The South West Public Health Training Programme, working with the School of Primary Care, support two GP Registrars each year to extend their final year of training to enable them to undertake a scholarship in Public Health leadership.
The posts enable Scholars to gain key public health skills alongside their general practice training thereby giving them the opportunity to manage and improve the health and wellbeing of the individual patient in surgery along with that of the whole population in which the patient belongs.
In the fast changing world of general practice and with clinically led commissioning, considering health on a population level has become more and more important for all GPs and those with experience, skills and links with public health teams will be in a very good position to ensure the needs of patient populations are met.
The scholarships provide the GP Registrars with the opportunities to explore areas of particular interest to them and develop skills that will be of benefit to them in their future careers. There is also a great opportunity linking to Public Health to really focus on improving health outcomes and reducing health inequalities.
The following case studies and reflections provide an insight into some of the important work that the scholars have led on.
Professor Maggie Rae FFPH, FRCP (Hon), FRCP Edin, FRCPath (Hon), FFSRH (Hon), FFOM (Hon), FRSPH
I am a GP registrar in my third year of the general practice training programme and have spent six months with South Gloucestershire Council, undertaking a public health scholarship alongside my primary care training. I chose to undertake this scholarship to understand and apply the core principles of population health and the actionable evidence to improve the health and wellbeing of populations. I also wished to develop my non-clinical leadership and management skills.
Together with my supervisor, I have undertaken several projects. The largest piece of work was producing the strategy update for the local authority suicide prevention plan. The development of this plan is in-keeping with the national strategy and forms part of the NHS Long Term Plan (2019). The strategy involved collaboration between several agencies across South Gloucestershire including Avon and Wiltshire Mental Health Partnership (AWP), University of the West of England, Highways England, Prison service, the Police and the Voluntary sector.
I learnt many skills through reviewing national and local suicide data including statistical analysis, critical appraisal skills and principles of epidemiology. The recommendations and action points I developed, take into consideration the significant impact COVID-19 will have had on suicide risk factors and the uncertainty about how this may be reflected in population level mental health over the coming months and years. This piece of work will be taken forward with the wider piece of the Adult Mental Health Needs Assessment and will influence action in the South Gloucestershire Adult MH Strategy.
Another piece of work, in collaboration with the BNSSG smoke free pregnancy practitioner, looked at addressing a gap in service delivery for women who smoke cannabis in pregnancy. I undertook a large evidence review of available literature and presented my findings to a multi-disciplinary meeting to discuss how this could be used to shape the implementation of this service for BNSSG.
The final project is a ‘Mini-Needs Assessment’ for healthy weight in the early years age group. This came about through discussion around childhood obesity and the stark reality that by reception age, 13% of children in South Gloucestershire are identified as being overweight or obese. I worked with the lead health visitor and healthy weight practitioners to review the data and suggest some recommendations. These are being taken forward by the healthy weight team as action points with possible funding from the COVID recovery fund to implement my findings.
Alongside my projects, I attended many meetings and training events provided by South Gloucestershire, including:
Health Inequalities Improvement Programme
Attendance at key strategic meetings within the local authority
Youth mental health first aid course
Body image and eating disorder awareness
Monthly public health registrar tutorials
Future Landscape of population and public health
I envisage that the skills learnt will help me with population health work I am due to partake in within my role as a salaried GP. Also, possibly thinking towards future involvement with Clinical Commissioning Groups (CCG), Integrated Care Partnerships (ICP) and Integrated Care Systems (ICS) organisations.
I undertook a six month Public Health scholarship (three month full time equivalent) alongside my General Practice training in the second half of my GPST3 year working with the Public Health team at Swindon Borough Council. I was given flexibility with how I used this opportunity and wanted to focus my time understanding the set-up of the Public Health team, the overlap with General Practice and how they can work more effectively together, to concentrate on an in-depth project giving opportunity to provide insight into workings of the Public Health team and develop critical appraisal and statistical analysis skills and to consider how I can incorporate Public Health into my onward career as a GP.
