‘Practice-ing’ Community-Centred Approaches!


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.

Story Telling                                                                                       

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:

Digital Inclusion

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.

My takeaways:

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!

Roz Davies, 

We Love Life & Recovery Enterprise 



Exploring the ‘We’ in Well-being!


The Kings Fund and National Voices have recently launched an excellent helpful paper ‘People in Control of their own Health’ designed to provide a practical framework to help turn policy rhetoric into a reality.

At the launch event the following question was asked:

What one thing do you think needs to change to support people to take control of their own health?

My simple response to this question is:

To change the lens through which we view and try to improve health from ‘I’ to ‘We’

This response is based on my personal experience of living with type 1 diabetes, supported by experience of working in community development and research around citizenship, peer support and well-being.

A good starting place might be this powerful definition of health I discovered a few months ago through social media in a post written by an Australian GP and writer called Tim Senior

‘Health is not just the physical well-being of an individual but refers to the social, emotional and cultural well-being of the whole community in which an individual is able to achieve their full potential as a human being thereby bringing about the total well-being of their community. It is a whole of life view and includes the cyclical concept of life-death-life.’

It is the Aboriginal definition of Health.

This is about having the opportunity to reach our full health potential no matter what health conditions or disease we may live with. It is also about recognising that our health depends not simply on clinical and medical care but on wider social determinants of health in particular our relationships and our community connections.

To bring this to life in our context, I have had a number of conversations with health care professionals in the last few months often in the context of diabetes around supporting self-management.

We have talked about some of the enabling resources from a more clinical perspective including training and support, equipment and digital technology, but we have also shared a belief that our relationships and networks including the very important human interaction between health care professionals and patients and our wider support network, the social capital in our lives are very important factors in our ability to take control of our health.

We know there is evidence of the impact of isolation and loneliness on our health generally. There is evidence to show that loneliness is worse for our health than smoking 15 cigarettes a day and has an impact on our immune system.

There is increasing evidence that support for self-management needs to be set in the context of social networks. A study published in June 2014 ‘Contribution of social networks to the health and self-management of patients with long term conditions’ showed that greater social involvement was significantly related to better self-management ability, better physical health or ability to cope with health conditions and greater emotional well-being.

Professor Martin Knapp and the PSSRU team at the London School of Economics has also produced a useful report and infographic on the economic case for building community capital.

So the idea of building a sense of community into supporting people to control their own health not only makes common sense but also has a growing evidence based behind it.

Important dimensions of ‘We’ not ‘I’ are the relationships between the health care professional and the individual, and the health system and citizens. As we are all aware this is delicate, tricky and complex because we are human beings. The place to start must be with shared purpose and responsibility, not paternalism and a lopsided power base but the co-production of solutions which are meaningful to us all. If we genuinely wish to support people to feel empowered and in control of their health, we must recognise that the person in the room is a whole person not a condition/set of conditions, e.g. ‘a diabetic’.

So here are some descriptions of people:

  1. A person who lives with Diabetes and Asthma and is a Patient Foundation Trust Governor
  2. A person who is a wife and mother of 2 primary school age children and a volunteer reading buddy at school.
  3. A person who has an MBA and is a CE of a social enterprise

This is not three people but one! When this person walks into the consulting room or surgery they bring all these different facets with them. Each patient or person comes with an individual set of circumstances and resources/assets and so does the health care professional, all of which may be useful but it can take time, trust and listening with intent to understand to effectively utilise all that we bring into the room.

The ‘We’ of community and peer support networks and the ‘We’ of the clinical/patient relationship are important factors of helping us to take control of our health.

Here are a few examples of existing and emerging related approaches and activities which help to build the ‘We’ into Wellbeing:

To complete this post a quote which sums it all up in one sentence…..

Ethos of We Love Life


John Walsh recently wrote a very thought provoking post on his excellent ‘yes to life blog’ which articulates the value of each of us taking responsibility for building collaborative and connected communities.