Published: 13/05/2004, Volume II4, No. 5905 Page 30 31
PCTs are winning praise for getting out into their communities to identify the issues that really matter to local people, such as transport links to health services.
Mark Gould explains
Getting nearly 70 people to a meeting about NHS transport facilities is not easy, even in the middle of a large city. But in semi-rural Easington, it is nothing short of a miracle.
Easington primary care trust has worked hard to build strong links with its population, one of the most deprived in the UK, which is still feeling the aftershock of the closure of 14 pits. It has the second highest proportion of registered carers in the UK and 33 per cent of the population has a long-term health condition. It is also the most under-resourced PCT in England with a 20 per cent deficit in funding, which equates to£26m this year.
The recent NHS staff survey by the Commission for Health Improvement (now the Healthcare Commission) asked, among other things, what employees thought of their senior managers' attempts to build positive relationships with the community.
Easington came out as one of the top 10 PCTs in the country for building community links.
Going out, talking to the community and getting valuable feedback to help improve services is the work of patient and public involvement co-ordinator Liz Allan.
Ms Allan says the PCT's predecessor primary care group laid good foundations by establishing eight community forums linking health, transport, education and policing to provide the local intelligence and feedback.
She believes there is no point in being half-hearted about community involvement. 'Just putting an ad in the local paper about a meeting means you get two men and a dog turning up. To properly engage you have to invite people.We are having a review of all health services in the Teesside area.We sent out invitations to 500 people, arranged a creche, organised lunch and, most importantly, transport, as we are semi-rural.
About 70 people came along - That is excellent.'
Transcripts of the meeting are sent to everyone who was invited and the views come back to the PCT and County Durham and Tees Valley strategic health authority.
'The meeting was about trying to get people to look past buildings and focus on services, which is why transport is key, ' says Ms Allan.
PCT chief executive Dr Roger Bolas took a day off to test for himself how long it takes to get to an outpatient clinic and back by public transport.
Ms Allan says that transport ties in with everything. 'If you live in a village with one shop that doesn't sell much fresh fruit and vegetables and you can't get to the supermarket in Peterlee or Seaham, you are stymied.We want to use this intelligence to influence the bus services.'
Bradford City PCT was also congratulated for its community work in the CHI survey. The city was hit by race riots last year, but the aftermath has seen new community links being forged between the PCT and the Asian community via neighbourhood forums that bring together statutory, voluntary and faith groups.
Meetings raise questions about access to GP and dental services, but have also led to a greater awareness of the problem of those who fail to turn up for appointments, according to David Ross, the PCT's patient and public involvement co-ordinator.
'We have produced a multi-lingual patient guide which sets out GPs' and dentists' obligations but also patients' rights and responsibilities.'
Mr Ross says that many people who do not speak English as a first language find it difficult to access services. 'Rather than carry out a massive review of diabetes services we asked staff to identify people who were diabetic and establish a series of focus groups to ask what they thought and suggest improvements.'
One of the innovations was a buddy scheme. 'People whose diabetes is controlled can act as mentors and supporters for those who have been newly diagnosed.'
Wednesbury and West Bromwich PCT Sure Start community development officer Matt Lee says the simple idea of moving health visitors out of GP surgeries into local Sure Start offices has been a great success.
'The health visitors felt a bit distant from the people they wanted to target, so offering them a more community-focused approach has meant their jobs are easier. They now work on the ground with education, training and employment staff.'
Mr Lee feels this grass-roots integration could mean that larger-scale mergers of health and social services departments are unnecessary.
The PCT has also put money into rebuilding a local nursery that will increase the number of childcare places and so free people up to go into training, education or work. It has also set up parents forums so that those involved in Sure Start can have a say in improving and adapting the services they receive.
Harlow in Essex was a social experiment. Established in the 1950s as a home for massive overspill from the East End of London, the town was built around neighbourhoods, each with its own GP, shops, dentists and 'local identity'.
Harlow PCT chief executive Pam Court says that entrenched sense of local communities has been vital to building good links with the PCT.
'When a surgery was due to close its branch practice there was a big public outcry that fed back to us. As a result we have negotiated a ground-breaking personal medical services deal with a commercial company who provide GPs services there.'
The town has a very young population so improving sexual health and cutting teenage pregnancy rates were considered a priority.
Much of the work was done by award-winning lead nurse for sexual health Mary Jackson, who works at the Young People's Information Centre, a walk-in centre that seeks to break down barriers and help young people to access health services in an informal environment.
'You can have all the right medical things in place, but if people can't or will not access them for some seemingly small reason then it doesn't work. Its all about getting the little things right.'
A survey of NHS staff by the Commission for Health Improvement highlighted top-performing PCTs on community engagement.
Numbers attending public meetings can be boosted by targeting transport and using existing networks.
A number of PCTs have helped community links by moving staff out of NHS locations.