International Posters 907 – 913

International Posters 907 – 913

907 Pathways to care: exploring accessibility and delivery of mental healthcare in southwest Nigeria

Titilopemi Oladosu

Background In Southwest Nigeria, mental illness is subject to various socio-cultural interpretations that many medical diseases are not. In addition, access to healthcare is varied and for many non-existent.

Aim This work aims to explore the factors that influence accessibility and delivery of mental healthcare in the Southwest through health-workers’ perspectives.

Methods Purposive convenience sampling was used to identify health-workers at Federal hospitals and the Ministry of Health. 26 semi-structured interviews were conducted and analysed using thematic content analysis. The 3 delays model was the main framework for exploring healthcare accessibility and delivery. Ethical approval was received from King’s College London and the National Health Research Ethics Committee of Nigeria.

Results The problems identified include lack of education and conflicting cultural interpretations of illnesses as a cause of delay in recognition. Delay in accessing care was impeded by both self and societal stigma, while delay in receiving appropriate care was compounded by the high costs of out-of-pocket payments and the lack of skilled mental health workers in primary care settings. Increased community sensitisation, dissemination of services to remote areas, and subsidisation of health cost were identified as potential solutions for the challenges faced.

Conclusions More needs to be done to reduce the marginalisation of vulnerable groups (in particular the uneducated, poor, and disabled) from access to mental healthcare. These groups’ adverse health outcomes may be compounded by the difficulties faced in accessing mental healthcare.

908 Mental Health Ethics and Law in Southwest Nigeria: a special focus on the Lunacy Act

Titilopemi Oladosu

Background In 2004, Nigeria published a mental health policy, however, with the current Lunacy Law (1916) the policy is not enforceable. Attempts to change the ‘Lunacy law’ have not been successful with the latest proposed changes being withdrawn in 2009.

Aim This study aims to explore health-workers’ perceptions of law and ethics in southwest Nigeria and evaluate the current mental health law and proposed changes using the WHO mental health legislation checklist.

Methods Purposive convenience sampling was used to identify health-workers at Federal Neuropsychiatric Hospitals and the Federal Ministry of Health. 26 semi-structured interviews were conducted and analysed using thematic content analysis. Ethical approval was received from King’s College London and the National Health Research Ethics Committee of Nigeria.

Results The majority of mental health-workers’ claimed that should they or their patients come to harm there was no healthcare, legal, or financial support available. Some cited numerous incidents of themselves or colleagues needing such protections and being left without. This lack of support was linked to unwillingness by health-workers to provide patient care in situations that were perceived as risky.

Conclusions A new law for mental health in Nigeria is fundamental for the protection of the patients and health-workers. The provision of such law if appropriately applied may improve health-workers’ and patients’ safety, and health outcomes for patients.

909 Integrating humanitarian medical training into UK general practice

Elaine Kirk

The reciprocal benefits of International work to UK General Practice are well recognised but so are the difficulties of job security, appraisal/revalidation and pension arrangements. The Crisp report on Global Health Partnerships (2007) encouraged the NHS to recognise the value of overseas training and to make it easier to gain this experience.Training in Humanitarian medicine has become more structured and the Core Humanitarian Competencies Guide (June 2011) identifies personal and leadership qualities that could be cross referenced with some of the domains of the NHS Medical Leadership Competency Framework.

In November 2015 Health Education North East (HENE) and UK-Med combined to offer a Fellowship in Humanitarian Medicine. The programme aims to increase the primary care input for deployments to sudden onset disasters whilst also acting as a recruitment initiative for General Practice in the North East.The elements of the Fellowship programme are a salaried post in General Practice, working towards a PG-Certificate in Global Health through the University of Manchester, deployment training, an overseas placement with UK-Med and a special interest project for which I have chosen women and child protection in the Humanitarian setting.

This is the first Fellowship in Humanitarian Medicine in the UK and was specifically targeted to General Practice, enabling a funded GP post with Humanitarian education suitable for appraisal and revalidation whilst also enabling full training for overseas deployment.Could this model make training for Global primary care more accessible?

910 Energising primary care in India – Group work with rural medical officers

Helen Crawley

Background and Aims This poster describes how a five-day RCGP International training programme for medical officers in Bihar influenced their culture of learning and leadership. Lessons are drawn for those planning similar courses. Content of presentation In response to an identified need for leadership and change management training RCGP supported a Training-of-Trainers course for experienced medical officers in rural health centres so that they could support new, inexperienced, medical officers arriving to live and work in a resource poor environment.

Relevance/Impact Two five-day courses covered attendees from almost every District in Bihar. The course design reflected identified needs and was delivered flexibly. Lessons learnt will be applicable to course delivery elsewhere.

