Supporting patients through multidisciplinary working

25 September 2020

"Been at any good meetings lately?" my friend (non-medical) sarcastically asked. We met up last month and it was good to see him. We talked about work and families and, of course, compared the seemingly endless Zoom meetings we were both engaged in.

The image from the start of The Muppet Show, where all the muppets are dancing in their viaduct style booths, is familiar to us all - but have we all had enough Zoom meetings?

RCGPNI Council

I have had a few excellent meetings recently and one which stands out was RCGPNI Council which was held last Tuesday night. You are represented by superb local GPs who are there to support you, raise your concerns and advance your priorities further. Please liaise with them and support their work.

You can see a list of your Council members on the RCGP website and if you wish to get in touch, please contact NICouncil@rcgp.org.uk.

Many issues were debated, and your NI Council have instructed me to ensure that government recognises that there are a lot of current demands on the GP workforce and general practice services.

Particularly with winter approaching, we will continue to raise capacity issues with key stakeholders and ensure that consideration and practical support are given to our practices, as without a strong primary care our entire Health & Social Care (HSC) system will struggle.

If you have wondered what happens at NI Council and would like to sit in on a meeting as a non-voting observer, please get in touch.

By switching to Zoom, it’s much more accessible for our members, particularly those who live far from our Offices in Belfast. If you are interested in attending, please contact our Policy & Public Affairs Officer Clare Higgins

RCGP Council was held on Friday 18 September and we are indebted to our RCGPNI Council representative Dr Waqar Ahmed for representing us at this.

Two papers stood out for me: Equality Diversity & Inclusion and Poverty, Health Inequalities and the Role of General Practice.

These papers, as well as the majority of the other papers, are available to all members so to access the council papers please log into the website and search under 'Council papers' section. It can easily be seen under the 'My RCGP' drop down at the top right of your home page.

Addressing diversity and inclusion

RCGP is working hard to improve its diversity and equality within our organisation.

Following the events in USA and particularly the death of George Floyd, many individuals and organisations renewed efforts to call out and tackle shortfalls in diversity and inclusion that sadly persist in our society.

The paper presented to NI Council suggested specific quotas of diversity could be aimed for, but after discussion we disagreed.

While we want to improve representation from underrepresented groups, our experience in Northern Ireland shows that specific quotas are rarely helpful.

Do you feel you are from an underrepresented group? We are keen to raise engagement from the ground up, so if you would like to be more involved in your College, get in touch and we will help ensure your voice is heard.

Our colleague Dr Carey Lunan, Chair of RCGP Scotland, presented a very powerful and important paper at UK Council, focusing on health inequalities across the UK.

I encourage you to read it by accessing via your RCGP web account. It was robustly debated with some GPs understandably questioning whether "this is our job".

I understand these views and respect them but a few administrative requests to my surgery this week highlighted to me its importance.

Personal Independent Payment

Most practices charge a fee for letters to patients. They do not do this to make huge profits, but to place value on our time and to deter endless requests of letters from schools, hospitals and other bodies. The phrase "just get a letter from your GP" is often the go-to for many issues. 

The first was a request came from my patient Anna (not her real name), who had come to Northern Ireland to work in 2018. She had only been working for three months before she registered with our practice and booked for a routine smear test. The results came through early, showing CIN II with possible invasive malignancy.

An MRI of her pelvis revealed an invading tumour into her endometrium and after a multidisciplinary team discussion in Belfast she received the most severe of treatments: radical hysterectomy with bilateral salpingectomy and pelvic node dissection, chemo-radio therapy and brachytherapy.

Thankfully, the outcome following treatment is that her cancer has been successfully cured; the consequence, however, is that it has changed her life forever.

Three weeks after her last treatment she required hospital admission for urosepsis where her ureter injury was discovered, requiring stenting.

The subsequent two years have been miserable. Her bladder capacity has been examined as 150mls and her vagina and perineal area are horrifically scarred and fibrosed from her treatment. Her request to me was to support her second attempt at Personal Independence Payment (PiP).

While she has been technically "cured from her disease", she is unable to stand for long periods of time and the discomfort and humiliation of having to return to her work as a manual labourer wearing what she describes as "a nappy" is unbearable.

Macmillan have been very supportive of her and it is worth remembering that as a charity they are very proactive with patients who have completed treatment but still need support.

There is a regional review of PiP underway and we need your feedback to help improve this important benefit. My personal bugbear is the size of the envelopes (they are tiny!) but I also find the questions unhelpful and I would personally benefit from a few examples of forms that have been completed well, to help me include the appropriate information.

