GP Training for Areas of Deprivation and with Marginalized groups

Problem

It is known that people from lower socio-economic groups have lower life expectancies and higher burdens of multi-morbidity. North Dublin is an area with large tracts of blanket deprivation. Despite this deprivation and the associated health problems the GP:patient ratio was 1:2500 versus 1:1600 nationally. This confirms Tudor Harts Inverse Care Law.There was difficulty recruiting GP’s in North Dublin, a factor not unique to Ireland. A 2001 UK study found non deprived areas had almost twice the amount of applicants for GP posts as deprived areas which resulted in difficulties filling 68% of urban deprived posts compared to 29% rural posts. It is also known marginalised groups have the worst health indices and have difficult accessing primary care.

Approach

This presentation describes the North Dublin City GP Training Programme which was set up in 2009 to specifically train GP’s to work in areas of deprivation and with marginalised groups.

Findings

The presentation will describe the NDCGP and how it specifically trains GP’s to work in areas of deprivation. It will describe the curricular modules that support this mission including 1. The Social Medicine Module that pervades the curriculum; 2. The Self-Care Module (inc Mindfulness Based Stress Reduction and Balint groups) that focuses on learning how to avoid burnout. 3. Advocacy and Professionalism training that instils the skills of advocacy and of change management. It will further describe a particular educational initiative, the Social Inclusion Special Interest Posts, that were designed to help GP registrars develop the knowledge and skills to work with marginalized groups including homeless people, migrants, prisoners and substance misusers. These posts involve GP registrars working one day a week for four months in homeless primary care services; another day in prison and ethnic minority primary care services; and another in Drug Treatment Services. The educational theory for these posts is based on the Contact Hypothesis which proposes that contact breaks down stereotypes. Videos of registrar feedback on these posts will be shown. Lastly, it will describe the successes of the Vision and Mission Committee and its activities which is led by GP Trainees and supported by the Programme Directing Team and whose role is to ensure the Vision and Mission of the scheme remains a living influence on the trainees.

Consequences

This GP training scheme is a new initiative both in Ireland and internationally and as such has relevance internationally where the difficulties of encouraging primary-care physicians to work in areas of deprivation and with marginalised groups is widespread. The scheme produced its first GP registrars in 2014. Results of feedback from these registrars will be presented. One of the outcomes is the creation of a Social Medicine Module on the Irish College of General Practitioners national curriculum.