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Primary care services are the front door to the NHS – they are the first port of call when we feel unwell and the main coordinator of care when we are living with ill health. The primary care team have an important role in making people feel welcomed, listened to and taken seriously. At National Voices we often hear stories from groups of people who struggle to have their communication needs met within primary care. As just one example, five years after the launch of the Accessible Information Standard, 67 per cent of Deaf people reported that still no accessible method of contacting their GP has been made available to them (Signhealth, 2022). This issue also affects other groups with specific communication needs - people who don't speak English fluently, people with learning disabilities, autistic people, people with dementia, people with low or no literacy, people who are digitally excluded, people living nomadically, people experiencing homelessness and more. We know that these experiences happen within the context of a primary care team under exceptional pressures. This workshop will bring together people with lived experience from all the groups mentioned above, as well as voluntary sector organisations, members of the primary care workforce, primary care policy leads, as well as commissioners and providers to discuss the challenges and co-produce solutions. At the workshop, we hope to build and improve understanding of: The experiences of people with diverse communication needs within primary care. The barriers primary care teams experience in meeting diverse communication needs, especially under existing pressures. Practical ways that we can embed and improve inclusive communications within the primary care setting. Register for the webinar. If you have any questions, please contact aleyah.babb-benjamin@nationalvoices.org.uk

1. People with eating disorders should not face stigma in the health system and barriers to 1 accessing support in 2022 - a blog by Hope Virgo People with eating disorders often find it difficult to get help and treatment from the health system because of pervasive stigma, misinformation and stereotypes around eating disorders. This blog by eating disorder survivor and mental health campaigner, Hope Virgo, looks at the barriers people face when they try to access support for eating disorders in the UK. She talks about her own experience of being told she was ‘not thin enough for support’ and calls for long-overdue action on funding, training and awareness of eating disorders within the NHS. 2. Leaflet - Seeking treatment for an eating disorder If someone suspects they may have an eating disorder, their first step in getting treatment is often a visit to their GP. This leaflet contains guidance for people who have, or suspect they may have, an eating disorder, as well as information for GPs and other people who may be supporting them. It’s based on the guideline on eating disorders from the National Institute for Health and Care Excellence (NICE), which GPs should use when making decisions about patients’ healthcare. 3. Freddie Flintoff: Living with bulimia Eating disorders are often seen as an illness that affects young women, but experts estimate that one in four people with eating disorders are male. As a result, boys and men with eating disorders most often live in silence with the double stigma of having a mental health condition that is not recognised in their gender. In this BBC documentary, former England cricketer and TV presenter Andrew "Freddie" Flintoff goes on a personal journey into the eating disorder he has kept secret for over 20 years – bulimia. He discusses his own experience and meets specialists and young men with eating disorders across the UK. 4. SAPHNA - Eating disorder toolkit This toolkit was co-produced by the School and Public Health Nurses Association (SAPHNA) with school nursing services, mental health campaigners, eating disorder experts, education colleagues and young people with lived-experience of eating disorders. It provides information and guidance for school nurses on how to identify and support students with eating disorders and their families, addressing issues such as consent, confidentiality and referral to specialist services. 5. Tips poster: First signs of symptoms of an eating disorder When someone has an eating disorder, getting early support and treatment can make a huge difference to their recovery. That’s why it's important that everyone can spot the first signs and symptoms of an eating disorder. This poster by the charity Beat Eating Disorders offers tips to help you spot the very first signs of an eating disorder. 6. Myths about eating disorders (HealthTalk.org) This webpage highlights young people with eating disorders talking about how they often come up against misunderstandings about the illness from their family and friends, the media and healthcare professionals. They describe how incorrect ideas about what eating disorders are can make their experience of living with an eating disorder worse. 7. Eating disorders: a guide for friends and family This booklet from Beat Eating Disorders is for anyone supporting someone with an eating disorder. It covers information about eating disorders and treatment, and offers guidance on how you might approach the subject if you’re worried about someone you know and how to support them after diagnosis, as well as looking after yourself. 8. Medical emergencies in eating disorders: Guidance on recognition and management People with eating disorders can reach a crisis point where their condition becomes a medical emergency resulting in serious harm or even death. This guidance from the Royal College of Psychiatrists makes a series of recommendations for primary care, secondary care and mental health services that aim to make preventable deaths due to eating disorders a thing of the past. There are specific recommendations focused on the needs of children with eating disorders, recognising the physiological differences between adults and children. Have your say Are you a healthcare professional who works with people with eating disorders? We would love to hear your insights and share resources you have developed. Perhaps you have received treatment for an eating disorder—what was your experience of healthcare services? We would love to hear from you! Comment below (register for free first) Get in touch with us directly to share your insights

