There is much talk of the value of staff in the NHS working in partnership with patients, citizens and communities. It’s in NHS England’s Five Year Forward Vision and is even enshrined (to some extent) in legislation for CCGs – ‘the duty to involve’ (guidance is worth a read).
There is a wealth of evidence, theories and approaches on why and how to do this. If you wanted to read one publication, I would recommend Public Health England’s Guide to Community Centred Approaches.
However, we are a long way from Community Centred Approaches being ‘how we do things around here’ across the system and country.
Recently, I have been involved in a small informal network of general practices and their communities and partners, who have been exploring different ways to build relationships and work in partnership with patients, citizens and communities. The people within the group are from a range of backgrounds, localities and interests and have come together organically, not driven by funding or policy but by shared values and because each individual, organisation and community has something to give and something to gain.
On 15 April, despite the usual challenges which we all face around time, costs and health, the group gathered at Dr Amir Hannan’s practice in Hyde. Health Trainers, GPs, PPG Members, NHS Managers and Commissioners, voluntary and community groups and even an actress and a policeman came together to share their experiences, problems, insights and ideas.
Amir recorded all the presentations of the day and the presenters generously consented to share this online with anyone who wishes to learn from their experiences and insights. They are all available here on the Haughton Thornley Medical Centre website. You might like their strapline in the top left corner;
‘There for all of your life, your good health with our support, empowering you to live well’
I have summarised what I learnt from each part of the day below.
Culture eats ‘Tick Box’ for Breakfast
As we walked into the Practice fresh from the other side of the Pennines, the first thing that struck me was the big call to action banner stand at the entrance inviting all who walk through the door to join others in taking a personal health pledge. This set the scene for a relationship with the NHS which encourages people to take control of their health and well-being in the context of community. Not for everyone but a symbol of ‘the way things are done around here’.
It is interesting to apply to this context Edgar Schein’s three levels of organisational cultures: artifacts and behaviours, espoused values and deeper shared assumptions. The banner stand offered hints of the Practice’s cultural artifacts and behaviours at the gateway to the Practice and the strapline offered an online insight into the espoused values. This entrance set the scene for the rest of the day. This Practice and the people in all their roles which connect around it have created a culture of partnerships of trust which takes activities that can easily become tick box exercises and turns them into powerful tools for positive change.
Partnerships of Trust with Patients (Patient Participation Group)
The event kicked off in the Practice’s large community meeting room with a rousing presentation from the inspirational Ingrid Bringle, who is the Chair of the Practice Patient Participation Group. Her presentation showed how much a genuine and powerful partnership between patients and people working in Practices can achieve. Just some of their achievements include record access workshops, collections for the food banks, getting a pharmacy next door, health promotion market stalls, bringing experts into the Practice and working strategically with other partners including neighbouring PPGs. Ingrid also shared the ingredients of their success, part of which I believe is the partnership of trust and shared values between her and Amir.
Next up was another volunteer Patient Participation Group member Dominic Sexton, who shared with us their local ‘Health Pledge’ campaign inspired by the NHS Change Day campaign. The essence of this campaign is about personal goal setting in the context of community building using both their local community face-to-face activities and online resources and tools. The ‘team’ had put a great deal of energy, time and effort into building and promoting the campaign.
As well as the content of the presentations, I also really enjoyed the banter between Amir, Ingrid and Dominic. I got the impression they knew each other well, had a great deal of respect for each other, shared similar values and purpose and had fun as well as working tirelessly to make a difference to the health and well-being of their community. Going back to Schein I think we saw the cultural layer of deep shared assumptions displayed across the team, for example valuing each other’s strengths and talents.
Amir also invited others from the community around the Practice to join in too. We heard from Christina Howard from the CVH First Class Group and Editor of their magazine. She highlighted the power of story-telling in building communities and in improving health and well-being. Barbara Hampson then told us her own fascinating story of her role (since 1967) in the National Association of Women’s Club, helping women to make friends and have a better life. Amir rightly pointed out that Barbara was an excellent role model within the community. And later Rehana from Hyde Community Action, who described how they draw on the asset based community development approach to unleash the potential of individuals and communities to come together to improve health and well-being.
Patient Access to Electronic Health Records
Amir went on to deliver an inspiring presentation appropriately starting with the Nelson Mandela quote: ‘A winner is a dreamer who never gives up’ exploring the idea of a ‘partnership of trust’ with patients.
He gave an excellent summary of how he is using a combination of offline and online support and resources to work in partnership with his patients and community. He explains the purpose, principles and practicalities of supporting patients to access their electronic health records. 35% of his patients are currently accessing their electronic health records. These are people from different backgrounds, different age groups and living with a range of long-term conditions. What I learnt from this presentation and the whole day was that it is the underlying purpose, values and culture that make this work in Hyde, seeking to genuinely support people to have the confidence, skills, information and connections to be able to take more control over their health and well-being. Amir rightly emphasised that digital is simply one tool, one means to the end.
Peer Support, Relationship Building and Digital Technology
Next up was Dr Farhan Amin, who, with his colleague Gareth Presch, travelled down from Cumbria. Farhan who works as a GP at Burnett Edgar Medical Centre, recognised the power of story-telling too and is using the video and digital technology to facilitate patients to share their experiences and insights of living with specific health conditions. He has developed Patient Memoirs for two main reasons: to enable patients to share experiences and insights with each other and to build more informed relationships between patients and health care professionals.
