Better Health For All

Each year at FPH in Scotland’s Annual Conference, the Littlejohn Gairdner prize is awarded to a public health trainee judged to be showing “outstanding potential in making a contribution to public health in Scotland.” The prize was first instituted by Dorothy Hedderwick to commemorate the centenary of the appointment of her father, Sir Henry Duncan Littlejohn, as Medical Officer for the City of Edinburgh, and of his friend, Sir William Tennant Gairdner, as Medical Officer of Health for the City of Glasgow.

In November 2018 it was awarded to Rachel Thomson, Specialty Registrar in NHS Ayrshire and Arran, for her work on a national needs assessment of gender identity services. In this blog she tells us about the project, why she thinks its important, and what she’s learned from it.

I was both surprised and delighted to be awarded this year’s Littlejohn Gairdner prize, and wish to extend my sincere thanks to the Faculty of Public Health (FPH), the judging panel and, of course, Dorothy Hedderwick. As a relatively small registrar group in Scotland we’re always aware of the impressive range of work others are involved in, and so to have our needs assessment of services for Scottish transgender (trans) people singled out made me very proud.

Any success is absolutely not just mine though. This piece of work was the result of a significant co-production effort between the Scottish Public Health Network (ScotPHN) and several LGBTQ+ third sector bodies (the Scottish Trans Alliance, LGBT Health & Wellbeing and Stonewall Scotland). The prize should really be considered a shared one, because without them there would be no report and I wouldn’t be writing this.

Since beginning the project I’ve always known it had real potential to effect change for trans service users if done well, and so I acutely felt the pressure to try and make sure the final product realised that potential. Waiting times for gender identity clinics are lengthy across the whole of the UK, and we know that those who are waiting are often at an extremely vulnerable point in their lives. There is often little in the way of support services offered by the NHS, with this gap either being filled by grassroots and voluntary organisations or not at all.

In our report, we hoped to provide evidence of the good practice in both the NHS and third sector that was already happening in some areas, and make recommendations for how services could both reduce waiting times and more appropriately care for those who were in this limbo period. We also wanted to better understand how trans people were using existing services, and whether the way that NHS gender identity services currently operated mapped well to the level of need we were seeing in Scotland. Most importantly, we wanted to elevate the voices of trans service users, and use previously untapped data sources to better understand the population that the services were actually for.

This meant a mammoth piece of work involving interviews, data analysis and stakeholder engagement, which took several months to complete. However, by the end of the process we were able to draw some solid conclusions about the population presenting to gender identity services services, how this had changed over time – with numbers of referrals increasing but potentially approaching a plateau, and more people being referred with non-binary gender identities – and how services could adjust in order to meet this need. We were able to feed our work back to the National Gender Identity Clinical Network for Scotland, who welcomed the findings and plan to discuss and take forward our recommendations, which you can read about in full in the published report.

This could not have been achieved without the co-production element of the work, in particular the involvement of the third sector – the range of perspectives and voices involved throughout the process benefited it at every stage, from design to completion. Equally importantly, it meant that the final report was something both the NHS and third sector partners were proud of and happy to disseminate, describing it as something they actively wanted to use to try and positively influence services for trans people in Scotland. I think that’s a real achievement, and would recommend similar co-production approaches to anyone considering such work in future. To have that achievement very kindly recognised with the Littlejohn Gairdner prize is just the icing on top of an already very pleasant cake.

Written by Rachel Thomson, Specialty Registrar in NHS Ayrshire and Arran. You can follow Rachel on Twitter @rachel_thomson. To read the Health Care Needs Assessment of Gender Identity Services written by Rachel and her colleagues Jessica Baker and Julie Arnot, click here. If you want to follow in Rachel’s footsteps, applications for this year’s Littlejohn Gairdner Prize are open until 1 August 2019. If you’re a specialty registrar undertaking public health training in Scotland and have delivered a significant piece of substantive work that clearly contributes to learning outcomes, like a Board-level paper or a needs assessment, consider entering via this link. 

