An emotional return to Sheffield uncovers important insights into general practice and communities

Introduction by Croakey: When Dr Tim Senior recently returned to Sheffield, a city in south Yorkshire, he was overcome by nostalgia as he reconnected with his family and professional roots.

Senior, who trained in Sheffield but now works in an Aboriginal Community Controlled Health Organisation (ACCHO) in NSW, says one of the lessons from his visit is how much the ACCHO model can teach health systems in the United Kingdom.

The article below is published as part of a Croakey series arising from Senior’s Churchill Fellowship, investigating GPs and primary care teams working in marginalised communities in the UK and Ireland.

Tim Senior writes:

As I got off the train at Sheffield station a few weeks ago, and made my way to my accommodation on Eccleshall Road, I was flooded with a feeling of familiarity and nostalgia, which was both surprising and reassuring.

My father’s family are from this neck of the woods, and the only place where I have seen patients with the same family name as me was working at the Northern General Hospital in Sheffield. I worked there as a junior doctor around the turn of the millennium!

I learnt my general practice here, in fact doing Deep End general practice before we had a shared recognition of what this meant.

It’s difficult for these formative experiences not to colour my trip to visit Deep End GPs in Sheffield. I felt at home amongst the people here. I love that bus drivers will greet anyone, man or woman, as “love” or “duck,” and I love the accent.

Sheffield is a small city, known for its history of steel making, including cutlery and surgical instruments. Historically, the well-off factory owners lived on the west of the city, while the workers lived on the east, as this was where the prevailing winds swept the air pollution from the steelworks.

This economic geography is still maintained, with the richer areas to the leafy west, reaching into the beautiful Peak District, and the poorer areas off to the east.

Connecting for wellbeing

The centrepiece of my week was Connecting in the Kitchen, a regular evening gathering of GPs started by Dr Alice Deasey at a local vegan/vegetarian café specifically to promote wellbeing.

This is in stark contrast to what I am more used to in Australia, an evening of Continuing Professional Development, or another PowerPoint from yet another non-GP specialist.

I can’t begin to tell you how refreshing I found the Connecting in the Kitchen approach.

Over a free meal, GPs had sessions as diverse as learning from each other about their own experiences in the health system, and creative writing.

Close observers of the photo of this event (featured above this article) will notice a large majority of women.

My observations during the week were similar. It seemed to me that the males involved in Deep End work were mainly connected with medical education. Several people told me during my visit that the GPs who co-ordinated the connections and activities of the Deep End in Sheffield were known as The Mighty Women of Sheffield!

Such was the success that on the evening I attended, a GP came for the first time after being advised by their appraiser that what they really needed wasn’t extra education, but to address their professional isolation (for an explanation of the appraiser’s role, see the end of this article).

Over beautiful vegetarian food, I presented on my experiences in Australia, including the distribution of our social determinants of health, and the history and ongoing effects of colonisation on Aboriginal and Torres Strait Islander people, and how this affects my work as a GP.

This evening showed up the themes in microcosm from my whole week in Sheffield. The whole week was about community connections – the community of GPs connecting over dinner, and more importantly, the connections to community of general practices and researchers.

Participation matters

Professor Caroline Mitchell (this link goes to her Twitter/X profile, but she may just have moved to BlueSky) at Sheffield University, who has recently taken up a post at Keele University, is working hard to ensure that marginalised communities are represented in research.

This is crucial; otherwise research evidence that is meant to improve care becomes irrelevant to those who need it most.

One of the most memorable days of my whole Fellowship trip was meeting the Deep End Research Alliance Patient Participation Group. They are a knowledgeable and passionate diverse group of people, with a profound and often personal understanding of migrant experiences in Sheffield.

“Ultimately, we’re here because you [the English] came to us,” was one pithy summary.

In discussing my experiences working with Aboriginal and Torres Strait Islander communities, this group had profound insight into the differences between a migrant experience and colonised Indigenous experiences. This distinction is frequently missing in discussions about cultural and linguistic diversity in Australia.

Networks

The connections of health services into communities were also highlighted for me when I met the Foundry Primary Care Network team lead by Rebecca Reeve.

This is a group of people funded across several practices to provide social prescribing and support to patients of these practices. They formed links between patients with complex mental health problems or chronic diseases and social and community services. They also formed relationships with these services, so while they were providing individual patient-centred care and practical support, they were also linking the health services with community services more effectively.

Every single one of these workers was going above and beyond their prescribed duties and working hours to be effective at providing this support.

As Reeve told me, the funding they got for their services was the same as that for the Networks in well-off leafy suburbs of Sheffield.

This doesn’t direct funding toward where it is needed most, and may even worsen health inequalities. In those richer areas, people already have local social capacity and services, so funding can go toward enhancing and supplementing these. However, in areas already struggling to fund local agencies and meet the larger demand, this funding is used to create the level of service already available elsewhere.

All general practices in the UK are required to have patient participation groups, and in Sheffield there’s an effort across the practices I visited to make this engagement meaningful.

This engagement is missing, at least formally, in Australian general practice. High quality practices will, of course, be well embedded and responsive to their community, and there is a requirement under general practice accreditation to seek and act on patient feedback.

Accountability

There was huge interest in Sheffield about the context that I work in – Aboriginal Community Control – and how this embeds primary care in the community it serves, and builds in community accountability.

We also had discussions about research ethics approval for Aboriginal and Torres Strait Islander health research, and the Lowitja Institute, as a community controlled research organisation.

It was apparent in our discussions that the England health system and research agencies could learn a lot from the Community Controlled Health sector in Australia about true community-led participation in primary care and research – as could the rest of the Australian health sector.

My trip to Sheffield was special.

I caught up with GPs who taught me and GPs with whom I trained. In going back to the place of my UK roots, I’ve heard about the importance of communities in primary care, and learnt that my actual home in Australia has the most fully implemented version of this, if only we can recognise it.

** Regarding the appraiser role: In the UK every doctor has to undergo a process of revalidation to maintain their registration with the General Medical Council. As part of this process, every doctor gathers supporting information to demonstrate how they have met their obligations under Good Medical Practice and meets annually with an appraiser to discuss this evidence and the doctor’s reflections. The appraiser, usually a doctor with knowledge of the context of the appraisee’s work, makes recommendations for the doctor’s professional and personal development. More information on appraisal is here.

• Thank you to Dr Amy Lucquiaud and family for the very generous offer of accommodation, to Dr Alice Deasey for organising so many visits across the Deep End of Sheffield, and to all the GPs, patients and professionals for being so generous with their time.

Bookmark this link to follow #ChurchillDeepEnd articles. Also, follow this X/Twitter list for news on Deep End general practice.