Family Medicine

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World Book of Family Medicine – European Edition 2015 Step 1 Getting started What population? What are you trying to achieve? Who needs to be involved? What resources are required? What are the risks? Step 2 Identifying health priorities Population profiling Gathering data Perceptions of needs Identifying and assessing health conditions and determinant factors Step 5 Moving on/review Learning from the project Measuring impact Choosing the next priority Step 4 Planning for change Clarifying aims of intervention Action planning Monitoring and evaluation strategy Risk-management strategy Step 3 Assessing a health priority for action Choosing health conditions and determinant factors with the most significant size and severity impact Determining effective and acceptable interventions and actions Take Home Messages Figure 1: The five steps of health needs assessment HNA is an approach that helps plan services that tackle ‘needs’ rather than just reacting to demands. HNA is a multidisciplinary and multisectoral activity and consultation is a key component. HNA is not only about assessment but also about taking action to improve the health of the population. Aim for small, achievable, measurable goals; this increases the chance of success. HNA is not an end in itself. Original Abstract http://www.woncaeurope.org/content/theme-b-needs-assessment-general-practice-family-medicine References BMJ. Series of articles on ‘Health needs assessment’ online: BMJ 1998; 316 (April to June 1998): http://www.bmj.com/content/316/ Gillam, S. & Murray, S. (1996). Needs assessment in general practice. London: RCGP occasional paper. Harris A. (1997) (ed). Needs to Know: a guide to needs assessment for primary care London: Churchill Livingstone. Hooper J, Longworth F (1997). Health needs assessment in primary care. A workbook for primary health care teams. Calderdale and Kirklees Health Authority. Kilduff A, McKeown K, Crowther A. Health needs assessment in primary care: the evolution of a practical public health approach. Public Health. 1998 May;112(3):175-81.PMID:9629025. NICE (2005) Health Needs Assessment: a Practical Guide. http://www.gserve.nice.org.uk/nicemedia/documents/Health_Needs_Assessment_A_Practical_Guide.pdf Scottish Needs Assessment Programme (1998) Needs Assessment in Primary Care: A Rough Guide. Glasgow. WHO Community health needs assessment (2001) An introductory guide for the family health nurse in Europe. http://www.euro.who.int/__data/assets/pdf_file/0018/102249/E73494.pdf 112
World Book of Family Medicine – European Edition 2015 John Salinsky, MD, FRCGP jvsalinsky@aol.com 36 – The Balint Experience John Salinsky, FRCGP General Practitioner and Training Programme Director Whittington GP Education and Training, London, UK. The Early Days of Balint Balint groups are named after the psychoanalyst Michael Balint (1896-1970). In the late 1950s, Michael and his wife Enid began holding psychological training seminars for GPs in London. This work was first described in the book The Doctor, his Patient and the Illness (1957). There were no lectures and the doctors’ education was based on case presentation and discussion in a small group of nine or ten with a psychoanalyst leader. To begin with, Balint encouraged the group members to hold ‘long interviews’ with their problem patients. This helped the doctors to concentrate on becoming good listeners. Subsequently the focus changed to studying the relationship between doctor and patient in the context of every day ordinary-length consultations. The groups met once a week for a number of years so that patients and their progress could be followed up. The continuity also enabled group members to feel at ease with other. Since those early days, Balint groups have spread across the world and in 20 countries there are national Balint Societies whose aim is to foster and develop the Balint approach. Balint Groups Today: What Happens? The group members and the leader sit in a circle and the leader (or one of the leaders if there are two) asks ‘who has a case?’ Someone volunteers to talk about a patient who has been on her mind. The problem may be that the patient has been emotionally disturbing or just difficult to understand or to engage in treatment. The group listens to the story without interrupting. When the presenter has finished, the leader invites the group to respond to what they have heard. Responses take various forms. There may be questions, advice to the doctor, emotional reactions induced by the patient’s story and speculations about what else might be going on. The group leader will gently discourage too much interrogation of the presenter, as the aim is to get the group members themselves to work on the case. In a variation of the group process, the leader asks the presenter to ‘sit back’ i.e. to push his chair back a little and to remain silent for the next 20-30 minutes. This effectively prevents the group from asking any more questions and throws them back on their own resources. The presenter is allowed to have her say and respond to what she has heard when she is invited to join in again later. The Role of the Leaders The leaders’ first aim is to make the group a safe place, where confidentiality is observed and members feel free to talk about their feelings and their work (including their mistakes). The leaders will discourage unwanted and intrusive questions about the presenting doctor’s personal life and history. Personal anecdotes are sometimes volunteered and can be helpful. The leaders will allow this provided there is no pressure. The group is not a therapy 113
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Family Medicine

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