Rudolf Virchow 1821-1902 (19mins). Virchow is famous for saying that politics is nothing but medicine on a large scale and that our role as doctors is to show the link between social conditions and medical diseases (21mins). Jonathan explains why Virchow's message is particularly relevant at the moment. We explore the role of a GP in advocacy and coordination of a response to support those who are most in need and vulnerable. We discuss how much our job in primary care should include advocacy on behalf of our patients (26mins) and Jonathon offers some ideas for some steps clinicians can take forward to achieve this. Jonathon mentions collaboration, networks (e.g. The Deep End Network), treating long term conditions. We finish our conversation talking about the importance of caring for our patients (28m 55s), Jonathon shares his favourite book (32m 10s), and he tells us what his magic genie wish would be (34m 40s). 

Jonathon’s recommended Book

Let Us Now Praise Famous Men by James Agee (photographs by photographer Walker Evans)

Other reading

“Caring Effects” Julian Tudor-Hart and Paul Dieppe (mentioned at 30mins 50s)

Jonathon’s excellent blog

My (Rachel's) favourites

• If you want to learn more about advocacy and Rudolf Virchow
• Jonathon has written lots about trauma informed care but this one will get you started
• Coronavirus consulting and more about Jonathon’s experiences over the last few months

You can also find Jonathon on tweeting on being a GP and topics related our discussion @mellojonny

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Dr James Matheson shares his experience on what is going on at his practice in Oldham, Greater Manchester, during this worldwide pandemic. James highlights how we are uniquely well placed in primary care to identify those most in need.

James shares some of the positive stories of support during this crisis. He gives an example of how those living with homelessness have been housed almost overnight after years struggling to achieve this. We also talk about what we can learn from this crisis to support the most vulnerable in the future.

Alongside seeing patients with Covid-19, James discusses the importance of continuing day to day care especially for the most vulnerable. He shares some of the things individual GPs can do to support these vulnerable people and how we can identify and reach out to those people most in need. We discuss the risk of Covid-19 for patients living in deprivation, but also the impact of little or no financial reserve during this time. He talks about some of the vulnerable groups that are particularly likely to suffer during this crisis. He mentions those living with homelessness, Gypsy and Travellers, refugees and migrants.

To finish James tells me why he is feeling positive about the future.

Please check out a recent blog post Fairhealth in the time of Covid-19 from Dr Tom Ratcliffe

The RCGP are releasing some guidance on supporting vulnerable patients very soon. Keep an eye out on their resource hub and I will also post a link here.

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Show Notes

I was honoured to have a conversation with Sir Michael Marmot just a few weeks before The Marmot Review 10 Years On is due to be released. He told me the report has been performed in ‘the spirit of self examination’ to see if there has been any impact or if any good has come from the original report (2mins). He mentions the importance of the report amid the current context of worrying life expectancy figures (2m45s) and sheds some light on the reasons behind these worrying trends (4m40s).

Sir Michael Marmot is world renowned as a specialist in the impact of inequalities on health with internationally acclaimed research, writing and public speaking on the topic. The professor talks to us about how he perceived his role in all of this (8mins) as someone who synthesises evidence and chains of reasoning (10m40s) to formulate recommendations. Despite being an international spokesperson for such an important issue, Michael tells me that he doesn’t see himself as particularly political (12m50s) but does feel able to present information ‘in the spirit of social justice.’ We discuss if the moral case is enough to inspire or create political change (13m30s) and how to create action around health inequalities. With years of experience of sounding the claxon for this important issue, he gives his views on how we unite people around this goal and how to deal with actors in the system that might not prioritise equity (15m 30s). With government promising more spending we talk about current opportunities for spending in areas that are most in need (17.30) and gives hope that there will be clear recommendations coming out of the report for where government should direct their resources. We talk about practical action for health professionals too with six recommendation of how we as health professionals can take steps try to tackle health inequalities (19mins).

With climate change likely having the biggest impact first to those most disadvantaged and in need, Michael is aware of the current importance of climate change and environment. He shares with us how he is involved in trying to bring the environmental and social determinants of health agendas together and how actions to improve health can contribute to meet carbon neutrality (23mins).

