Key contacts
Isabel Raynaud – isabel.raynaud16@imperial.ac.uk
Kajal Ruparell – kajal.ruparell16@imperial.ac.uk
Dr Nina Dutta – n.dutta@imperial.ac.uk
Dr Arti Maini – a.maini@imperial.ac.uk
Introduction
During Year 3 all Imperial College medical students spend 9-10 weeks on a general practice placement as part of their Medicine in the Community Apprenticeship. During this placement, all students complete a Community Action Project. This is a project that aims to improve an aspect of health and welfare of the communities in which they are based. They are encouraged to engage with members of the community (including patients, community groups, third sector organisations and health professionals) and use quality improvement principles including building sustainability into their project.
Since 2017, there have been 179 student projects. A significant proportion of these have related to child health, encompassing a range of topics from addressing cultural barriers to childhood immunisations to raising awareness of childhood asthma via teaching at local schools and creating a video. The community action projects have allowed our students to engage in meaningful community engagement and make real impact on the health and welfare of the communities in which they are working. Student feedback following the projects showed that students engaging in this service-learning approach felt empowered to make positive change and were more engaged in their learning. We will be continuing the project in the 2019/20 with research addressing the impact of the project on both the student learning experience and impact on local communities.
An excellent example of a Community Action Project completed by two Imperial College students, Isabel Raynaud and Kajal Ruparell, in March 2019 is the development of a Youth Patient Participation Group. Isabel and Kajal have described this project in their own words below.
CAP project – Youth Champions – Objectives and Delivery
As part of our university course at Imperial College School of Medicine we were given the challenge of setting up a Community Action Project. We were placed in a GP setting in Mottingham, South London, for 10 weeks and used the time to spot, analyse and produce an intervention that could help the community. During the placement, we soon realised that the practice was struggling to keep the local youth satisfied with their services and we wanted to help address this.
Through discussion with our GP lead and other doctors at the practice, it became clear that there was an issue with getting and sustaining the interest of young patients. It seemed that they were dissatisfied with the services being provided at the GP but were not taking the opportunity to voice their opinions through the means available to them (e.g. family and friends questionnaires, PPG). We wanted to do something to bring young people on board, giving them a bespoke platform to express their views.
The practice already had an adult Patient Participant Group (PPG) so it seemed a logical step to try and introduce a similar concept to 16-19 year olds. This would be in the form of a focus group, giving young patients a platform to openly discuss what the practice was getting right and which improvements could be made to keep them satisfied as patients. Our aim was to create the foundations of this practice-based Youth Patient Participation Group (PPG) by the end of our 10 week placement.
Patient safety was an important factor in the group we targeted. We chose to speak to patients between the ages of 16-19 because we felt they could speak for themselves and that there would be less concern from parents and carers should the group meet in person. From the age of 16, patients are deemed competent to take their care into their own hands, unless evidence is provided to the contrary. We also felt that above the age of 19, patients should be encouraged to join the adult PPG.
Initially, as this was a pilot project, we wanted to ensure that the patients we invited to the youth PPG would be regular visitors to the practice. The idea behind this was that they would have more experience of the practice and the way it runs and would therefore be able to provide us with more extensive opinions. To ensure the young people we invited to the meeting had a regular attendance record, we selected our initial group by using the GP’s records to put together a list of patients with chronic conditions. These conditions included asthma, type 1 diabetes, sickle cell anaemia and mental health conditions (e.g. depression and/or anxiety).
We put together a shortlist of patients and made initial contact via telephone. We were happy that many of the young people we contacted seemed excited at the opportunity to have their views heard. We also used the initial contact to ask a preliminary questionnaire and start collecting data on the changes young patients would like to see being made. We also took further contact details to maintain contact with these patients via email.
Finally, we invited the group to take part in a face to face meeting. We were pleased with the initial feedback and we were able to use it to gain some constructive feedback for the surgery. We did however have limited attendance and it became clear, that more needed to be done to entice the youth to attend meetings.
The poor attendance to the meeting made us think harder about how we could get young people fully involved with the idea. We decided a change of branding might help – changing the name from “Youth PPG” to “Youth Champions”. We also wanted to keep the project fun and fresh, putting together some memes for the GP to put out on their social media inviting young people to get involved. We also thought hard about how we could incentivise people to come – in the future there is scope to make the meetings more of a social affair with fun activities for the young patients to get involved in before discussing their feelings about the practice.
Progress made: What have you learned from doing this?
We learnt a lot from the young patients at the practice. Through our telephone interviews we found that they were largely satisfied by many aspects of the surgery and its services but that there were a few key concerns. They were not only worried by the usual concerns of waiting times and admin, but by the more pressing issue that their doctors were not taking them seriously because they were young. This message came through a number of times – it was especially prevalent in those we had short-listed due to their diagnoses of mental health issues.
We also recognised that there were issues with communication at the practice. Some patients felt that they were sometimes “dropped” or left without an explanation or diagnosis after their visit. It became clear that the follow-up process needed to be clarified with patients.
In terms of improving the Youth Health Representative project itself, we wanted to work on incentivising the young people in the local area to attend the group, improving numbers and getting a broader range of opinions. We are considering adding a social element to the meetings, as well as potentially opening a lottery system where patients are entered to win a prize if they attend meetings. In addition to this, we recognise that between the ages of 16 and 19, people are thinking hard about their futures – we thought it would be a nice addition to add a workshop element to the meetings so people could learn something from the meetings. We also wanted to provide certificates for the patients that attended which could be useful additions to UCAS applications and CVs.
We also want to work on communication with the young people. Telephone interviews were useful, but there were a number of constraints – including the fact that the majority of the patients we contacted were in school during the hours we tried to make contact. Email is also useful, but had a limited response. We need to think of appropriate ways to get into contact with young people – we are currently considering an online forum/group chat approach, but need to reflect on how we can do this safely and without impacting patient confidentiality.
We would also like to open the group out to more people to hear a more varied group of people. This would mean extending the invitation to all patients between 16-19, not restricting it to those with chronic conditions. This would hopefully improve numbers and increase the pool of opinions represented.
What’s your take home message?
We were excited by the simplicity and potential for the project to have a direct impact on how the practice helps young people. We tried hard to organise the meetings and get people onside, but a key issue presented in how to contact and incentivise young people to attend. We recognise that patient administration is always complex and difficult to manage, but feel we have laid a foundation for a youth PPG. Through further liaising with the adult PPG and our GP consultant, we hope the group we have put together can be further supported to make it more useful in the future.
It is critical that young people are made to feel welcome and appreciated by their practices and that they feel they are being taken seriously.
This project taught me the importance of enthusiasm and persistence in Medicine. It was tricky getting young people to engage but by staying keen and trying different ways of contacting people we gained some traction. I have also learnt that creativity is vital and that there is nothing wrong with trying to make projects fun and inventive to get people on board. A major part of creative thinking is collaboration and it was a pleasure to work with people from different backgrounds, both patients and colleagues at the GP.
We would love to keep working beyond our pilot and keep coming up with fun and inventive ways to get young people to keep talking about the changes they would like to see in this GP practice.