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Dr. WCD Lovett, OBE, BSc, MBBCh (Wales), MD (London), DPH, DTM&H, FFPH. 

Donald Lovett died on 7 July 2018 at the age of 100 years. He qualified at the Welsh National School of Medicine, Cardiff in 1942 (and from London University as an external student in the same year). He served in the RAMC in Nigeria, Kenya and Somaliland and the experience gave him a taste for medical administration. 

Consequently he took the Diploma of Public Health at Queen’s Square, London in 1948, whilst in passing obtaining a Doctorate in Social Medicine from London University by examination in 1947. He impressed the viva examiners with his knowledge of the public health risks of the Haj that he had gained in Somaliland.

After a short spell as an Assistant County Medical Officer he joined the Colonial Medical Service and took up a posting in Somaliland as specialist in public health. The range of his responsibilities there was very wide, taking in inspecting abattoirs and a tuna canning factory, selecting land fill sites for refuse, planning and building a new hospital at Hargeisha, drawing up ‘standard architect drawings’ for housing (to ensure conformity with public health regulations), and mosquito and insect control. As part of the latter he carried out a successful relapsing fever eradication campaign, which he believed earned him the O.B.E. in 1958. He ran a vaccination and immunisation clinic and dealt with the medical aspects of famine relief, as well as dealing with a smallpox epidemic (alastrin). He drew up ration scales for prisons, schools and troops and revised the regulations for running medical services within the Protectorate. He assisted in the establishment of a system of tribal dressers, an intervention that would later be called ‘barefoot doctors’.

Whilst on home leave he studied for and obtained the Diploma in Tropical Medicine and Hygiene. In 1957 Donald was promoted to Senior Medical Officer in Tanganyika taking up his first position in Mtwara, Southern Province. There he was responsible for the medical services for a population of one million. This involved the services provided by Christian missionaries as well as those run by the colonial government. He set up a TB domiciliary treatment scheme relying on the admixture of methylene blue to isoniazid tablets to facilitate monitoring of   patient treatment compliance. Those who took the tablets passed blue urine. Interestingly the provincial Senior Medical Officer was regarded as the local expert opinion on all clinical matters so Donald had to personally manage some challenging obstetric emergencies. 

Donald’s second Tanganyika posting was to Northern Province based in Arusha. His time there was however quite short as in 1959 he was promoted to Assistant Director of Medical Services based in Dar- es- Salaam. In that capacity he was involved in facilitating the transition to Independence with Africanisation of the administration. He also served as Director of the Dar-es-Salaam Red Cross running a scheme assisting local Asian young women to train as nurses in the UK. After Tanganyika’s independence, Donald remained and was particularly proud of his role with Maelor Evans, CMO, in setting up a Medical School in Dar-es-Salaam with a curriculum directed at public health training and clinical practice in rural conditions with limited facilities. He ended his Colonial service in 1963 as Acting Chief Medical Officer. 

Upon his return to the UK Donald embarked upon a new career in public health becoming Assistant Senior Administrative Medical officer with the Welsh Hospital Board in 1964. He remained in Cardiff for the rest of his life finally retiring in 1983 from his post as Principal Medical Officer at the Welsh Office. During this time he was in 1974 made a Member of the Faculty of Community Health(later the Faculty of Public Health Medicine ) and in 1976 elected to a Fellowship. He found being a medical administrator in the UK rather more constraining than in the Colonial Medical Service but did comment that managing a meeting of Welsh hospital group secretaries was little different to negotiating with Somali tribal elders under a village meeting tree.  

Donald’s colonial experience was made use of by his participation in two working parties under the aegis of first the Colonial Office and then the Ministry of Overseas Development, advising on the development of Health Services in two newly independent states, firstly in Guyana in 1965 and then in the Northern Trucial States (now the United Arab Emirates) in 1969.  

