Ageing Gracefully – Island GP’s vision for elderly

There can’t be many people who would describe dementia as their “passion” – but that’s exactly how Island GP Dr Michele Legg refers to the debilitating condition.

As the Lead GP at Ryde’s Tower House surgery and recently-appointed Chair of the Island’s Clinical Commissioning Group, mother-of-two Dr Legg is keen to raise awareness of dementia and Alzheimers, and find ways of easing the burden for sufferers and their carers.  Jackie McCarrick has been finding out what drives her enthusiasm.

A poignant personal memory from her childhood probably holds a key to Michele Legg’s present-day focus on elderly mental health.

Dr Legg reveals that when she was a pupil at Ryde Convent School in the early 1980s, her own maternal grandmother developed dementia, and, among other things, began to confuse one member of the family with another.

“As a teenager, I used to visit her, and I’d keep trying to get her to remember things” Dr Legg recalls.

“Of course I didn’t realise it at the time, but what we now know is by doing that you are adding to the pressure, which tends to make dementia patients even more agitated”.

That close-up experience of the effects dementia can have on a whole family were to prove invaluable in her future career – but at that stage, the young Michele Legg had no thought of going into Medicine. In fact, she says she could just have easily opted for the Arts.

Early calling

Though she was born on the mainland, Michele’s family had re-located to the Island from Biggin Hill when she was aged 10 and her brother was four.  Dad Michael was a self-employed builder and their mum Patricia was a part-time antiques dealer – a trade that the young Michele found fascinating and could easily have taken up herself.

“I loved the antiques and seriously considered studying Fine Art for a while” she says.

However, during her five years at the Convent School she also began to consider medicine as an alternative career.

“I’m not sure why – it was an idea that just seemed to grow with me” she says.

“At first, my mum wasn’t that keen for me to do it because of all the years it would mean at medical school – and actually it was a bit of a departure for my family as nobody has ever gone to college or University before”.

Once her family realised that she was serious about medicine though, they were right behind her.

She won a scholarship to Portsmouth High School and then left the Island at 19 to begin her studies at UCL and Middlesex Medical School. The same uncle who had paid her school fees at Ryde Convent helped the family again to finance her University costs.

Michele recalls being a hard-up student in London, working during the summer holidays as a cleaner in University halls, to help subsidise her study costs.

“Looking back I can see that I was quite poor at college  so I didn’t do all those wonderful things you’re meant to do as a student in London” she says, “but I did really enjoy my studies and that was what mattered”.

Her hard work paid off with an Honours degree in neuro-science – but she never really enjoyed the years she spent working on hospital wards as part of her training.

“I found the environment very old-school and hierarchical, and one in which I always felt quite awkward” she says.  “I think I always knew that I would be more suited to working as a GP.”

Having spent four years working in London hospitals, Michele did two years of medical rotation in Yeovil – including a very significant six months in geriatrics, which seemed to nail her main area of interest.

By this time, she was in a long-term relationship with fellow medic Andreas Lehmann, who she had met when both were junior doctors at the Island’s St Mary’s Hospital in 1995.

Having conducted their relationship on long-distance basis for three years, she finally moved to Middlesbrough to be with him after she became pregnant.

True to her gritty nature though, she carried on working 100 hours a week in Yeovil until the sixth month of the pregnancy, and then moved north to start their family life.

Their firstborn, Dylan arrived in 1998, to be followed three years later by a second son, Conor, and Michele says she enjoyed her time off as a mother, living in a variety of locations including a primitive cottage in the Derbyshire Peak District of Whaley Bridge.

Island Return

Like many people who have grown up on the Island, Michele always expected to return – and her chance came in 2004, when she, Andreas and the boys relocated back here, and she began her long-anticipated training as a GP.

Her two-year training was at Sandown Medical Centre and Tower House in Ryde, and was followed by three years working at Sandown, and then a move to Tower House – this time as a partner.

With her children by this time attending nearby Ryde School, she was able to perform the professional-domestic juggling act that so many mothers do.

As she always expected, Michele finally found her passion in working as a family doctor.

“I adore being a GP” she says.  “It’s a privilege and an honour to be involved with people on such a personal level, and to have them put their trust in you.

“Some people think of GP work as being about just coughs and colds, but in fact It’s an incredibly varied job – certainly never boring. Every case I see is totally different”.

