Sunday service – doctors go to church to get Merton men talking about their health

If you thought getting a group of men to open up about their waterworks – in a church hall – after Sunday service – might be challenging, you’d be wrong. A men’s health project confronting the issue of urology has shown that people have plenty to say on the subject.

Says Dr Vasa Gnanapragasam, Merton Clinical chair and urology GP lead for South West London NHS: “As doctors we sometimes think that if it’s not about, say, heart disease or diabetes, you can’t get people to talk in a group. Discussing urology and the symptoms it brings – it’s not a British thing to do. But the groups we’ve talked to really weren’t shy. They showed us our thinking was still in the Victorian age on these things.”

The partnership project brings together St George’s Hospitals NHS Trust, East Merton Primary Care Network and NHS South West London CCG. It came out of an idea by Ben Ayres, Consultant Urologist at St George’s, which he put to Vasa and Dr Mohan Sekeram, from Mitcham’s Wideway GP Practice.

Says Ben: “We have standard processes for how patients get referred from primary to secondary care. But all the changes we’ve gone through over the last 18 months got me thinking. Could use this as a time to look at different ways of patients accessing care?”

The aim was simple – to demystify the bladder and prostate problems that could be a sign of cancer, making it easier for people to seek early diagnosis and treatment. It was also about helping people access care and self-manage other urology conditions, bypassing the normal referral system.

The project began with a series of focus groups held under lockdown. The groups recruited people with experience of urology issues, including frequent urinary tract infections and catheters, for online sessions. Participants were offered the chance to talk one-to-one, but their willingness to join open discussions, even going off-topic into areas such as erectile dysfunction, inspired the partners to take the project further.

The first live event was in Pollards Hill Baptist Church in July and was aimed at men from the area’s African and Caribbean communities. After the service, worshippers were invited to stay behind and hear Ben give a presentation before opening up to the floor.

Says Ben: “The idea was that the presentation might jig some thoughts in their heads, like ‘Oh yes, I have seen blood in my pee, maybe I should talk to the doctor about that’. Our messages were very clear about signs of urological cancers. We also talked about PSA testing (a blood test to help detect prostate cancer) and how there are some ethnic groups where prostate cancer is more common.

“But the focus wasn’t just on cancer. We covered difficulty passing urine, incontinence, testicular pain – all sorts of urology conditions. I was amazed at the number of questions afterwards – it all seemed very natural.”

According to Vasa. “It was quite fascinating because one person would ask a question about his symptoms, and another would pitch in with his experience. We also talked about weight and smoking. We got home the message that, especially if you’re a smoker, and you’re 50 or 60, your symptoms could be cancer. If not, you could have a problem in the bladder which needs to be dealt with.”

Pollards Hill is an area of east Merton where health inequalities need to be addressed and innovative solutions found to the barriers to accessing to care. South West London as a whole has also seen a sharp reduction in people starting treatment for some cancers since the first lockdown.

Says Vasa, “We know that during the pandemic the number of people diagnosed with bladder cancer did drop. We know too that the barriers to accessing care are greater for less advantaged people. In east Merton there are barriers because of transport issues or language issues or because people have work commitments that mean they can’t afford time off to see the doctor.”

For Ben, the project is unique because it brings healthcare right to the community. “We deliberately chose an area where we felt we could tackle some health inequalities. Speaking to patient groups has already been happening for years. What was different here was that, in addition to a group presentation and discussion on urology and health promotion, we offered patients the chance to have a one-to-one consultation with a specialist about something urological that was on their mind – on a Sunday. We would give them appropriate advice, and if required, start their process through the system for any other investigations, treatments or whatever that might be needed.”

After the church event, the team had a presence at the Pollards Hill Funday, joining additional partners including Macmillan Cancer Care and mental health service Merton Uplift. The event, over the bank holiday weekend, reached a bigger demographic, including women and younger people, with wider messages about healthy living.

The project has been delivered at no cost, thanks to the clinicians giving their time to make it happen – and to community support, including from Pollards Hill Baptist Church and its minister, Rev Deji Ayorinde. “The support of the Pastor, a leader in the community, is vital for projects of this nature to be successful. It provided us the platform on which to build enduring relationships,” says Vasa.

For the future, another session at the church is booked for later in November. But the project has bigger plans – to cover other cancers, healthy living, heart disease and strokes. Experience of how willing people are to engage with difficult topics means suicide prevention and even organ donation are on the agenda, and there are ambitions to take the model to targeted areas across South West London.

According to Vasa, the project also took inspiration from the COVID-19 vaccine programme, which successfully went out to communities to encourage take-up. But it was about demonstrating that the NHS is here for people at other times too.

“Sometimes communities feel a bit battered, a bit targeted, when they’re singled out as not taking up the vaccine. We didn’t want people to think we only come to them when we need them to do something. So, it was like going back to say thank you, we are here and we will carry on engaging, with topics you want to talk about and issues which are important to you and your communities.”