Throughout his career Donald was ably supported by his wife Mary whom he had met in 1939 when he was a medical student and she was starting as a nurse.  Mary died in 2002 and they are survived by three sons, eight grand-children and twelve great grand-children.  

Written by Donald’s son, Dr Jonathan Lovett.

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Last summer parkrun and the Royal College of General Practitioners (RCGP) joined forces to create #parkrunpractice, an initiative to get more people active and volunteering. I was quick to sign my practice up as I had been a regular parkrunner for the previous year. parkrun (with a small p) is a free, weekly timed 5k walk/run held most Saturdays across the country at 9am. The volunteering opportunities are plentiful; want to simply cheer then have a go at being a marshal or come last and tail walk? Take some photos, scan barcodes, guide a blind runner, or pace someone to a time. There is a role for everyone and no experience is required.

The idea of the collaboration is for general practices to register to become an official ‘parkrun practice’ and forge close links with their local run. There are many ways primary care clinicians can encourage parkrun as a beneficial activity for improving mental/physical health and social interaction within discussions around lifestyle. We have noticeboards and TV screens in the surgery waiting rooms explaining what parkrun is and regularly post on our social media channels about what the benefits can be.

The first step in becoming a parkrun practice is to contact your local parkrun. To help you locate it, there is a handy map on the parkrun website showing your nearby runs. You can email the run directing team and a lot of the runs have facebook, twitter and/or instagram accounts, and are easily contacted via these methods too. I approached one of Heslington parkrun’s run directors and asked if they would like to collaborate with us as they were 1-2 miles from a few of our sites. They were very keen and I signed us up via the RCGP website; certificates were emailed, printed and proudly displayed in all of our waiting rooms in no time.

We held a ‘parkrun takeover’ in March of this year, which I organised along with some of my GP colleagues and one of the run directors. We filled the volunteer roster with over 30 of our staff, patients and friends of the practice. We involved the local Clinical Commissioning Group (Vale of York CCG) by promoting the event in the weekly CCG bulletin and they helped spread the word through their twitter feed. On the day we had Nigel, the Clinical Chair of the CCG, chasing down Dan, the CCG cancer and end of life lead. It was fantastic to see clinicians from different practices across the patch joining forces to celebrate the benefits of parkrun. The York Integrated Care Team (YICT) are closely linked to the practice and several of their nurses and carers took part in volunteering and running on the day.

On the day over 200 participants ran or walked Heslington parkrun in the pouring rain. Despite the awful weather, there were smiles and high fives all around. It takes energy and enthusiasm to organise a takeover but I would encourage all practices to sign up and give it a go as the feedback has been fantastic across the board, one of many messages we received:

Priory Medical Group you were amazing -so many volunteers and runners, full of joy and enthusiasm, and in those conditions! Incredible! Inspirational!

To celebrate the first anniversary of the launch of parkrun practice, pledge to parkrun hopes to get 1,000 GPs to take part in a parkrun on 1 June 2019.

On a personal level, I remember being really apprehensive attending my first event after just graduating from a couch to 5k program the previous month. I needn’t have been because everyone was encouraging and it was very inclusive. I now love parkrun because on a Saturday morning for two hours I get to be me; not a doctor, not a mum, just me! I meet my pals on the start line, try my best during a 5k run and grab a coffee and a catch up afterwards. Every week I meet and chat to someone new, maybe before the run I’ll talk to a ‘parkrun tourist’ from Shrewsbury or a runner might see me struggling in the last kilometre and encourage me on. I was a working mum without any regular time out for exercise, struggling to balance everything, and parkrun gave me important headspace and kickstarted me to get active again.

The parkrun practice initiative can provide benefits to all aspects of health. I have seen some of my patients with mental health problems improve their energy levels, confidence and self-esteem thanks to couch to 5k and parkrun.  The physical health benefits of a regular 5k walk or run are clear to see. Social prescribing is on the rise and parkrun is one of many ways we can reduce the need for lifelong medication. It offers the chance to improve health and wellbeing and also encourage social inclusion within a local community.