My primary focus during my Public Health scholarship was to undertake a project assessing and addressing health inequalities in the uptake of Swindon NHS health checks. This involved obtaining data on the demographics of those who had taken up the offer of NHS health checks in Swindon GP practices as well as the demographics of those presenting to Swindon pharmacies for NHS health checks learning statistical analysis skills in excel to compare my data sets. I also carried out detailed research on the successes and challenges of projects undertaken by other local authorities in England to tackle their own health inequalities around the inequitable uptake of NHS health checks. I used this research and our local data to formulate proposals to tackle our own health inequalities. I considered how altering the way the tariffs are paid to GP surgeries for carrying out NHS health checks and how this could impact on service provision for each surgery and local health inequalities, I developed a training package for GP surgery receptionists on registering those without a permanent address to ensure they had access to health services such as NHS health checks and I considered developing targeted outreach clinics in more deprived areas of Swindon. Following the success of this project, I wrote a business case for targeted NHS health check outreach clinics in Swindon.
Other opportunities included:
- Attending Public Health registrar tutorials
- Planning and leading a full day joint GP and PH registrar tutorial day with one of the Public Health registrars
- Leading a ‘lunch and learn’ session to present my NHS health check project to the team
- Liaising with the Swindon voluntary sector and other community teams closely connected to the local authority
- Attending emergency planning strategy meetings
- Attending coronavirus outbreak management meetings
- Meeting with a broad range of members of the Public Health team in order to familiarise myself with the set-up of the team and varying roles.
- Being on the covid response team, addressing queries from the public, such as how the government roadmap rules apply to their businesses, how to manage outbreaks in their school/car home/work places or vaccination role out.
- Being involved in strategic meetings addressing the low uptake of coronavirus vaccines by ethnic minority groups in Swindon
- Visiting local businesses with the outreach team to address poor compliance with government pandemic roadmap rules or to help identify potential improvements where there had been a coronavirus outbreak.
I will be starting a job as a salaried GP in Bristol this month and am grateful for the skills and experience my Public Health scholarship has provided and the opportunities it has highlighted for developing my future portfolio career with involvement in my Primary Care Network, Clinical Commissioning Group, Integrated Care Partnership and Integrated Care System as well as highlighting how my day to day clinical work and projects within my future GP practice can have significant impacts on local population health.
I had the opportunity to undertake a Public Health Scholarship with Gloucestershire County Council (GCC) during my third year of General Practice training. I was given a total of 60 days to work with the Public Health team and had the freedom to choose how to use this time. I decided to start my placement in March after completing my GP exams, so that I could commit fully to the placement. Initially I was with Public Health for one day a week, and then increased to two days a week for the second half of the placement. I have always been interested in the wider determinants of health and reducing health inequalities, and this placement gave me the opportunity to consider how I can bring these interests into my work in General Practice.
I undertook a variety of projects during my placement including:
- A sexual health training needs survey
- A literature review
- Planning an audit of equalities data for Public Health Enhanced Services (PHES)
- A project to understand the potential barriers in primary care to offering Long Acting Reversible Contraception (LARC)
The literature review aimed to understand the barriers and enablers to ethnicity data collection in healthcare settings. This was suggested as a project after the local Director of Public Health annual report highlighted the inequalities faced by Black and Minority Ethnic populations in Gloucestershire, particularly during the Covid-19 pandemic. My review and recommendations fed into an ethnicity data collection audit which was carried out by another staff member, as well as a wider project on the effect of health inequalities on local maternity care. This was a great opportunity to build on my research and critical analysis skills, as well as my written communication.
Another project during my placement was to undertake a survey of GP LARC services and potential barriers to provision. The local specialist Sexual Health clinic had highlighted an increase in demand for routine LARC appointments within their service, indicating possible gaps in primary care provision. GCC Public Health are responsible for commissioning GP LARC services, so it was important to identify any areas for improvement. I worked closely with a colleague for this project, and I was able to learn more about both quantitative and qualitative analysis which were relatively new skills for me.
