Ten years as a Marmot city

I started this fellowship in a unique, privileged position, as a mid-career GP, already connected to much of the health inequalities locally and regionally and being rooted in the community that I have worked in for 10 years.

We recognised that all our doctors have a significant personal commitment to social determinants of health, proportionate universalism and that all of us have experience of the complexity of people's lives in the community, citing things such as high rates of adults with lived experience of sexual abuse or physical abuse, poor educational standards, high unemployment (16.9% of our patients, Coventry Council data, 2022), low levels of health literacy and poor health activation and low personal ownership of health-related issues. We also recognised the strength of the local community with assets both tangible and embedded in the fabric of people and their connections.

We aimed to raise the profile of health inequalities work amongst the wider practice, to improve our thinking on the issues, and to tangibly reduce inequalities in access, experience, and outcomes for our patient population.

Alongside the training and peer support sessions, there was time for us as a partnership to have conversations together framed around the lens of reducing unjust, inequitable practices and outcomes.

Ownership of health-related issues

We felt it important to focus on something tangible and local using a population health management (PHM) approach for this defined Fellowship period. We used local and practice data as well as brainstorming with staff and patients, ensuring that we had a community- centered approach even to a "medical model". Using practice data, Core 20Plus5 priorities, patient experience, and practitioner and community voice under-treated hypertension and high rates of cardiac death were given particular attention at a practice level to identify patients with poorly controlled hypertension and stratified them based on medical and lifestyle risk factors.

We aimed to telephone patients to invite them in via text message and letter and up-skill nurse associates in hypertension management. This resulted in improved achievement of target blood pressure (surrogate endpoint). Outcomes of improvement in CVA, MI occurrence, and death awaited.

The project also aimed to pull together the prevention of heart disease with simple lifestyle messaging; training children in basic life support (BLS) and inspiring and aspiration about roles in teaching and health care.

Successes

The training package was delivered in collaboration with the school to:

• Three schools, 96 children, ten parents, and five teachers.
• Two youth groups, 16 children.
• Three peer group primary care sessions, 38 staff.

We were also able to use some of the monies for capital expenses such as the resuscitation dummies and a Fractional Exhaled Nitric Oxide (FeNO) machine for asthma to reduce inequity of provision of best care in our community.

The fellowship has been central in helping me shape my practice into something that fits well with my philosophy around health inequalities, the wider system, and community involvement and keeps me passionate about my core values.