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We are the champions

One frequent criticism of health systems is that they are based on antiquated models. For instance, the argument is often made that most care should take place at community level and not, as is the case at present, in hospitals. Another criticism is that, in spite of the push to have more patients involved in their care, the medical model of healthcare still prevails. It is this status quo that the UK organisation, Altogether Better, seeks to challenge.

Altogether Better, which was formed in 2008, is part of the NHS but it is allowed a great degree of independence to develop a more patient-centric health service. The uniqueness of its approach is encapsulated in the concept of the health champion. Health champions are people who volunteer to engage with and develop their local health service through tailored initiatives designed to meet unmet demand.

Originally, the concept was more geared towards community health champions who would create groups to meet local needs and direct people to relevant support and services. Now, however, the emphasis is more on linking the champions with the health service.

Health Summit

Director of Altogether Better, Ms Alyson McGregor, will come to Dublin on 7 February to speak about the organisation’s work with GP practices through ‘practice health champions’ at the 13th National Health Summit, which takes place in Croke Park. Speaking to the Medical Independent (MI), Ms McGregor, who has over 30 years’ experience working in a range of health systems, said that having champions working alongside GP practices is more sustainable than having them work independently in the community, and ultimately, is of greater benefit for patients.

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Ms Alyson McGregor

“Community health champions were something that we used to do four years ago,” explained Ms McGregor.

“The people were fabulous, they came forward in their thousands and they generously gave their time and energy, but you always needed funding to pay for that co-ordination role. We knew the NHS didn’t have the money to do that, and we knew that people would not be able to sustain that.

“What we have done is, we have developed and prototyped a sustainable model of work that involves GP surgeries inviting people on their list or people in their local community to work alongside the practice to improve the health and wellbeing of their patients. So we are using everything that we have learned from community health champions, but we have built on it. And many, many people are still working on that community health champion model that we prototyped but they are finding it difficult to sustain. What we have found is a sustainable way of doing this work and what we have done is stumbled upon a new model of general practice in doing that. And we are really excited about that. We think it has the potential to transform the NHS.”

Working alongside GPs offers numerous advantages, according to Ms McGregor, such as the ability to use the existing infrastructure of general practice and the links surgeries have with local communities. She said people are more likely to participate in initiatives if they are asked by someone they trust, such as their general practitioners, rather than a stranger.

“If I was asking you to be a community health champion, you would think, ‘who is she? Where is she from? I don’t know that organisation — why would I want to do that?’” she said.

“If you get a text message from your surgery and you love your surgery and they looked after your mum and your grandma and you want to give something back, you might actually answer the text message.”

But a significant reason for targeting general practice is that it has a patient population who could benefit from having a greater range of services available to them. Ms McGregor cited research which found that many people who attend general practice surgeries do not need to be there, or do not necessarily have to see a doctor to resolve their problem.

“The things that people present with in general practice are isolation, loneliness and difficulties in managing multiple morbidities in long-term conditions,” said Ms McGregor.

“When the NHS was set up, it was to treat infectious disease and it did a really great job in that. But what people present with — and we are not absolutely certain what people present with in general practice because we only collect data on what happens to people, not what they come with — but there are estimates, there are different research surveys, that 40-to-50 per cent of people who present to general practice could be better served somewhere else. We have a GP colleague in Exeter, and he did an estimate over a period of a week, and he said between 40 and 55 per cent of the people who walked through his door do not need to see a man with five degrees. What they needed was a friend, a job, somewhere to go on a Wednesday afternoon.”

Wellbeing

The process starts with the organisation finding practices interested in developing a new model of care designed to help them to assist patients whose health and wellbeing needs can’t be met by a clinical intervention alone.

Local people are then identified who are willing to give their time to work alongside the practice as volunteer practice health champions.

Evaluation of work in 30 general practices, drawing on evidence from the UK Government’s Foresight Project and the New Economics Foundation, shows that 216 ‘types’ of practice health champion-led activities brought about improvements in patients’ wellbeing, resilience and ability to adapt, cope and live well with long-term conditions as well as helping them gain a better understanding of how to use services.