Outcomes A detailed learning needs assessments was crucial to course credibility.In a culture used to didactic teaching and individual testing, a high level of support was initially needed to encourage joint working. However participants enjoyed group learning and noted how agreeing rules influenced ethos e.g. punctuality. Practicing constructive feedback and consultation skills led to several light-bulb moments. Participants found the wide-ranging discussions of leadership style, change management and ethics empowering.

All participants wrote a development plan, often addressing workplace culture e.g. punctuality or cleanliness. Participants found reading English easier than listening. Powerpoint slides worked best if they included specific examples of key concepts and group exercises were described in detail.

Discussion Medical officers will need ongoing support and involvement from other key members of the primary care team (e.g. managers) to innovate change.

911 General Practice Globalisation: A consultation on Global Health Competencies

Lucy Obolensky

Relevance: Global health is becoming increasingly relevant to general practice. With rising migration and shifting disease patterns, GPs are being challenged to deliver effective care to multicultural communities with diverse needs. GPs also require an understanding of, and the ability to respond to the effects of globalisation on health and health systems. GPs may choose to work abroad in diverse capacities and advocate for the role of primary care globally.

Aims: To determine competences in global health relevant to GPs and other doctors and health professionals.Methods: A modified Delphi including an online survey, face-to-face and telephone interviews was conducted to develop core global health competencies that could be used across all post graduate curricula. 250 stake holders from around the globe participated including patients, doctors, nurses, the public, policy makers and allied health professionals.

Outcomes: All participants stated that global health competence is essential for doctors. Five core global health competencies were defined: Diversity, human rights and ethics; Environmental, social and economic determinants of health; Global epidemiology; Global health governance; Health systems and health professionals.

Discussion: The five Global Health competencies were published and supported by the Academy of Medical Royal Colleges. There has been a positive response from the RCGP curriculum leads to include fundamental global health learning outcomes into the training curriculum. A survey is being completed to assess current levels of interest and knowledge in global health of GP trainees, and the confidence of trainers to deliver such competencies. We aim to present this, and the revised curriculum, at the GP global health conference in March 2017.

912 USHAPE – a skills exchange to address unmet need for family planning in Uganda

Clare Goodhart

Aims To address unmet need for contraception in rural Uganda by training Ugandan nurses and midwives as family planning promoters and providers using a whole institution approach in mission Hospitals.

The Challange Uganda’s population is growing exponentially. 24% of Ugandan women use modern contraception. Teenage pregnancy rates are highest in the world. 25% of maternal deaths are due to unsafe abortions. Every day Four women, including two teenages die due to abortions.

Response Long term GP volunteers recruited through RCGP have developed a cascade model of training whereby the health staff we train, disseminate positive messages about family planning through village health workers and community leaders. We have had great success among teachers who are now campaigning for comprehensive sex education in local schools.

Outcomes A comprehensive set of training materials have been developed by volunteers. 86 Ugandan nurses and midwives are now trained as family planning providers. 300 teachers and community leaders and have benefitted from USHAPE training. Several thousand young people have attended sex education sessions.

Discussion We discuss the role of GP volunteers in spreading the USHAPE initiative and acheiving these outcomes. The personal growth of the 15 GPs who have contributed to the development of USHAPE over the past 4 years is highlighted. We are ready to encourage short term volunteering to support these efforts.

913 Is Primary Healthcare Sunnier in Spain? Reflections from an EU-funded Exchange Programme

Ula Chetty

Background UK General Practice is faced with increasing challenges with funding cuts, increasing workload and high bureaucracy. Such pressures can make it difficult to reflect on working practices. GP exchange across Europe provides an opportunity for fresh perspectives by exploring how General Practice functions in another country. I obtained a EU bursary, which provided fascinating insights.

Methods Observation during a two-week placement in Mallorca, September 2013. A summary report was reviewed by my Spanish supervisor.

Results Major differences in primary health care in Spain were noted. GPs did not see children under 14 years or any obstetrics/ gynaecology as these specialties were seen directly by their respective specialists. GPs were salaried and contribution to out of hours care was mandatory. Nurse to GP ratio was 1:1, both worked in parallel with collaboration. Impressive features included an electronic prescribing card, liberating GPs from signing repeat prescriptions and admirable patient continuity. GPs and hospital doctors could access each other’s notes meaning improved knowledge sharing. The GPs had few house calls since the nurses did most. Spanish GPs were envious of our flexibility, part-time work/ specialist interest options, level of employment and our high salary.

Conclusion Primary healthcare in Spain was impressive and included some features that the UK could learn from in order to reduce bureaucracy and improve communication with secondary care. Whether it is ‘sunnier’ depends on personal priorities, as for example, many UK GPs enjoy the inclusion of paediatrics in primary care.