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COLLEAGUE of Dr Peter Cawston has described him in the magazine Pulse as a bit like a professional horse rider: “They sit there and jump huge fences and yet you hardly know they are moving – no fuss.” Certainly this soft-spoken GP has played a significant but understated role in seeing through an innovative policy shift in the


way health inequalities are being addressed in Scottish primary care. Cawston is one of the founding members of GPs at the Deep End – a group of primary care doctors working in the 100 general practices that serve the poorest populations in Scotland. His own practice – Garscadden Burn – is in the Drumchapel district of Glasgow, based in an ageing NHS health centre shared with five other practices. It’s a typical deep-end practice with 62 per cent of its 5,100 registered patients living in the 15 per cent data zones categorised as the most socio-economically deprived. In these areas healthy life expectancy among men can be up to 18.8 years less than in more affluent areas and 17.1 years for women. Studies have also found that practices in deprived areas have 38 per cent more patients with complex health needs (five or more long-term health conditions) and twice as many with combined physical and mental health problems than in more affluent areas. GPs at the Deep End was established in 2009 as both a


network and advocacy group for practitioners dealing with health inequalities on a day-to-day basis. Says Cawston: “Away back when we started no one was really talking about the role of GPs in areas of deprivation. It was never really discussed. Inequality was seen as a public health issue, not a medical issue. So within general practice it was invisible.” In 2013 the group published a “manifesto” on What can NHS Scotland do to reduce and prevent health inequalities? Cawston authored an annex to the report proposing the employment of “community link workers” within deep- end practices. “A great many health problems are caused by social conditions,” he says. “GPs were being asked to address a lot of social conditions that we weren’t equipped to deal with in a very effective way. That’s where the idea of having a links practitioner as part of the practice came from.” The role primarily involves “social prescribing” and


improving links with local community resources and services. Links workers embedded within a practice can help patients with issues such as adult and child protection orders, bereavement, rent arrears or threatened eviction, dealing with police and social workers, as well as promoting healthy living, including organised walks, yoga and cookery classes. The scheme also gives GPs greater confidence to ask patients about underlying issues, such as debt or domestic violence, because they now feel able to offer an adequate response. The proposal was picked up by Scottish Government and in April 2014 seven practices – including Garscadden Burn – began a pilot employing a “links worker”. “We were very lucky as Peter was the lead. He’s pushed and pushed for this for years,” says Elaine Smith, the practice manager at Garscadden Burn. “A lot of patients we would see week in, week out – we now see less of because their problems have been sorted out by Margaret Ann [the links practitioner]. They only need to speak with


10 / MDDUS INSIGHT / Q2 2017


DOCTOR AT DEEP END


a doctor if they are genuinely ill.” Says Cawston: “As a pilot practice we kind of felt we had to lead by example. But this has been a passion of mine ever since I became a GP, really, bringing together the social and medical models of health. General practice striding across the two.”


AN UNCONVENTIONAL APPROACH This passion is perhaps not surprising considering Peter Cawston’s background. He was born in Peru where his parents were missionaries and he lived there until a young teenager, before moving to Scotland. After doing medicine at Glasgow University he took a job in the south of France for two years, working in HIV medicine and psychiatry.


Photograph: Shannon Tofts


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