Written by Dr Abbie Brooks, GP partner at Priory Medical Group, York. To find out more about the Royal College of General Practitioners’ parkrun practice initiative click here. To find out more about parkrun – the free, weekly, timed 5k – or to locate your nearest event, click here. Lastly, you can find out how parkrun began by reading this blog  by parkrun founder Paul Sinton-Hewitt from the Better Health For All archives.

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Hello, my name is Kathryn.  I work as a public health consultant for North Yorkshire County Council.  I was invited to write this blog to share my top tips and reflections on the transition from registrar to consultant.  I hope you find them helpful. 

1. The end of training feels like the words longest interview

Like Part A exams, needing a job feels exposing.  Recognise your value.  You are a highly trained and valued resource, your skills are needed in the system, the trick is getting employed to use them.  Most people get a job at the end of training, but it’s not uncommon for public health specialty registrars (StRs) to feel demoralised if they don’t land a job at their first interview.  Look after your mental health – eat well, exercise, sleep well, talk to friends, do what makes you feel good.   

2. Professional peer support is gold dust

The StRs you trained with could be help for life.  Be generous with your time and support, invest in your networks.  Examples of ways to do this – be in an Action Learning Set (a structured method enabling small groups to address complicated issues by meeting regularly and working collectively), train to be an Educational Supervisor, volunteer to be an appraiser, offer mentoring support.  When you need help, ask for it, there is always someone who knows more than you and can help you on the path to achieving your goals quicker.   

3. Embrace the organisational differences

As a consultant at least 40% of my time is taken up with non-project related meetings e.g. team meetings, business meetings, leadership forums and consultant catch up meetings.  In addition I line manage staff which includes objective setting, monthly 121s, appraisals.  Add to that mandatory training, budget management and negotiating sensitive office politics.  Initially I resented these commitments but now realise they are an important part of public health leadership. 

4. Embrace professional differences

As a consultant you no longer have the security and framework of the training programme.  However there is a different cradle of support, including professional appraisal and FPH continuing professional development requirements.  You can develop your support systems for example a mentor and Action Learning Set.  Also there is a move from producing work to supporting others to do it.  You are a leader in a system you don’t have to do it all, create followership – from direct reports, but also staff in other directorates and partnerships. 

5. To thine own self be true

Work out your values.  They will become useful to guide you when you have to make tough decisions.  Take opportunities to reflect and request 360 feedbacks.  It is good to know yourself. 

6. Choose projects wisely

Do routine work rather than exciting work so you’ve had a go before you are a consultant. Also choose work you don’t love or feel confident doing, practice with the safety of a supervisor.  

7. Finding a vacancy

Visit directors of public health to ask them about their “priorities and plans”.  Seek a placement where you would like to work. Remember you have a choice – think about how your values and passions fit. 

8. Preparing for interview 

Interviews can feel stressful and exposing.  It is always easier to get a job when you have a job which makes end of training even more stressful.  Start early prepare well and keep a sense of perspective.  

9. Your first year as a consultant

Write annual objectives whilst considering a three year time span.  The first year as a consultant is challenging: first professional appraisal, first annual FPH CPD return, managing budgets and staff, fitting in to a new team, building relationships with new partners, learning new portfolios, geographies, building up a body or work and a good reputation etc.  Expect your confidence to dip.  In comparison, year two is a pleasure, as you tick off all your “firsts” so they are no longer daunting, you build relationships, increase knowledge, deliver meaningful work and receive good feedback. 

To conclude

Look after your mental health at the end of training and prepare well for interview. Do mundane mainstream work and don’t avoid what scares you. Know yourself, your values and your worth. Secure a mentor and structured peer support. 

Invest in your public health networks – be generous. Value the dull organisational requirements. Be realistic about what you can achieve.  Prioritise. Understand the complexity of your portfolio. Most importantly, enjoy your new job when you secure it. 

Written by Kathryn Ingold, Public Health Consultant, North Yorkshire County Council  

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