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Episode 14- Jonathon Tomlinson

Season 1, Ep. 14

In this episode we catch up with Dr Jonathon Tomlinson, an amazing GP in Hackney. Jonathan fills us in with how he is getting on during the coronavirus crisis. He shares his experience working in a practice in one of the hardest hit areas for coronavirus in the UK (1min 40). He tells me how his team has acted quickly to manage the acute situation but also continues to support the long term conditions for many of his patients in the community. 


We talk about some of the many changes in primary care over the last few weeks (5min 40s). These include; phone and video consultations; losing the GP waiting room; sharing clinical decisions and talking more with colleagues. We discuss the effects of coronavirus on those people living in deprivation (10mins 10s) and Jonathon shares some experiences from his practice and his patients (11mins). Jonathan talks about the social determinants of health and the importance of prevention along with all the stuff we are seeing in the media at the moment like PPE (14mins 50s) . 


One of the things that GPs can do is advocacy and Jonathon was keen to discuss the work of Dr Rudolf Virchow 1821-1902 (19mins). Virchow is famous for saying that politics is nothing but medicine on a large scale and that our role as doctors is to show the link between social conditions and medical diseases (21mins). Jonathan explains why Virchow's message is particularly relevant at the moment. We explore the role of a GP in advocacy and coordination of a response to support those who are most in need and vulnerable. We discuss how much our job in primary care should include advocacy on behalf of our patients (26mins) and Jonathon offers some ideas for some steps clinicians can take forward to achieve this. Jonathon mentions collaboration, networks (e.g. The Deep End Network), treating long term conditions. We finish our conversation talking about the importance of caring for our patients (28m 55s), Jonathon shares his favourite book (32m 10s), and he tells us what his magic genie wish would be (34m 40s). 


Jonathon’s recommended Book

Let Us Now Praise Famous Men by James Agee (photographs by photographer Walker Evans)


Other reading


“Caring Effects” Julian Tudor-Hart and Paul Dieppe (mentioned at 30mins 50s)


Jonathon’s excellent blog

My (Rachel's) favourites


You can also find Jonathon on tweeting on being a GP and topics related our discussion @mellojonny

More Episodes

4/17/2020

Episode 13- James Matheson

Season 1, Ep. 13
Dr James Matheson shares his experience on what is going on at his practice in Oldham, Greater Manchester, during this worldwide pandemic. James highlights how we are uniquely well placed in primary care to identify those most in need.James shares some of the positive stories of support during this crisis. He gives an example of how those living with homelessness have been housed almost overnight after years struggling to achieve this. We also talk about what we can learn from this crisis to support the most vulnerable in the future.Alongside seeing patients with Covid-19, James discusses the importance of continuing day to day care especially for the most vulnerable. He shares some of the things individual GPs can do to support these vulnerable people and how we can identify and reach out to those people most in need. We discuss the risk of Covid-19 for patients living in deprivation, but also the impact of little or no financial reserve during this time. He talks about some of the vulnerable groups that are particularly likely to suffer during this crisis. He mentions those living with homelessness, Gypsy and Travellers, refugees and migrants.To finish James tells me why he is feeling positive about the future.Please check out a recent blog post Fairhealth in the time of Covid-19 from Dr Tom RatcliffeThe RCGP are releasing some guidance on supporting vulnerable patients very soon. Keep an eye out on their resource hub and I will also post a link here.
2/21/2020