More than 1,400 English GP practices, around one in five, offer patients access to their prospective medical records: that means patients can see new entries to their medical records such as tests results, appointment notes and hospital letters online and through the NHS App and certain other apps. This webinar aimed at patients explains more about NHS England's programme to enable patients to access their medical records via the NHS App. Hear from: Patients Association members Claude and Greta about what the benefits are to them of being able to access their health information digitally GP Dr Brian McMillan, a Senior Clinical Lecturer at the Centre for Primary Care and Health Services Research, University of Manchester, and a Registered Health Psychologist, whose research interests include how digital technology can improve patients' experiences of primary care Registered nurse Tristan Stanton who is Assistant Director of Programmes – Primary Care, at NHS England and leads the programme to give people access to their online health records. The Patients Association's Chief Executive, Rachel Power, will chair the webinar. Sign up for the webinar

“Yes.” This was the dismaying response of consultant breast surgeon, Mr Hemant Ingle, when asked at a talk, hosted by the Centre for Health and the Public Interest (CHPI), whether he thought another scandal on the scale of that caused by Ian Paterson could unfold today. Disgraced breast surgeon Paterson is currently serving a 20-year sentence after unnecessarily operating on over 1,200 patients at NHS and private hospitals in the West Midlands area between 1997 and 2011. Three months into my first year of General Practice Specialty Training, I sat in that auditorium utterly stunned at Mr Ingle’s candour. Was it pessimism or devastating realism? Having watched the appalling events unfold in a screening of the ITV documentary ‘Bodies of Evidence: The Butcher Surgeon’, we were honoured to be joined by a panel of experts, including Debbie Douglas, one of the indescribably courageous patients who helped to expose Paterson. Over the next hour, the panel unpacked the factors deemed to have enabled Paterson’s actions, his potential motives and the consequences of the subsequent inquiry for society at large. It made for disturbing listening. Having trained entirely within the public sector, as all new medical graduates must do in the UK, I was completely ignorant to the circumstances within private hospitals which had catalysed Paterson’s reign of terror. I had no idea that private hospitals bore no responsibility for the patients treated within their walls, that doctors working in such hospitals often had no requirement to adhere to otherwise national guidance on healthcare provision, that private hospitals may have no facility to provide adequate emergency treatment to those suffering medical complications after procedures performed on their own premises. Before that evening, I had never before heard a patient state so heartbreakingly that they struggled to trust medical professionals. That disquieting symposium was not my first exposure to the sinister side of medicine. Seeking supplementary education in a field strikingly neglected in my own core undergraduate and postgraduate medical education, I had, just a few weeks before the CHPI event, joined a webinar hosted by the British Society of Sexual Medicine (BSSM). One of the presenters was a patient who had experienced first-hand the pernicious effects of vaginal mesh insertion. Whilst her story had a positive outcome, other vaginal mesh patients have not been so fortunate. Thousands of women continue to suffer from chronic pain, fatigue and urinary dysfunction, amongst countless other symptoms. Through subsequent investigations, it has emerged that vaginal mesh manufacturers had significant financial links to clinicians, researchers and Royal Colleges, and that side effects and complications were widely under-reported. Campaigns such as Sling The Mesh, founded by Kath Sansom, ensure that this landscape is changing, but it should not have come to this. I’m not sure how to feel any more. I’ve spent a lot of time with doctors over the last eleven years. At sixth form, I would send countless unsolicited emails to consultants at local hospitals, pleading for the chance to observe their surgeries, to shadow their ward rounds. Throughout university, I scribbled down every word of juniors, registrars, consultants, hoovering each crumb of knowledge that might make me the best doctor that I could be. Since I graduated in 2020, and started working as a Foundation Year Doctor in London, these professionals have become my peers, my colleagues, my 'bosses'. Whilst of course, some have been more personable, more welcoming, than others, I have thankfully never had the misfortune of encountering a character like Paterson. In Ipsos' 'Global Trustworthiness Index', most recently released in October 2021, doctors were ranked highest in 28 countries, with over 70% of UK respondents believing us to be the most reliable of all professionals. This was the