I also had the opportunity to attend a range of meetings and events which gave me an insight into working in Public Health within a local council setting. These included:
- The South West Public Health Scientific Conference
- The South West Public Health Annual Training Conference
- The South West Public Health Development School
- GCC ‘Levelling Up’ Conference
- GCC ACE’s panel development workshop
- Public Health Senior Leadership Team finance, performance and risk session
- Health Protection CPD sessions
- Emergency Planning and Incident Response training
- Meetings with members of the Senior Management Team to gain insight into their portfolio and current projects
- Fortnightly local registrar catch-ups
Working in Public Health was a significant change from my work in General Practice, and initially I wasn’t sure how I would fit into the team. I was unsure how much I would contribute to meetings given my lack of previous Public Health experience, but I quickly found that my work in clinical practice brought a new perspective which was valued by other members of the team. Even when I was invited to meetings which were not related to my own projects, I often found that I was the only clinician present, and that any insight I had was greatly appreciated. I was glad to be able to bring a new perspective, and in turn I learned a huge amount from my colleagues in Public Health. Going forward, I hope to bring this wider view of health into my clinical work in General Practice, and possibly build a portfolio career further into the future.
I undertook a six month public health scholarship with Bristol City Council in the final year of my GP training. I spent two days working remotely on public health projects alongside my clinical GP commitments. I had always been interested in the wider determinants of health and how we as clinicians can work to improve the health of the population on a broader scale and I wanted to learn more about how primary care could work more effectively with public health. In addition to developing my critical appraisal and non-clinical leadership skills.
I have an interest in women's health inequalities so I spent the majority of my scholarship time with the sexual and maternal health teams. This included two main projects; post-partum contraception provision before discharge from maternity services, and improving access to Long Acting Reversible Contraception (LARC) in primary care. The largest piece of work was creating a Post-partum contraception business case and bids for funding, to enable training of maternity staff and provision of contraception before discharge from maternity services. This involved reviewing existing evidence, national guidelines, cost modelling, and use of the Public Health England’s return on investment tool. In addition to undertaking research on the successes and challenges of post-partum contraception initiatives in other regions. I led many stakeholder meetings and worked closely with the Obstetricians and midwives within BNSSG, Clinical Commissioning Group, and other public health teams. The pilot has subsequently been awarded funding and is underway.
The other main project involved exploring barriers to LARC provision in primary care and inequalities in this provision across BNSSG from the 2019/20 Primary Care LARC audit, in addition to the impact of the COVID-19 pandemic on this. It was thought that many of the barriers included number of LARC fitters and access to training, in addition to pressures on the workforce within primary care. We created a proposal for a Primary Care Network (PCN) Hub model pilot whereby GP surgeries can refer patients into one central surgery for LARC with the aim to increase resilience in the workforce, decrease waiting times and increase the percentage of patients having LARC thus decreasing unintended pregnancies. This entailed working closely with the Local Medical Committee, GPs, and sexual health clinicians, in addition to pharmaceutical companies providing LARC. The work towards this pilot and wider women’s health hubs is ongoing within the department.
To increase my knowledge of the wider determinants of health I worked with the healthy lifestyles healthy place team on creation of a whole system map surrounding healthy weight. The aim was for this to be used as a tool to engage with new partners by illustrating where their work can fit into the overarching whole systems approach. This would help to model how the components are related and establish gaps in provision including knowledge, activity and data. Through my involvement of this project I learnt about the importance of systems approaches and the value in working with a broad range of stakeholders in order to identify ways in which they can collectively change how the system works. I also understand more how I as a clinician can work with patients surrounding healthy weight.
Other opportunities included:
- Completing the Introduction to Evaluation in Public Health and Care online course through NIHR Applied Research Collaboration North Thames
- Shadowing the Health Protection team on call- covering the infectious diseases reporting including COVID.
- Attending emergency planning strategy meetings
- Meeting with wide ranging public health colleagues to familiarise myself of their differing roles and value within the teams
- Assisting with a joint GP and PH registrar tutorial day
- Attending public health registrar tutorials
I am now working as a GP Locum alongside one day per week of public health work with Bristol City Council. I know that the skills I learnt on this scholarship have been invaluable in allowing me to pursue my interest in population health. I now feel much more confident working within a diverse team and taking on quality improvement roles and I hope to work further within the Primary Care networks and Integrated Care Board going forwards.