Abstract
Learning about global health may seem low down on the priority list, especially when it seems like there are already not enough hours in the day. We could easily get through our daily routine serving our population without ever looking outwards. However, now, more than ever, we are seeing international affairs on our doorstep. We see the words ‘migrants’, ‘refugees’ and ’Brexit’ daily in our newspaper headlines and it is impossible to escape the effects of globalisation. As GPs, we see a cross-section of our population and understanding the wider world can help in the consultation room. Furthermore, the UK general practice system is often seen, rightly or wrongly, as utopian by family physicians worldwide. Despite its flaws, the National Health Service (NHS) stands worldwide as a pillar of equitable healthcare, with GPs enjoying the enviable position of gatekeeper. Since the establishment of the NHS in 1948, GPs have been on the front-line of NHS services to ensure efficient and cost-effective population-based healthcare and the rest of the world wants to know how we do it.
The RCGP Junior International Committee (RCGP JIC) is a group of 16 young volunteer GPs (Associates in Training or GPs within the first 5 years of qualification) with an enthusiasm for international primary care. We aim to increase and enhance training opportunities in Global Health for other young GPs and to push these opportunities further up the agenda. We believe that experiencing healthcare systems abroad makes us better doctors and aim to harness this interest, providing sustainable and ethical opportunities for all. Here, we discuss the opportunities to get involved in global health without even leaving your consultation room, as we appreciate that not all GPs can go gallivanting around the world!
Host a GP from abroad
‘Hosting’ an international junior colleague (a trainee or a newly qualified GP) can be a reinvigorating and rewarding experience. Placements are purely observational, and normally last 1 to 2 weeks, ideally using your whole healthcare team for a varied experience. Hosting is flexible, and you can host once, sporadically or regularly, with no obligation to timetable social activities or provide accommodation, although there is no rule to say that you cannot do so! GPs at any stage can host, including trainees if your training practice is supportive. We are looking for internationally-minded UK GPs who want to participate.
Being able to discuss, debate and contrast primary care systems can open our minds to the differences, but more often the similarities, between cultures. The JIC are constantly contacted by junior GPs from abroad wishing to observe UK general practice: one of the longest established primary care systems in the world. With so much negative press about our profession in the UK, we can easily forget how much there is to be proud of. Most countries worldwide have an under-developed primary care service and experiencing the NHS first-hand can inspire doctors from often fragile and unrewarding systems. Hosting colleagues from abroad can stimulate innovation for both host and visitor. It can be an excellent forum to learn about new clinical practices, new technologies and new methodologies as plausible solutions to daily challenges. Reflecting upon UK general practice with a keen international colleague can be fascinating, allowing a unique perspective upon our own clinical care, attitudes and procedures. Hosting can contextualise specific patient populations’ attitudes and health beliefs, perhaps allowing us to connect more thoughtfully with local populations by better understanding their healthcare choices, prescribing and referral expectations.
Needless to say, these reflections can be useful both on a personal level, for appraisals and revalidation, but also help develop professionalism and leadership skills. It is also a great way to learn or practise a new language, try new foods and connect culturally without leaving the consultation room. And last, but not least, it gives an excuse to place the UK on the cultural map, an opportunity to quash the international reputation of bad food and bad weather, and to reach out to our neighbours from under the shadow of Brexit.
Twinning
Let us suppose you meet a colleague from abroad and it is a meeting of two minds. How do you develop this relationship further? Twinning is a concept of pairing two institutions from two different cultures to share information that is successfully used in schools and between town halls. Through the means of high-speed communication and networking events, we can empower GPs from other countries in finding solutions to their dilemmas and, in return, they can give us perspective on our daily grind. Take the KNUST–Grantham partnership between a medium-sized GP practice in South London and a university hospital in Ghana. Originally developed from a friendship between Dr Sharma and Dr Ayisi-Boateng, this long-term partnership promotes the provision of high-quality population-based medical care for each locality. For KNUST, this means promoting and developing family medicine as a speciality. For the Grantham practice, it means reaching out to their local Ghanaian population for optimal disease prevention and holistic care. These partnerships are organic and individual and the JIC can help guide you on how to make it work.
Volunteering
Health and wellbeing, whether for asylum seekers, the homeless or other marginalised populations, is a human right. The ability to provide good quality healthcare with judicious use of resources makes GPs best placed for volunteering and there are multiple opportunities in the capital and across the nation. Remember to sign up with a reputable organisation and also to check with your indemnity provider. Most organisations will request that you are an independent practitioner, although some charities will be happy to provide some supervision for trainees.
Advocacy
The junior doctors’ contract brought out the activist in many of us, learning how to spread a message through social or mainstream media, canvassing local politicians or taking to the streets. As GPs we see the effects of the social determinants of health on the wellbeing of our populations and raising awareness may help combat the rising tide of negativity and exclusion. Whether for torture victims or those stuck in the asylum process, having an advocate can help send a powerful message. However insignificant it may feel, small injustices need to be highlighted to prevent larger ones. Edmund Burke reminds us that ‘The only thing necessary for the triumph of evil is for good men to do nothing’.
Get connected
The Vasco de Gama pre-conference, preceding the annual WONCA Europe conference, is a great place to meet European colleagues. Our young doctor counterparts from all across Europe join together for 2 days of workshops and talks, and there are plenty of social events to meet new colleagues and friends if you decide to come alone. This is followed by the WONCA Europe conference, but there is no obligation to attend both events. The JIC have a strong presence at the RCGP annual conference as well as WONCA and are very approachable. Let us know if you are thinking about coming and we can help you network with like-minded people.
Finally
If you have a project in mind, then the JIC want to hear about it. For those of you new to the concepts of global health, exchanges to Europe and the rest of the world including Japan are an easy starting-point. Contact us about our organised sustainable volunteer placements in Uganda if you want something more substantial. Within the UK, we are collaborating with the other Colleges to campaign for the inclusion of Global Health competencies in the curriculum, as well as advising for Global Health GP fellowships. We can provide advice and possibly signpost you to supportive individuals and networks if you are creating and planning your own opportunities, and aid you through the process with our toolkit for GPs planning to work abroad.
We would love to hear from you if you are interested in any of the projects above, or would like to be involved with the JIC. You can also contact your local RCGP international faculty representative, via your local faculty website, to see if there are any other opportunities near you.