The other aspect of her job that Dr Legg enjoys is the fact that, as a partner, the medical practice is also essentially her ‘business’.

“I’m incredibly proud of my surgery” she says. “Not that I’m suggesting we are always perfect – but because we have ultimate control over what we do, we’re always striving to do things better”.

Dementia friendly

In particular, and in line with Michele’s special interest in dementia and older people’s health, her practice  has worked towards making itself ‘dementia friendly’ – which has involved training all staff, including reception and admin as well as medical practioners, in dementia awareness.

In addition, any environmental changes that are made, from installing new flooring or furniture to painting the walls, are done with dementia awareness.  This has included avoiding shiny floorings, which some dementia sufferers can confuse with water, and even incorporating the proven dementia-friendly colour, pink.

Dr Legg explained that Tower House’s resident “Dementia Champion”, care assistant Sam Poore, suggested changing her uniform to pink after reading research that suggested it calms and reassures people with dementia. The pink uniform was promptly adopted, along with dementia-friendly signage around the surgery.

“We can respond and make changes quite quickly, whereas the wheels of change in hospitals tend to turn much more slowly” said Dr Legg.

She is also acutely aware – not least because of her own personal experience – that dementia affects families and carers just as much as the person who had the condition.

“We have this big move towards people being cared for in their own home, which is great in itself – but it does have a big impact on the carers, and we’re very conscious that a lot of husbands and wives  really struggle with the burden of caring for their partner”.

The approach at Tower House is to sensitively work with carers to give them the support they need; an approach that was congratulated at the practice’s last inspection by the Care Quality Commission.

The surgery is also more generally ‘Age Friendly’, having worked together with Age UK and its own Patient Participation Group to come up with a range of measures that make the building easier to navigate for older patients.

On a wider level, Dr Legg has also been involved with groups running community and social events such as Alzheimer’s Cafes and healing arts, that help to prevent social isolation.

As she points out, with 28% of the Island’s population now aged 65 or over, the need for age-friendly services has never been more acute, and can only increase.

Another disease that’s commonly associated with ageing is the bone-degenerating condition of osteoporosis, in which Dr Legg also has a deep interest.  In fact she’s currently President of the Island’s Osteoporosis Society, a role that was held for many years by the late Gioiaa Minghella – “a very big pair of shoes to fill” she says.

Brotherly support

Working three days a week in general practice at Tower House and another two days in her role as  Chair of the Island’s CCG (which is effectively responsible for ‘buying in’ healthcare of the whole Isle of Wight) means that the pace of life can certainly get hectic.

But Dr Legg has a particularly close ally and keen supporter in the workplace – because her brother Patrick is Manager of the 13,000-patient Tower House practice, the third largest on the Island.

What started as a temporary measure three years ago has turned permanent because Patrick, a trained accountant and well-known Island businessman, fitted into the role so well.

“I must admit it felt odd in the beginning to be working with my brother and I know some people had their doubts about it at first, but it’s been an ideal solution.

“I know he’s my brother so I’d be expected to say this, but he’s absolutely amazing and the staff love him” says Dr Legg.  “He has our backs, he looks after the GPs and he’s keenly business-minded, which is crucial when we have so much pressure on our health services”.

Away from the hectic pace of the practice and her CCG schedules, Dr Legg winds down by walking the family’s Sproodle dog Archie on the beach near their Shanklin home, or reading her favourite type of escapist fiction – crime novels.

“Having two teenage boys at home is very grounding too!” she laughs.  “As soon as you get home they’re talking about other things, like football and rugby, which bring you right back down to earth”.

Neither of the boys has yet shown any sign of wanting to follow their parents into medicine:  Dylan is a passionate surfer who’s considering studying oceanography at university, whilst Conor is still doing his GCSEs at Ryde.

Dr Legg is happy to let them find their own path, just as her parents allowed her to find hers.

Meanwhile, she reckons the Island “has a big job ahead” when it comes to providing services for the elderly in general and dementia sufferers in particular.

“People will need lots of support, and we also need to think more about the carers” she says.

“With the CCG having to make £13 million of savings this year, we need to engage much more on self-care, prevention and community initiatives, such as the inter-generational work, involving schoolchildren with their elderly neighbours, that’s being done with Big Lottery funding”.

“The community is already doing great things like the Alzheimer’s cafes, and other GP practices have now become dementia-friendly – but I still think we have a big job ahead of us”.