The types of activities depends very much on the needs of the patients and the champions themselves. For example, the Robin Lane Medical Centre, Leeds, has 50 practice champions who deliver 19 different kinds of groups and activities. As well as a number of champion-led social groups, the practice now runs a ukulele group, provides seven-day a week breast-feeding support, keeps a constantly updated dynamic directory of local services and resources, and directs people to activities in the community.

‘He said between 40 and 55 per cent of the people who walked through his door do not need to see a man with five degrees. What they needed was, a friend, a job, somewhere to go on a Wednesday afternoon’ 

Champions also support service delivery in many different ways, including increasing the numbers of people attending Saturday flu clinics from 300 to over 800 people.

Ms McGregor said practices often become more popular with patients, and within the community, when they become involved in such activities.

The Robin Lane Medical Centre has increased its patient list by 57 per cent, from 8,500 to 13,000 patients, without any increase in primary or secondary referrals and has seen a 10 per cent reduction in the use of emergency departments.

The initiative has been developed in over 94 GP practices in 18 Clinical Commissioning Group (CCG) areas in England.  Ms McGregor plans to export the model to practices in Wales, Scotland and Ireland. Altogether Better is even doing work in this area in Canada at present.

“What happens that is sustainable is, we work alongside the practice, we show them how to be with citizens in a way that works, and then we pull back. We are like invisible glue — we pull back and we just leave them to it,” Ms McGregor said.

“The practice manager is always going to have a job, the health centre is always going to be there and so the work continues. One of the things that we find happens is, the champions often go on and get jobs because they have been able to build up their confidence and their self-esteem improves. And we know that finding a job is one of the best things you can do for your health.”

Ms McGregor asked an expert from the London School of Economics what it would mean for general practice if the 4,500 additional patients seen in Leeds was replicated across the country.

“He just laughed and said ‘you would need a third less GPs’,” according to Ms McGregor. “Now, you would never need a third less GPs because GPs are working 13-hour days; they can’t keep that up. It would actually mean that GPs saw the right people, for the right reason, and people’s needs would be met by the right things. That is what our work is now.”

Care homes

Ms McGregor said the model utilised with GP practices can also be used in other healthcare areas. Altogether Better has worked to develop the champion model with emergency departments and hopes to do so with nursing homes.

“In this country, one care home pulls out of the market every week,” she said.

“The funding model for care homes is not working out. It is private providers; their local authority funding is being squeezed, there is not a sustainable financial model. What that means for the NHS is if there were no care home beds — and we have seen a decreasing number of care home beds and an increasing number of older people — the only place for those older people to go is to hospital.

“A hospital bed costs three times as much as a care home bed, so the future for the NHS is apocalyptic if we cannot address this idea. So my idea for the future, and partly driven by my passion around what I see happen to my dad, who is in a care home, is that we create care homes in the same way we have created general practice, that has got this extended care team.

“So I want an extended care team in care homes — that includes the general practice, local citizens — and that when you go to a care home, you don’t go there just to die. That you can go back into your community to go dancing, or down to the post office, to go to the supermarket, because two or three people will take you. Kids will come in from junior schools and the secondary schools to sing at Christmas. You will get people to come in and do their school cookery assignments in a care home. You might get students living in spare rooms in care homes, the payback for that is you spend four hours a week chatting to people. We have started a piece of work with the Health Foundation, it has just been funded to do a piece of prototyping work in North Tyneside using the principles we have learned in general practice, which is to bring citizens and services together as equal partners.”

Summing up her philosophy, Ms McGregor said getting citizens involved in healthcare settings is the way forward for the future. “This model can work anywhere because it is all about people.”

The 13th National Health Summit takes place at Croke Park, Dublin, on Tuesday, 7 February. For more information, visit www.healthsummit.ie.

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