I have personal experience of benefiting from peer support and really value the empathy and understanding, real life tips on how to deal with some of the challenges of living with type 1 diabetes and as a spin off the friendships that have grown from the initial connection. Janet Harris from Scharr at Sheffield University, who was unfortunately unable to join the group on the day, has carried out some excellent research which highlights the power of peer support in health and well-being which gives some academic backing to my anecdotal experience.
Patient Activation Measures
Dr Ollie Hart from the Sloan Medical Practice in Sheffield then shared with us his experience of using ‘Patient Activation Measures’ (PAM). He started with a very good point: as patients, we do not label ourselves as activated or not. Ollie recognised that although PAM is not a perfect model, it is one tool which, when used in the right context, culture and approach, can be part of the kit creating the conditions where people can build the confidence, knowledge and skills to better manage their own health and healthcare. Ollie is using PAM to help him and his colleagues to ‘tune into’ more customised and personalised approaches to supporting patients and ‘meet people where they are’. It helps clinicians to work out with patients how engaged/activated people currently are in their own healthcare. Subsequently clinicians can work in partnership with patients to develop more appropriate packages of care. This prompted some interesting discussions, e.g. how motivation levels impact on the results, how this work impacts on the prioritisation of limited resources and how this approach connects with tackling the wider determinants of health and community building.
Communities Got Talent
Lyn Brandon from Sheffield City Council Public Health Team and Chris Hanson and Karen (See clip on some of Karen’s work as a Health Trainer here) from Shipshape Sharrow shared the Sheffield community well-being model, which has evolved over 20 years, and described a wealth of community activities including the introduction to community development in health course, community health champions, health trainers and social prescribing. Community organisations like Shipshape Sharrow are working in partnership with Practices to help build the confidence, knowledge, skills and connections for individuals and communities to be able to improve their health and well-being. Chris highlighted the importance of a holistic connected approach in communities and the systematic support and infrastructure across the city. All three of the speakers talked about how this approach enabled people to travel along a pathway both towards improved self-management and getting involved in their community.
Engaging The Public and Businesses: Ambassadors
Gareth Presch, District Nursing Service Lead from Cumbria Partnership NHS Foundation Trust, brought in a strategic perspective and shared his innovative ideas for improving engagement, learning from and working in partnership with other business, universities and role models. From using social media to working with the Carlisle Business Ambassadors network, Gareth was challenging us to take a collaborative approach and to think outside the box.
A couple of postscript extra thoughts from me:
Much of the discussions today blended together both face-to-face activities with digital resources. The group recognised that digital technology is an important tool in the 21st century Practice kit and that it helps in many ways, e.g. promoting activities, building understanding and connections, supporting people to take control of their health through access to electronic health records and becoming more informed about their health conditions or medication. The group is connected to Tinder Foundation’s NHS England funded widening digital participation programme. See Ollie’s experience of bringing digital inclusion into his local Practice here. Tinder Foundation has produced an excellent infographic on the current picture of digital inclusion which explains that there are 11 million people who lack basic digital skills.
Tinder Foundation also say ‘there is a huge synergy between groups that are digital excluded and those who experience health inequalities’. This means that it is important that Practices that use digital resources need also to consider supporting digital inclusion. Tinder Foundation currently offer Practices access to free online training on using GP online services such as repeat prescriptions, booking appointments and access to records. Practices can add a ‘widget’ or link to their websites directly to ‘Learn My Way’. In addition Tinder Foundation also provides access to its 5,000 strong community organisation network where people can access face-to-face support. Practice staff can find out who their local UK Online Centre is by entering their postcode on the site.
I have been reading Martin Seligman’s ‘Flourish’, which I found via the fantastic New Zealand organisation LifeHackHQ. Martin Seligman is one of the founders of positive psychology and talks about the PERMA (Positive Emotion, Engaged, Relationships, Meaningful Achievement) approach to creating the conditions where people can flourish. You can find out more in this clip.
I wondered whether understanding this holistic approach to helping people to flourish could help to reframe the potential and purpose of the Partnerships of Trust which these Practices and their communities are building.
Every person who contributed brought their own unique set of talents and resources into the room and freely shared their experiences and insights. Despite knowing that the session was being filmed and shared, it felt like a safe space where everyone was equally valued, diversity was respected and people could be open and honest. Yet at the same time, it was purposeful and useful. Each of us was also able to take away new knowledge and ideas and I think a sense of community began to emerge as new relationships were forged. I learnt that:
- GP Practices can become focal points for community building and community centred approaches.
- Culture matters; you can’t fake it and it manifests itself in many ways from the physical facilities to the relationship between the PPG and the Clinicians.
- Partnerships of trust with patients, carers, citizens and communities take time and require courageous and authentic leadership, honesty, a healthy respect for diversity, and the development of shared values and purpose.
- Flexible multiple activities not fixed singular approaches are more likely to work.
- There is an element of risk to change but often the risk of remaining the same seems to be higher. Ollie observed the people in the room were all ‘risk takers’.
- There is a need to accept and understand the importance of the messiness and organic nature of community centred approaches.
- There is great value in building connections and purposeful knowledge sharing across different communities and Practices. It worked well for this group because of shared values and because each person shared their gifts, felt valued and gained new knowledge to take back to their Practice and communities.
I have a hunch that this will not be the last gathering of this group of people and I hope next time there will be others with different gifts to share!
Thank you to all the people who took a day out to share their amazing stories, insights and ideas. We are at a crossroads in healthcare and it certainly felt to me that the development of Community Centred Practices could be a very positive step forward in supporting individuals and communities to Flourish!
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