Living well at the Deep End

6th July 2021

Last week at the Society of Academic Primary Care’s Annual Scientific Meeting, Deep End researcher and GP trainee Claire Norman led a workshop on ‘Living Well at the Deep End.’ Here are some of the top discussion points.

The theme of the conference was ‘Living and dying well’ and I confess that when I entered my application to host this workshop back in January, I wasn’t entirely sure what it would entail. Since then, I have been involved in some projects and conversations about the place for ‘lifestyle medicine’ in socioeconomically deprived areas and I decided that this would be another good forum for discussion.

The workshop was attended by a mixture of Deep End GPs from Scotland, England and Ireland, along with some colleagues who worked in more affluent areas but were keen to learn about the cause.

We began with a general discussion about lifestyle medicine, and the factors that prevent people from making good lifestyle choices. There was concern that this field of medicine implies that unhealthy lifestyles are solely down to individual decisions and ignore the wider determinants of health that contribute: lack of time and resources, stress, geography and environment.

“We have to make the healthiest choice the easiest choice.”

However, the purpose of this workshop was to try and come up with positive and practical solutions rather than dwelling on the upstream determinants that are often out with our control. The group shared their experiences of social prescribing link workers – generally very positive, except for one case when the link worker overstepped the mark and began commenting on the biscuit and cake eating habits of practice staff! We all agreed that staff wellbeing is important but perhaps one needs to pick one’s battles!

The link workers often approached people at “face value,” without the historical baggage that sometimes comes with GP continuity. In addition to the traditional social prescribing activities around exercise and befriending, we heard of practical support such as getting patients better mobile phone contracts and affordable wills. Other great ideas included a boxercise class that took place in the GP practice itself.

Unfortunately, most workshop attendees had experience of well-intentioned lifestyle interventions that had completely failed to serve their communities. We heard tales of ‘pre-habilitation’ exercise coaching that took place in an intimidatingly posh gym on the opposite side of town, as well as lots of short term interventions that failed to lead to meaningful behaviour change. Although lifestyle interventions may seem less harmful than some of the medications we prescribe, there is a risk that they can lead to a sense of personal failure.

For the second half of the workshop we split into two groups to discuss how two common ‘lifestyle’ interventions could work in the Deep End: a running group and a community garden.

The main factors for success were similar in both groups:

• Co-design – working with communities to create something that is authentic and fulfils a community perceived need. Don’t try and force an idea on anyone.
• Location – any intervention should be in a familiar space that is accessible, safe and non-intimidating, ideally somewhere that is already a community hub.
• Consider catering for specific groups who may not feel comfortable in mass participation events, e.g. women, ethnic minority groups, older adults or teenagers.
• Marketing – wording was important: “exercise” may have connotations of only being for the super-fit, whereas “activity” was less intimidating.

Overall participants felt that there was a place for downstream ‘lifestyle’ interventions, but that these had to be implemented carefully. Public and patient involvement was key, and the role of general practice should be to encourage and promote community-led initiatives.