Thread by @deependgp

The inimitable @HarryBurns16 on the importance of focussing on wellness rather than illness
#ICL50

Invest in a "What matters to you?" approach...

AND

"The most efficient way to spend money on the homeless might be to give it to them" (The Economist)

#ICL50

@HarryBurns16 finishes with his prescription for public services of the future... assets-based and co-produced
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Next up is @grahamwatt4, long time friend and colleague of Julian Tudor Hart, noting that 50 years of the #inversecarelaw would not have been an anniversary JTH would want to celebrate...
#ICL50

Prof Watt, driving force behind the @deependgp project, introduces the 'killer slide' which shows the #inversecarelaw now - GPs in most economically disadvantaged areas lack the time and resource to adequately address complex health care needs
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"If health care is not at its best where it is needed most, inequalities will widen."

#ICL50

Advocacy is not only what you say but also what you do

@grahamwatt4 reminds us that not all GPs see their role in the same way @Breannon_Babbel

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Prof Watt hopes that the work and example of @deependgp groups across the world, written up in "The Exceptional Potential of General Practice" can inspire future generations of health care professionals.
abetternhs.net/2019/02/15/the…
#ICL50

The exceptional potential of general practice can only be fulfilled with three forms of accountability...
#ICL50

... and support where it is needed most.
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@grahamwatt4 ends with this rallying call for more inclusive health care.
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Prof Watt described a day shadowing @petrasambale

"Discretion is the better part of general practice"
bjgp.org/content/65/635…

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Now @CatrionaMorton3, GP in Craigmillar and @RCGPScotland Policy lead, outlines the influence of economic disadvantage on premature ill health, food insecurity, etc and how COVID has exacerbated the situation, particularly for health care access & digital poverty. #ICL50

Recent paper in @TheLancet shows how unbalanced the UK medical workforce has become, particularly in light of increasing hospital work shifted to primary care and rhetoric of "care close to home/in communities"
#ICL50

@CatrionaMorton3 ends with her suggestions for a 'new kind of Practice' to address unmet need
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Next up is @Stewmercer, Professor of General Practice and "warm-up act" for @lokiscottishrap
#ICL50

Prof Mercer recaps some of his ground-breaking work on how the #inversecarelaw manifests in general practice consultations:
- more complex health issues
- shorter consultations
- less patient-centred
- less enablement
- worse outcomes
- GPs more stressed
#ICL50

Practitioner empathy is key for patient 'enablement' (leaving a consultation feeling better able to manage one's health conditions) #ICL50

Now @Stewmercer summarises landmark @TheLancet paper on Epidemiology of Multimorbidity
thelancet.com/journals/lance….
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What happens when you address the #inversecarelaw by supporting general practice to have:
- longer consultations for people with multiple health problems
- empathy and continuity
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...you get better outcomes (improvements in wellbeing and quality of life) which are cost-effective!
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What next? Unanswered questions / future research agenda... #ICL50

Next up... @lokiscottishrap on "The Crisis in Social Connection", reading an excerpt from his new book
#ICL50

Social connection is everything in life.
There is no substitute for human touch, connection.
Our lives are improved by interacting with others.
Safety, security, wellness follow.
#ICL50

But social connections are under increasing strain in post-industrial Britain.
Coping strategies (drugs, alcohol, gambling, etc) may provide short-term relief, but often lead to further social withdrawal.
#ICL50

Social connections are the mechanisms by which people foster resilience, share stories, learn, etc.
We learn how to love by being loved.
The violent severing of social connections (see Glasgow's post-war housing policy) have had lasting effects...
gcph.co.uk/assets/0000/59…
#ICL50

Naureen Ahmad quotes @MichaelMarmot "Do Something, Do More, Do Better" in outlining @scotgovhealth approach to mitigating health inequalities in general practice and primary care.
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The Scottish Government's Short-Life Working Group is working on a range of initiatives, drawing on learning from Deep End projects such as Govan SHIP, Pioneer scheme and @LWPmakeslinks, as outlined in @DrGregorSmith CMO Annual report cmoannualreport.theapsgroup.scot
#ICL50

Welfare Advice and Health Partnerships are another example of Scotland's policy response in this area:
gov.scot/news/welfare-a…
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PANEL DISCUSSION TIME:
@BecksFisher - to address health inequalities, we need to address fundamental inequalities in provision of care.
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Dr Naureen Ahmad - we need to understand funding flows better to address #inversecarelaw

@CatrionaMorton3 - issues of capacity to host additional staff in Deep End practices. Points to Pioneer Scheme (led by @petrasambale & @dnblane) for example of supporting recruitment/retention in economically deprived areas (w/ protected time!): gla.ac.uk/researchinstit…
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@Stewmercer - also highlighting the importance of protected time for catalysing quality improvement work (see Govan SHIP: gla.ac.uk/media/Media_76…)
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@lokiscottishrap - who are the trusted sources of support within communities? Not necessarily health care professionals. Example of recovery communities - self-funded, no hierarchy - can be very effective. Humility is key. #ICL50

@grahamwatt4 - advocates the random sample of patient experience as a marker of quality of care. Establishing norms of good practice by supporting sharing of learning. #ICL50

@Stewmercer - concerns about erosion of continuity of care (particularly important for those with multiple health conditions) with mega-practices
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@BecksFisher - similar concerns about continuity with additional roles (e.g. physio, pharmacy, links worker) shared across practices in Primary Care Networks. Also, practices in deprived areas finding it harder to recruit to these roles. #ICL50

@grahamwatt4 - without examples of shifting the existing order of power and resource (including balance of funding to primary and secondary care), there will be no change to #ICL in next 25-50 years... #ICL50

@HarryBurns16 - need to take a collaborative improvement science approach to address #inversecarelaw (@jasonleitch - what d'ya reckon?) #ICL50

@CatrionaMorton3 - new models of practice
#ICL50

@Stewmercer - political will and the funding to follow
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Naureen Ahmad - how do we address the implementation gap - incorporating citizen voice and human rights approach throughout #ICL50

@BecksFisher - 'proportionate universalism' - resource, funding and workforce where they are needed most #ICL50

Videos and slides from this afternoon's conference will be posted on the Deep End website in the coming weeks gla.ac.uk/deepend ... Thanks for joining us... I'm off for a lie down! 🤪 #ICL50

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