To feedback any challenges or issues relating to PIP and help shape the College’s response to the Review, please contact Clare.

The other letter came from my patient Susan. Susan is 20 and married Joe (again, not their real names) two years ago. Joe’s story is sad and recognised by many of us. A shy child at school who found it difficult to express himself or integrate.

With likely emerging mental health issues, he got in with the wrong social crowd and started smoking cannabis aged 15. This gave him temporary confidence, but his habit drastically increased, and time quickly passed by, leaving him paranoid and dependant.

His "friends" moved on and Joe was left along, uneducated and unable to secure long-term employment. Joe and Susan then married and had two children. Her request to me was for a letter to support her application for childcare support during further education.

The request from Susan didn’t initially make sense so I phoned her to clarify. She had applied to study in the local technical college but needed help to apply for the grant available to support childcare. The aftereffects of his cannabis use have made Joe unable to cope with the challenges of children and he can be snappy and unpredictable. 

There was little benefit in me debating the causes or blame of Joe’s cannabis consumption - it has happened, and the damage is irreversible. The arguments in my head about not supporting Susan were easy: it’s not my work, I’m not funded to do it and I’m very busy. But what she said on the phone brought me up short: "If I don’t get this post I will never get out of the fish factory".

The Townsend Centre for International Poverty’s alternative ten tips for health suggest in point eight to “Claim all benefits you are entitled to”. It was hard not to feel Susan’s sense of urgency. Could this be the way to lift her family out of poverty?

Multidisciplinary support for patients

Whether we feel Anna or Susan’s issues were "my job" or not, having an inhouse social worker as part of a GP-led multidisciplinary team (MDT) would have been a fantastic help.

Are you part of an MDT practice with inhouse social work? Please get in touch and share your experiences.

It would be most helpful if you could share patient stories and examples where your social worker has helped. Policy makers and politicians respond better to patient examples rather than position papers (Great alliteration in that sentence don’t you think!)

I can assure you all that we are influencing the Department of Health and other stakeholders to ensure they understand the value and necessity of MDTs embedded within practices and we will lobby hard until the MDT scheme is rolled out across all our practices in full.

Mental health

Dr Ursula Mason and I met with Professor Siobhan O’Neill on Tuesday and it was a very helpful and informative meeting.

As you can imagine, we were both able to highlight to her the benefit of having a mental health and social worker in practice as part of an MDT and illustrate how this reduces wasted patient journeys, as well as being a great way to address health inequalities in our society.

We were also able to highlight that with the scheme only partially rolled out, patients currently face inequity of access to services depending on their postcode, which is intolerable.

Areas about the mental health worker role she was unaware of included the potential for our colleagues to help get "upstream" with our patients who have mental health issues and prevent them from entering crisis. 

We were keen to highlight to Siobhan that while patients with mental health needs were best attended to by our mental health practitioners, they still would be treated "under our roof" and that by acting as one team the patient’s GP would still be next door to offer continuity of care.

Siobhan is a frequent guest on BBC Radio Ulster and is worth taking a moment to listen to if you have the chance.

She gave a lovely piece of advice when William Crawley asked about how to deal with the disappointments that restrictions in travel are causing.

Her advice was to take a moment each day to list the things you can be thankful for. I know I keep this in mind to help me put things in perspective.

Continuity of care

Continuity of care is such a vital part of our job and it is well worth reading this important paper by Professor Denis Pereira Grey on its advantages to patient mortality.

While we celebrate the importance of continuity, how we connect with our patients is vital in this digital age and a fantastic and humane piece of writing on connecting with patients by our esteemed teaching colleague Professor Gerry Gormley is well worth reading also.

Gerry is a tutor in Queen’s University Belfast and hugely respected for his work teaching our students in clinical skills.

Am I thankful for more meetings? Actually, yes! I’m lucky to have a satisfying, well paid career which is interesting, stimulating and I get to work with brilliant fellow professionals who share my values. Lots to be thankful for I feel.


Post written by

Dr Laurence Dorman, Chair of RCGP Northern Ireland

Dr Laurence Dorman took office in November 2019 after three years as Deputy Chair of Policy for RCGPNI. A GP principal in Mourne Family Surgery, Kilkeel, Co Down, since 2007, he is the fourth generation of GPs in his family. He was also, until recently, the Chair of Newry and District GP Federation. 

Laurence has particular interests in new ways of working in primary care, cancer care, and inspiring the next generation of GPs. He set up the successful Dear Colleague initiative to improve the interface between primary and secondary care and has been a strategic advocate for interface and communication since September 2017.

During his time as Chair, he wants to support College members to ensure that the future of GP services is protected, supported and sustainable.


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