To finish we ask for Michael's book recommendations (24m10s) and his genie wish (28m10s)

Michael's book recommendations (24m10s)

Development Is Freedom – Amarta Sen

Capital Twenty First Century- Thomas Picketty

Great Expectations by Charles Dickens (first 2 pages if nothing else)

Further reading

World Medical association report- Doctors for health

Look out for the Marmot review 10years on report due to be release on February 25th

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'My experiences of life have lead me to believe that in most public services the inverse care law applies, it shouldn’t. It’s an inefficient use of limited resourse’ - Victor Adebowale

Show Notes

Lord Victor Adebowale is a busy man so I was so pleased he managed to squeeze in a chat with me for the podcast. He talks with honesty and humour. Every time I have met him our conversations give me so much to think about.

Victor shares his experiences as Chief Executive of Turning Point. He tells me how he and his team make it their mission to try to tackle the inverse care law (2mins). He talks about the importance of a clear vision for his team and what a privilege it is to try and improve the complex lives of others (7mins). Turning Point’s role in the system is complex but made even more so by the need to run an effective business amid all the complexities of the system (9mins 10s).

Victor thinks about how we can best design services to fit the system and the population. He explains the importance of having positive rather than negative value transfer (10mins) and how Turning Point put clients at the centre of service redesign.

We discuss competition and his experience of collaborating with local services and the community (14m30s) and when this does or doesn’t work. We bring in the concepts of place based approaches and population health explaining how his team works hard to understand the needs of and build trust within a particular community to try to deliver this.

In his chief exec role he explains the importance of working out what the right question is (21m 10s) and says that is often questioning whether a process matches the intention (23mins). For Victor one of his main intentions is tackling the health inequity and the inverse care law (24mins). He says ‘What else are you going to talk about if you are involved in health care?’ For him he says this is a logical approach (25m 50s) for him and feels this would be the same for any sensible human being wanting an impact in the system. He talks about how we cope when other people in the system don’t share the same priorities and how we can build some accountability to ensure health inequity moves up the priority list(28mins 40s) . We discuss measuring success and impact in a system (29mins) and how trying to reverse the inverse care law should be taken into account when thinking about any measure we use for the system.

Victor’s recommended reading

Anything by Professor Michael Marmot e.g. The Marmot Review: Fair Society, Healthy Lives

Invisible cities by Italo Calvino

Genie question (48m10s)

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As a medical student, just over 10 years ago, Laura saw ‘health being done badly’ and having a big impact on her friends and neighbours. Laura decided with a team of colleagues to set up her own GP service which was the founding of Hope Citadel. She is now responsible for running 9 GP surgeries across greater Manchester.

I was so excited about talking to Laura as I personally find her inspirational. Her dedication to the people in her community and team is heart-warming. Whenever I see Laura I leave with a feeling of belief that change can happen. Laura starts off our conversation by telling us what is so special about Hope Citadel and how it compares to normal general practice (3m30s). She shares her experiences working in one of the most deprived areas of the country (8m15m) and how important, particularly working in areas like hers, to be fantastic generalist (10m30s).

We discuss co-planning, patient centred care and bargaining (12mins) and how important primary care is in all of this. We also hear about focused care at Hope Citadel (14m45s) and how they are using their incredible focused care workers to help with some of their more complex patients.

‘If you go to outpatients are you going to see an SHO and is that worth half a day off work on a zero hour contract?’ (13mins)

Laura is rightly proud of her team and what they have created. She shares with me her insights into how she chooses her team at Hope Citadel (18m40s) and where this all sits in the bigger picture of Manchester and beyond (20m40m). We touch on the complexity of politics and the role of doctors and health professionals in speaking out about what we see (23mins). Laura tells us how she feels her voice has developed more validity over time (24m20s).

Laura’s career so far has been anything but conventional. We discuss her courage of stepping off her medical career journey and choosing to do something to make a difference (26m40s). She says she wishes doctors were braver, but she admits that she is not sure if she knew then what she knows now whether she would have created Hope Citadel (30m30s). She describes her naivety as being really freeing and shares some of her lessons she has learnt along the way (32mins).

We discuss Laura’s faith (37mins), her family and friends (40m30s), and how these all play a part in making Laura who she is. Laura shares her insights on values, imagination and vision as part of all of this (38m20s). Despite all of this, Laura still finds time to have fun too (42mins).

