participation and engagement. “The research only just scraped through,” says Cawston.


“It was somewhat unconventional.” Local volunteers created the questions and tested them


before going to bingo halls and youth groups and other community settings to interview peers and conduct focus groups. The data was then analysed with Cawston acting as a facilitator. “It was blood-stirring stuff,” he says. “One woman was learning how to read alongside the research. She was literally taking transcripts of interviews to her English teacher and learning to read the words of her peers.” Cawston describes the process as an action-learning


cycle – small cycles of change, taking a specific issue and trying to bring about change as quickly as possible to give people a sense that they actually could affect how things are done. The automatic doors in the health centre were a result of the process, as well as the introduction of adjustable examination couches for disabled people. “What people also talked about was how doctors did not understand the bigger picture – and that has coloured my view ever since. Patients come in with a symptom but there is this whole back story that’s invisible – not present – and isn’t allowed into the consulting room. And that back story may be the key to why they are so distressed. In a sense the links worker programme is a direct consequence of listening to people talk about this bigger picture.”


Certainly it seems that Scottish Government is THE


Jim Killgore chats with Dr Peter Cawston – a GP at the coalface of health and social care integration in Scotland


He is fluent in both French and Spanish. “I chose to work in North Marseille which is a very


deprived area with lots of North African immigrants – profoundly affected by drug addiction and prostitution. So I was already pretty deeply ingrained in seeing the role of the GP as being social as well as medical, and about trying to bring social change through practicing scientific medicine in a community.” Cawston returned to Scotland and began a two-year higher professional training fellowship, working two days a week practicing in Drumchapel and also undertaking a “participatory action research project” for his MSc in primary care. The topic was, not unsurprisingly, bringing about change in the health service by community


listening, with the integration of health and social care at a structural level now a legislated priority. It recently published an action plan involving the recruitment of 250 community links practitioners to work with GP surgeries across Scotland. Peter Cawston has been asked to advise on the implementation.


COALFACE ACADEMIC Cawston describes himself as an academic practitioner but also a “coalface” GP. He worked for a number of years as a part-time clinical lecturer at Glasgow University but found it difficult to balance with his role as a partner at Garscadden Burn. “I tend to give a hundred per cent to whatever I do.” GPs at the Deep End – with its strong alliance between academics and practitioners – has allowed Cawston a toe in both camps. Another aspect of the organisation that appeals is its active interest in influencing health policy. “That we can be heard at a national level if we join forces,” says Cawston. “It’s politics with a small p; perhaps advocacy is a better word.” A central theme in the work of GPs at the Deep End has been the recognition – backed up by extensive research – that those patients most in need of adequate healthcare are often least likely to receive it and, conversely, those with least need tend to use health services more (and more effectively) – the so-called inverse care law. Says Cawston: “If health services aren’t configured to


take into account huge health inequalities then we actively contribute to them. It’s not a neutral situation. There is very solid evidence that the NHS, though free, isn’t impartial. It actively favours affluent populations.” And this, he adds, is a challenge that must be faced


by policy makers. “I think the line ‘at its best where it’s needed most’ encapsulates the whole argument.”


Jim Killgore is managing editor of Insight


MDDUS INSIGHT / 11


Dr Peter Cawston with practice manager Elaine Smith


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