In this series patient champion and charity leader Jeremy Taylor talks to people leading work with patients, families and carers.
What have you done?
Altogether Better has been part of the NHS since 2008. We’ve developed a way of working called Collaborative Practice. It helps services, patients and local people work together as partners in ways that make life better for everyone.
We work predominantly with GP practices who want to do things differently to tackle the problems that medicine can’t fix but that bring people back again and again to the doctor.
We act as facilitators, helping people in practices work on issues that matter most to them. Clinicians want the best outcomes for their patients, but they also want their own difficult problems solved. Collaborative Practice helps them achieve a better work-life balance: reasonable hours, seeing their children, more rewarding work, and so on.
The first step is helping the GPs explore their data and really talk about it together. Sometimes this is for the first time. It can lead to surprises and reveal patterns and trends that challenge their assumptions. They often find that the most frequently attending patients can come from a large range of age groups, including lots of younger people with mental health issues. We worked with a practice in Dorset who believed they had a problem with older patients but in fact a lot of their most frequent attenders were younger patients including one who had attended 148 appointments in the previous year.
Typically, we find that a small percentage of the patient population accounts for a significant proportion of the total resource. Really looking at where the time and costs are lying becomes a motivator for the practice to think and do differently.
We then help the practice think through how they can work alongside local people. The offer is to “extend your team”. They invite people in to work in partnership as volunteer practice health champions to improve services and expand the practice’s offer to patients. When champions join the team, new activities emerge which meet patients’ social needs, in turn freeing up clinicians to spend time on the people who really need their medical skills.
We know that as many as 50 per cent of patients who go to the GP have non-medical problems. So a lot of what the practice champions do involves connecting people to other people and to sources of non-medical support. For example, 92-year-old Florence was coming to one of our practices three times a week. Dave, one of the practice champions, took her along to a local singing group. She has met three other ladies there, has a range of new social activities and connections and is no longer a frequent attender. That’s around 150 appointments saved over a year.
People ask if this is social prescribing. It’s all of the other things that social prescribing link workers offer – but also more. Collaborative Practice is a systems approach which changes the identity and culture of the practice.
We have now worked in more than 150 practices in 24 clinical commissioning group areas and in other NHS settings too, for example in accident and emergency and mental health services.
What was your motivation?
Quite simply, I believe this work can save primary care and save the NHS!
How were patients and families involved?
We talk about people, rather than patients. Even the term “communities” doesn’t quite work as it suggests that connections already exist when sometimes they don’t, and our work can help create them. “Community” also implies something “out there” that is separate from the practice, but the practice is part of the community.
What was the impact?
Our work has been well-evaluated. We see changes in how people use services, for example a recent evaluation in Gateshead showed a 30 per cent fall in the most frequent attenders. And there are better health outcomes for people, including for the practice health champions who so generously gift their time and talents to this work.
We see practices evolving and adapting, with improved recruitment and retention and improvements in quality of life for staff. A GP we worked with described how she’s been in general practice for 20 years but that the past year has been her most rewarding.
Fundamentally, it’s about people and humanity and it brings meaning and fun back into healthcare. Work becomes joyful again. We often quote a practice manager who said to us, “this is simply how we do things around here now”.
What have you learned?
This is not a project or a job to be done. We see it as a new model of care that also changes patient-clinician relations. It’s about the whole system and everyone in that system needs to be involved. Relationships matter. When we invest in those, the rest follows.
Language matters, too. When one of our Stockport practices texted out their invitation to people to work alongside them, nearly 600 people came forward. They felt honoured to be asked and privileged to give something back to a practice they held in high esteem. I don’t think there would have been the same response if the practice had simply printed out flyers to “recruit” volunteers.
We talk about meeting unmet need, not “managing demand”. We talk about connections rather than “referrals”. And we avoid labelling people. All this helps the staff to see people as people rather than as hordes of patients to be managed – that’s terminology we have heard expressed!
We are keen to spread the approach and we see the ambitions in the long-term plan and the new responsibilities of sustainability and transformation partnerships, integrated care systems and primary care to develop primary care networks as a huge opportunity.
What is your message to HSJ readers?
It’s better when people work together as partners and peers with joy, enthusiasm and passion because then amazing things happen! I genuinely believe this work will help save the system and meet the needs of patients.
I would really encourage people to take a closer look at what we are doing and appreciate that we have evidence and amazing stories. Be brave! Take a step towards thinking and working in different ways. Come and chat to us.
The past What about the patient?