‘A new trick for old dogs’
Guest blog by Dr Lisa Horman, Taunton Vale Healthcare
There is only so much a middle-aged GP can take… and in my case, it was the cumulation of 26 years of full-time partnership and increasing demand. A list size of 3000, obsessional traits and a perfectionist streak eventually take their toll. If only Davina had been around, I might have gone on HRT, but as it was, I had a series of mental health episodes; a bit like the survival curve for chronic disease, they became longer and deeper each time, and I never quite got back to baseline. It was clear that SSRIs and talking therapies alone were not the answer, and Something Had To Be Done.
I will forever be grateful to my partners for looking at my abilities and strengths, rather than what I couldn’t do. I had already been doing a weekly clinic at the homeless clinic and working with Learning Disability care homes, so this has expanded to become the mainstay of my new role. As well as the day-to-day care of some very complex disabled people, I did the LD annual health checks for the 200 eligible people on our list. I took over as Safeguarding lead, carried on being an educational supervisor, and kept up 2-3 sessions of telephone triage to keep in touch with the generalist role.
In the past four years, the role has adapted to meet the changing needs of the practice and patients – sometimes doing more F2F consultations, spending freezing cold days in gazebos doing COVID vaccinations at care homes, adding video consultations, doing clinics at the homeless drop-in centre as well as the hostels. As long as the work gets done, I have complete control over how I structure my week, which certainly helps with stress levels.
I’ve always been interested in the complex and challenging aspects of primary care but having the time to deal with them properly have been a revelation. Instead of running an hour late and cutting other patients short, I can schedule longer appointments and spend time developing trust and rapport with some of the most excluded people in our society. Success take time and is often modest, but always to be celebrated.
The other, unexpected, gain was working with a wide range of other people and organisations. The multi-agency Creative Solutions team brings together professionals from health, social care, mental health, substance misuse, housing, support services and more, to develop a person-centred strengths-based approach to long term homelessness. To see people moving into their own homes after years of living on the street or in hostels has been inspiring. But the work doesn’t stop there, and they still need additional support to be able to achieve the same health outcomes as other people. The setting up of a Homeless Outreach nursing service across the county has transformed the care we can give in so many ways. The commitment of people in the ICB and County Council to ending homeless has been remarkable – with the Homelessness Reduction Board making real progress. (I’ve never sat on a Board before – there is a surprising amount of common sense!).
As well as the HRB, I’ve been asked to contribute to other teams and working groups – on annual health checks, cancer screening inequalities, adaptations for people with LD and autism and exploring the trauma-informed approach to health inequalities. This week marks the start of the most exciting development so far – two GP trainees have joined the practice, each of whom will work half-time with me for 6 months, focusing on Health Equity and disseminating their knowledge and experience to their peers.
When I retire in two years, I hope there will be a legacy of young GPs who understand and relish the challenges of this kind of work. Does your practice have a Health Equity lead? Is there a middle-aged slightly burnt-out GP who needs a change of pace and focus? Or a bright young enthusiast who wants to help those who most need it? I would encourage anyone to give it a go. I’m happy to have a chat to anyone who would like to know more.
Dr Lisa Horman is a Specialist Salaried GP at Taunton Vale Healthcare.