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) FRSH (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.