‘We need to be moving away from just using a medical model, we need to think about our patients as part of a community, with social factors impacting their health and the support out there to help people.’ (York trainee, 2020)

GPs have an integral and persistent influence throughout patients’ lives, with intimate and privileged knowledge of their circumstances (social, cultural, medical) and are well placed to both identify and influence determinants of health.

The RCGP curriculum stipulates that GPs should understand the community in which they are working; this includes understanding the socioeconomic and ethnic composition of a community as well as the health inequalities that exist in the community. The curriculum explains that GPs should be able to assess the health needs of local populations and sub-groups. It goes on to state that GPs should recognise that effective primary care requires the co-ordination and commitment of a multi professional team working in partnership with patients and that leading and managing improvement in healthcare systems is just as important as acting on behalf of the individual patient.

Community placements allow trainees to take a step back from the individual patient and consider the make-up and needs of the community in which they are working. This will allow trainees to reflect on how the community’s health needs are being met, from individual consultations, to the way patients access care at their practice (and the barriers that might exist to care at all stages), to the wider socioeconomic environment in which patients live.

The recent publications of the NHS Long Term plan and new GP contract place a strong emphasis on integrated care and population health, a key component of these being improving relationships between primary care and the wider health and social care community.

One of the new service specifications for primary care networks is that of tackling health inequalities, which includes increased provision for social prescribing. For social prescribing to be of maximum benefit and for primary care networks to tackle health inequalities, it is important that GPs understand the context in which patients live and have an understanding of the organisations supporting patients in the community.

‘It’s an opportunity to get out of the surgery, to go into the community, to see how people live and to learn about what services are available to help people.’ (Scarborough trainee, 2020)

You will spend a minimum of two half day sessions with a community or voluntary organisation of your choosing, relevant to the populations you are working in. You will arrange the placements yourself and will then present your learning back to your practice and at VTS training/Half day release.

Trainees have spent time with a wide range of organisations; from national organisations such as Age UK and Barnardo’s, to regional organisations like housing associations, to local community interest groups, to organisations supporting specific groups – such as refugees and asylum seekers, ethnic minorities, homeless people, sex workers, people with drug and alcohol problems or people with learning disabilities and we would encourage to trainees to follow their own interests.

All practices should have links to a social prescribing link worker who manages social prescribing referrals. Their role may vary slightly from practice to practice, but broadly speaking they receive social prescribing referrals and will triage and assess individuals, signposting on to relevant support organisations.  You may opt to spend one half day shadowing the link worker, for example when they are triaging referrals and meeting with patients, and then one-half day with a third sector organisation of your choosing, as opposed to two half days with the organisation. Or you might spend two half days with different organisations. This will depend on your interests and the availability of the social prescribing link worker.

‘I would say start arranging early, find something that you’re interested that is relevant to the community. Talk to the people in your practice, your trainer, the other staff, the social prescriber if you have one.’ (Wakefield trainee, 2020)

First you need to consider the communities in which your practice is based. Does your practice serve an area with a particularly elderly population? Is there a high proportion of ethnic minorities or migrant groups? Are there particular issues affecting the community? Such as housing problems? Loneliness? Problems with drugs and alcohol? Lack of physical activity? Or problems with finances and benefits? Is there a group of patients or an issue that you have come across that you would like to learn more about/be able to help patients with/signpost patients?

Next you need to research organisations providing support in your area. You could start by discussing with the practice staff and by researching online. A key person to contact will be the social prescribing link worker attached to your practice or primary care network who will have details of the organisations supporting the community.  

Once you have identified an organisation you would like to spend time with you need to contact them to arrange two half day placements. These can take place in your personal study afternoons or mornings or if there is no VTS/HDR scheduled during a particular week. They can also take place during your tutorial time with the agreement of your trainer. In order to attend a certain organisation or session it may be preferable to switch your clinical sessions one week, please discuss this early with your trainer and your practice. Some trainees may opt to spend a whole day with an organisation as opposed to two half days, if this is possible with their timetable.