mindset in which I trained; I felt comfortable and worthy of such an accolade. I want to be the person that patients can rely on at their most vulnerable, that relatives feel they can approach with any worry, large or small. To hear now that, for entirely good reason, the implicit confidence that the public had in their medical professionals is no longer a guarantee, made me feel rather unsteady. How do I feel about being part of a profession in which such deceit can go unchallenged? Do I want to be associated with 'experts' who fail to acknowledge the legitimate anxieties of their patients? I'm not going to leave medicine. Fortunately, the Patersons of the world are hugely outnumbered by respectable, conscientious, genuine, caring doctors – those that do earn the premier spot in an Ipsos poll. However, I do think that I have been naïve. Whilst Paterson’s actions are deplorable, a single ‘rogue’ surgeon can be dealt with. This is not to downplay the absolute devastation and anguish that he has caused his patients and their loved ones, and not to diminish the fact that his ousting took far too many attempts from those bold enough to question him, and not nearly enough support from those who should have held him accountable. It is the systemic failures which allowed Paterson to operate unmonitored, which enabled vaginal mesh surgeries to continue unchecked, which permitted side effects to go unrecorded, that I find so unsettlingly insidious. Whether these repeated failures in the healthcare system are underpinned only by financial motives, by greed, as seems the most obvious explanation, we may never know, and perhaps finding reason should not be our priority. As a doctor, my duty is to advocate. Fortuitously for themselves and those whom they are now able to advise and support, both Debbie Douglas and the patient featured in the BSSM webinar are intelligent, well-spoken, confident women. Others affected by the scandals mentioned here, and countless more that are not, may not be so well-equipped. Those who are perhaps older, less educated, who do not speak English as a first language, with other medical conditions rendering them less able to campaign, rely on others to do so on their behalf. This is only one piece of the jigsaw – in order for patients to request help, they must know who is able to help them, and must feel secure and empowered to ask for assistance. Similarly, doctors must feel emboldened in discussing issues with appropriate colleagues. This is not necessarily easy. A conversation after the CHPI panel discussion highlighted how GPs in particular, often mistakenly viewed as lesser doctors, may feel pressured to maintain respect for themselves within the medical profession and, thus, be reluctant to escalate patient concerns for fear of ridicule from secondary or tertiary care. It goes without saying that such anxiety should never alter the care we provide to patients. However, this perceived imbalance of medical aptitude, resulting in such a discrepancy in the level of esteem to which medical professionals are held, is just one example of a saddening toxic facet of the medical world. This is also reflected in the response to whistleblowers, both in the moment and through the lasting effect on a professional’s career, as exemplified by Mr Hemant Ingle speaking of the hospital that previously employed both himself and Paterson: “They don’t like me, of course they don’t”. Only by changing this mindset, and curating a more supportive, protective, transparent culture, where healthcare professionals of all levels and types can freely voice concerns, can we ever hope to avoid such disasters in the future. So, in real terms, what should I do as a training GP? Put simply, I must abide by the GMC’s ‘Duties of a Doctor’. Firstly, I must remain aware and knowledgeable of current biomedical and medicolegal affairs to ensure that I do not inadvertently, even if innocently, reassure or dismiss patient concerns through ignorance. Attending regular knowledge update courses and accessing appropriate journal articles are more formal avenues of learning, but I should supplement these by keeping abreast of health news in popular media, such that I may pre-empt problems with which patients may present. This is all with the understanding that I must never act beyond the limits of my competence and must never allow fear of criticism to prevent me from seeking advice, whether this is from more senior colleagues, supervisors or specialist doctors. For my patients, and indeed for colleagues who may come to me with their own queries, I should reciprocate by remaining approachable and sympathetic. My interactions with colleagues and patients alike should take place in a partnership model – while of course there are many times when hierarchy can be appropriate, I aspire to be the doctor who equips her patients to become experts in their own health and to advocate for themselves. I will strive to communicate with patients in formats appropriate to each individual. Once a patient has chosen to trust me, I must be mindful of the fact that trust can just as easily be lost as gained. I shall keep patient safety at the fore by following GMC guidance on raising and acting upon concerns, reporting any adverse effects of medication or treatment that are divulged to me, obeying my duty of candour if I believe a patient to have been placed at risk, not allowing any conflicts of interest to influence patient care, and acting with overarching honesty and integrity. Yes, another Paterson-level scandal could, and will almost certainly, unfold again. However, if I aspire to achieve each aim outlined above, I will indeed become the kind of doctor that sixteen-year-old me held in such high regard. Until we fix the system, all I can do is my best.