Episode 12- Sir Michael Marmot

Season 1, Ep. 12
An interview with Sir Michael MarmotShow Notes I was honoured to have a conversation with Sir Michael Marmot just a few weeks before The Marmot Review 10 Years On is due to be released. He told me the report has been performed in ‘the spirit of self examination’ to see if there has been any impact or if any good has come from the original report (2mins). He mentions the importance of the report amid the current context of worrying life expectancy figures (2m45s) and sheds some light on the reasons behind these worrying trends (4m40s).Sir Michael Marmot is world renowned as a specialist in the impact of inequalities on health with internationally acclaimed research, writing and public speaking on the topic. The professor talks to us about how he perceived his role in all of this (8mins) as someone who synthesises evidence and chains of reasoning (10m40s) to formulate recommendations. Despite being an international spokesperson for such an important issue, Michael tells me that he doesn’t see himself as particularly political (12m50s) but does feel able to present information ‘in the spirit of social justice.’ We discuss if the moral case is enough to inspire or create political change (13m30s) and how to create action around health inequalities. With years of experience of sounding the claxon for this important issue, he gives his views on how we unite people around this goal and how to deal with actors in the system that might not prioritise equity (15m 30s).With government promising more spending we talk about current opportunities for spending in areas that are most in need (17.30) and gives hope that there will be clear recommendations coming out of the report for where government should direct their resources. We talk about practical action for health professionals too with six recommendation of how we as health professionals can take steps try to tackle health inequalities (19mins).With climate change likely having the biggest impact first to those most disadvantaged and in need, Michael is aware of the current importance of climate change and environment. He shares with us how he is involved in trying to bring the environmental and social determinants of health agendas together and how actions to improve health can contribute to meet carbon neutrality (23mins).To finish we ask for Michael's book recommendations (24m10s) and his genie wish (28m10s)Michael's book recommendations (24m10s)Development Is Freedom – Amarta SenCapital Twenty First Century- Thomas PickettyGreat Expectations by Charles Dickens (first 2 pages if nothing else)Further readingWorld Medical association report- Doctors for health Look out for the Marmot review 10years on report due to be release on February 25thMichael Marmot’s five recommendations of what doctors can do to tackle health inequalities1. Education2. Seeing the patient in a broader perspective/wider context3. Health service as an employer and the health system having an impact on the broader environment and community4. Working in partnership5. Advocacy
1/28/2020

Episode 11- Victor Adebowale

Season 1, Ep. 11
An interview with Victor Adebowale, Chief Executive Turning Point'My experiences of life have lead me to believe that in most public services the inverse care law applies, it shouldn’t. It’s an inefficient use of limited resourse’ - Victor AdebowaleShow Notes Lord Victor Adebowale is a busy man so I was so pleased he managed to squeeze in a chat with me for the podcast. He talks with honesty and humour. Every time I have met him our conversations give me so much to think about.Victor shares his experiences as Chief Executive of Turning Point. He tells me how he and his team make it their mission to try to tackle the inverse care law (2mins). He talks about the importance of a clear vision for his team and what a privilege it is to try and improve the complex lives of others (7mins). Turning Point’s role in the system is complex but made even more so by the need to run an effective business amid all the complexities of the system (9mins 10s).Victor thinks about how we can best design services to fit the system and the population. He explains the importance of having positive rather than negative value transfer (10mins) and how Turning Point put clients at the centre of service redesign. He gives an example of how they have done this at Turning Point by integrating alcohol and drug services.We discuss competition and his experience of collaborating with local services and the community (14m30s) and when this does or doesn’t work. We bring in the concepts of place based approaches and population health explaining how his team works hard to understand the needs of and build trust within a particular community to try to deliver this. He says the concept is easy but the application is rather more difficult. He explains that for him this means ‘leadership beyond boundaries’ and ‘system leadership’ (from 20m30).In his chief exec role he explains the importance of working out what the right question is (21m 10s) and says that is often questioning whether a process matches the intention (23mins). For Victor one of his main intentions is tackling the health inequity and the inverse care law (24mins). He says ‘What else are you going to talk about if you are involved in health care?’ For him he says this is a logical approach (25m 50s) for him and feels this would be the same for any sensible human being wanting an impact in the system.He talks about how we cope when other people in the system don’t share the same priorities and how we can build some accountability to ensure health inequity moves up the priority list(28mins 40s) . We discuss measuring success and impact in a system (29mins) and how trying to reverse the inverse care law should be taken into account when thinking about any measure we use for the system.As always we finish talking books and dreams. Victor gives us his recommended reading (34mins 40) and his one wish to tackle health inequalities (35mins 20s).What I really liked about this conversation is that everything we talked about came back to trying to reverse the inverse care law. We hope you enjoy the episodeIntro about Victor (1m45s)Victor’s recommended readingAnything by Professor Michael Marmot e.g. The Marmot Review: Fair Society, Healthy LivesInvisible cities by Italo CalvinoHe recommends us to read books that aren't about what we know about already but new things people that we haven’t come across before.Genie question (48m10s)‘In a nutshell, there are only three challenges that face the NHS: Equity, Access and technology, in that order.’(11mins 30s)Victor Adbeowale