Make initial contact either by email, phone or by visiting the organisation’s building. (There is an example email at the end of this guide). Don’t be disheartened if you don’t get a reply, try an alternative method of contact or try another organisation. Many trainees find that phoning gets a much quicker response than emailing. When contacting an organisation explain why you want to spend time with them, and what you are looking to learn, this will help them arrange a meaningful placement for you. For example ‘I am interested in spending time with your housing association as I would like to learn more about you support people with housing problems…’.

If you are having difficulty securing a placement, please discuss with your trainer.

‘I think this has helped me understand the local community that I work in and how social issues such as poor housing, problems with benefits, and social isolation can have an impact on mental and also physical health. It is difficult to manage this as a doctor as I can’t provide support for these issues, so it’s really good to see there is a service available to address these issues for people.’ (Sheffield trainee, 2019)

The programme aims for you to:

• Gain a greater understanding of the health needs of the population in which you work and the contextual social determinants of health.
• Gain an understanding of the key role third sector organisations play in supporting individuals and communities.
• Reflect upon the relationships between primary care and third sector organisations.
• Reflect upon the role of GPs as advocates for their patients in a wider socioeconomic context.
• Develop your leadership and organisational skills in arranging placements.
• Develop your communication and presentation skills in presenting back to your peers and your practice.

• The goals above are purposefully broad and we expect all trainees to take initiative in negotiating with the organisation what they will be doing on their two half day placements.
• It may be that the you spend time observing the work that goes on at a certain organisation, be that groups or workshops. You may shadow a specific worker or service user. The organisation may wish tailor a half day so that volunteers, staff and service users can engage with trainees and discuss issues they face with them.
• The important thing is that you take time to listen, outside of the consulting room, out in the community and get a better understanding of the community you work in.
• Previous trainees and third sector organisations explain that it is important to know what your interests and goals are in order to arrange a meaningful placement. These might include things like ‘To learn more about the work of organisation X’, ‘To learn about the experience of living with a mental health disorder in community Y’ or ‘To learn how organisation Z supports people facing housing problems’ or may be more specific depending your interests or the organisation.
• When arriving at your placement it is important to keep those goals in mind; for example you may want to spend some time with the people running an organisation/group to learn about how they work, you may want to spend to spend time observing a group so that you can better explain what happens to patients at such groups, or you may want to spend time talking to people accessing the service/organisation to hear about their journey.

‘I spent my placement with an organisation supporting people with drug and alcohol problems, they were really welcoming and keen to explain what support they could offer, they’d never had any one from the GP surgery visit before, so seemed pleased about that. They showed me round, explained their services and I sat in on part of a session.’ (Airedale trainee, 2020)

‘I shadowed the social prescriber linked to our practice, we visited four patients at home, and I got to see the all different challenges they were facing and the ways in which they could be helped and supported. In between patients we chatted about the different groups out there and how GPs can best refer.’ (York trainee, 2020)

‘I visited a community forum near to our practice, I had no idea about the huge range of groups and services available in our area, and neither did my GP colleagues. After spending time with the manager of the forum we decided to work together booklet to create a booklet with all the groups and services listed, so that the GPs, nurses and pharmacists could use it to direct patients.’ (Sheffield trainee, 2020)

‘I spent time at a social group run by a hosing association, supporting people who are isolated and lonely. When I first arrived they seemed a little unsure about why I was there, but when I explained who I was and that I wanted to learn about what support they had to offer and who could access the group so that I could help signpost people in future, they thought it was a great idea. Everyone wanted to tell me their story of how they came to the group and how it helped them.’ (York trainee, 2020)

You will be required to complete a reflective piece about your learning on community placements. You will be sent a template to complete and upload to your eportfolio, this is a NOE workbook requirement

Trainees will also be required give a short presentation about their experiences of community placements to their VTS/half day release group on a specified date. We also ask that you present your learning and experience back to the practice team.

Organisations that trainees have spent time with have been keen to be involved and spend time with training GPs. They were keen to speak to doctors about the work they were doing and the challenges they were facing and often saw doctors as a difficult to reach group. We hope that the programme will foster better relationships between the third sector and primary care.

The programme aims for the practices to benefit by learning about the third sector organisations working in their area through your feedback. Again, we hope the programme will foster better relationships between practices and local third sector.