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How public health work has developed my practice as a GP

This year as part of my ST2 posts I am doing a public health job. This has been frustrating and uncomfortable at times as my educated professional perspective on life is challenged.

For example, when asked to assess local Gypsy and Traveller health I first discovered my opinions, and then, yes, my prejudices about responsibility, culture and citizenship. 

Using research literature I identified a key vulnerability of this community is poor primary care registration so I triangulated this issue locally by talking to both the community and primary care practices. 

I found we had 100% registration and so with my commissioning and systems hat on, I thought, fine, job done, they are engaged in a sustainable model of healthcare. 

That was, until I read some other evidence: namely that these people in these communities’ life expectancy is 20-30 years less than the population average.

An internal debate began. I wrestled with critical thoughts on the one hand: they’ve got the same as everyone else and as a GP on the coalface, and I will jeopardise other (also socioeconomically vulnerable) patients if I favour them.

But I was still shocked by the facts: look at those statistics. The system (which they also pay their taxes in to) is not working for them.

So I am currently piggybacking on the work of a colleague to instigate a grassroots initiative where health trainers help these communities effect behaviour change with a view to long-term, intergenerational sustained lifestyle changes that will improve their life expectancy. 

One of the things I’ve found interesting is that the solution has not come from within the NHS, or from a well-recognised NHS professional. It may be this is true for other socio-economic and lifestyle challenges your local population currently faces.

Dr Alex Thomson-Moore is an ST2 in the Severn Deanery.