Laura’s Best Book (50m45s)

Growing pains by Dr Mike Shooter

Genie question (48m10s)

Recommended reading- Harry Potter

‘If you do the right thing clinical outcomes will follow’ - Laura Neilson

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An interview with Dolly Theis

Dolly is currently doing PhD in Public health at the University of Cambridge and runs the “Big Tent of Ideas” festival, a national debating festival bringing people together for conversation and debate.

Show Notes

I learnt so much from talking to Dolly. Her graduate studies in politics have been so different to mine in medicine, yet I was fascinated in her insights in tackling health inequalities, public health, and policy….and wow does she pack a punch!

Dolly kicks off by telling us about her work, a few years ago, at the Centre for Social Justice (CSJ) (3mins). She describes her role as ‘a conductor of an orchestra of musicians,’ convening experts to inform the piece she led on obesity (5mins). Her work at the CSJ seemed pivotal, leading her to academia (masters then PhD) in public health at Cambridge. Her long-standing interest in individual liberty and the works of John Stuart Mill leads us to a discussion about what it means to make free choices about health, both at a policy level and for individuals (6m 30s).

Dolly is now working on her PhD, looking at what influences the policy making process at a local and national level (15mins and 39m20s). She tells us how important it is to think about who, what and how arguments and evidence become influential. Dolly is keen for everyone to be involved in the policy making process (17m 30s). Dolly then goes on to talk about the practicalities of using research in analysing policy: recognising our own previous experiences; our own ideas of what evidence is (28m 30s); peer review (31mins); and how we can make the policy making process more transparent (31mins).

A key theme to our whole conversation was bringing together different people’s experiences (33mins). We talk about the importance of understanding our own and other people’s motivations and values (38mins).

We finish our conversation talking about politics (43m 50s). We cover Dolly standing for parliament, and her role with the “50:50 #ask her to stand” campaign, encouraging more women to stand for parliament.

Intro about Dolly (1 min 20s)

Dolly’s top reading (58 mins)

On Liberty- John Stewart Mill

Geoffrey Rose- Sick Individuals and Sick Populations

Professor Kay-Tee Khaw- Cambridge University

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An interview with Dr Nigel Hewett OBE

Nigel is a GP and set up the national charity Pathway, a model of integrated care providing patient centred care for the homeless. He is also a founding member of the homeless and inclusion health faculty providing education and a network of health professionals dedicated to supporting health in excluded groups across the U.K.

Show notes

We hear about what got Nigel Hewett interested in vulnerable groups, particularly the homeless (8mins). He talks about the health services he has been involved in and run over the years to try and help with this important vulnerable group. He also talks about staff attitudes to the homeless, quality of care for these patients and how important it is to educate and support professionals early in their careers around this topic (7mins). Health professionals working with these groups can feel isolated and we discuss the importance of forming alliances with other health professionals and supporting each other (24mins). He gives some top tips for working with homeless patients (9mins) including ways of managing drug seeking behaviour (10m30s). He also suggests using warm, understanding and empathetic scepticism rather than cynicism. He gives some tips on negotiating too (22m30s).

Nigel outlines some of the problems homeless patients face when admitted to hospital (12m30s). He gives some suggestions of seemingly simple but often overlooked questions to ask homeless patients when they are admitted like ‘Do you have somewhere to go to on discharge?’ He talks about how pathway teams can take a multi-agency overview to both support and advocate for these patients while in hospital and before discharge.

We discuss the fact that the health of the homeless identifies emerging trends in health and the system (27mins), politics (28m20s), legislation (31m35s), housing (32m20s), picking your battles (35mins), and something that he feels is key to all of this, child poverty (41mins).

With years of experience working with marginalised groups, particularly homeless patients, both on a one to one and national level, Nigel gives us an insight into some of his learning along the way (39m20s) and how professionals working with vulnerable groups can protect and look after themselves (46m25s). We also hear about what is new on the horizon for Nigel and his team (50m40s).

Nigel gives such a great overview of the challenge of supporting and providing health care to vulnerable groups in the UK. We hope you enjoy our conversation.

Nigel’s one book (51mins 35s)

Even the dogs by Jon McGregor

Further reading

Homeless service standards for commissioners and providers

Professor Suzanne Fitzpatrick at herriot watt- pathways into homelessness-

Pathway

Focused healthcare

Buurtzord system, Netherlands

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