GP Training and the Health Equity Fellowship – Dominic Patterson

How did you first become aware of the impact of Health Inequalities in your clinical practice?

I work in an area of mixed deprivation in Doncaster in South Yorkshire, meaning there are deprived post-mining communities and pockets of relative affluence. My clinical work has always shown me this contrast from patient to patient. It was a conversation back in 2016 with Dr Tom Ratcliffe (former GP Tutor with Health Education England, now GP) that initiated my journey to learn more about health inequalities and to reflect on the impact that they had on individuals and communities, particularly the patients that I was seeing during consultations.  At the time, I was actively involved in the GP training programme, so I began asking questions about whether anybody received training in health inequalities?

How did the Health Equity Fellowship come about? 

Our starting point was to survey about 1,000 GP doctors in training from across Yorkshire about their previous and current health inequalities training. The message came back that their training to date had been limited and there was increased appetite in learning about both health inequalities and social justice. And so, our question became: how do we incorporate learning to tackle health inequalities into training programmes?

I then started looking into social accountability and created a mind map to explore how general practice training could be more socially accountable – responsive, responsible, and accountable. To be socially responsive, we put health inequalities training and education in place for every GP doctor in training. And with the higher tiers of social responsibility and social accountability, we came up with the idea of taking individuals who are really interested in social accountability, and giving them the knowledge, skills, and some of the leadership qualities to tackle this. This is where the Health Equity Fellowship started.

What's involved in being a Health Equity Fellow?

In summary, you undertake a rotation that provides relevant clinical experience in deep-end general practices, A&E, mental health, substance misuse or inclusion health services alongside the normal educational activities of GP training. One of the things we learnt from teaching GP trainees' health inequalities, was that trainees felt they did not know what to do in practice. They would see the injustices and inequalities and not know what to do as they had not been equipped with the practical skills.

Alongside the rotation, we developed an enhanced education program for those individuals, so our GP doctors in training were more likely at the end of training to feel able to work in deprived areas and serve their patients.  The fellowship’s vision was that it would leave GP doctors in training with more confidence to take up post-qualification fellowship roles, or other roles related to Health Equity. We wanted our GPs to have the knowledge, skills, and confidence to practice in an area of deprivation so they can apply for jobs in deprived areas and deep-end practices, or in relevant leadership and education roles.

How else does the fellowship support GP doctors in training to reduce health inequalities in their communities?

When I did my Masters in medical education, my dissertation topic was to design a curriculum for health equity for general practice training. What we asked was: what do people need to know, and what skills do they need to reduce health inequalities? What came out were things you might expect around the basics of health inequalities, in terms of knowledge, but also things like an awareness of the benefits system, local community assets and resources, sickness certification, substance misuse, specialist inclusion health knowledge, etc.

In terms of what people need to be equipped with, obvious things like learning about empathy, holism, and communication skills came out, but also a lot around leadership and advocacy, particularly how to advocate for your patient. The Health Equity Fellowship programme is designed to give people the confidence to advocate for their patients individually or as a group, and to step into local system leadership roles and make change. And to empower people earlier on their career with more energy and capacity.

How has the fellowship programme been received?

The fellowship began in Yorkshire and was well received and well evaluated. So, we thought: how can we spread this to other areas? At this point we asked regions to express interest in hosting their own fellowships. In August 2022, we had about 150 Health Equity fellows start in post across various regions. The fellowship is supported by a national programme of education sessions which is coordinated by Dr Rahhiel Riasat, Training Programme Director who has recently been appointed as the National HEFT Education Lead. Fellows are also receiving local support and experience via peer-to-peer feedback and through local relevant contextual topics. And we are about to recruit another 150 GP Trainees in August 2023.

Going forward the programme will want to focus on expansion, but more specifically on improving the quality and consistency of the national education sessions, local peer learning and support as well as how we can use technology to facilitate this blend. The ambition is to keep it growing to get regions on board who have not had the opportunity yet to get involved. And we would like to have 10% of the GP training intake going through Health Equity focussed training which would be around 400 a year.

And finally, what advice would you give to someone wanting to get into a health career about their sphere of influence to address health inequalities?

When I am teaching about health inequalities my summary points are that they are present, unjust, and unfair, and that healthcare has a limited but really important role in tackling them. If you are someone that sees the injustice of health inequalities and wants to do something about it, consider: where can you make a difference in tackling and addressing health inequalities? Get up every day and consider, what are my spheres of influence, what can I bring to bear today that is going to make things better than they were yesterday? But, to counter that, it is tough, difficult, and challenging to work at the ‘deep-end’ particularly across a career to recognise you cannot fix everything. Just fix what you can and look after yourself, because it is very much a marathon, not a sprint.

For more information on the Health Equity Fellowships and to find local contact details please see our GP Fellowship webpage.