Why we need a Community Health Service

Bill Graham from New Wortley Community Association in Leeds explains why community and third sector organisations play a key role in building helping communities to be more healthy, and imagines a Community Health Service in which this role is even more impactful.

A key driver of health is feeling part of a community. So connecting people and creating community is our core health task.

We often hear that our health service is broken or that the National Health Service is under great strain but public satisfaction in our health service remains high amongst people who use it and remains a national treasure in many eyes.

We should all be thinking about how the NHS can be strengthened. The work I have been doing at the Leeds Institute of Quality Healthcare, and on the Community Business Leaders Programme, has given me a real insight into how the third sector and community businesses can be part of the solution.

We have all read about the pressures in hospital A&E departments – people turning up who should probably go to a GP instead; patients attending who need support, but not the emergency service that our hospitals provide. Already some A&Es have a GP on site to try and ensure this pressure is reduced.

Health isn’t driven by medicine. It’s driven by having a purpose in life, feeling valued and enjoying strong human relationships.

We also know how difficult it can be to get a GP appointment. It can be deeply frustrating not to get a GP appointment on demand, but the truth is that on the patch where I work, in Leeds, 30-40% of GP appointments are for non-medical issues and this appears to be the case throughout the UK. In most cases, the GP is not the most effective person to see, and may indeed just refer the patient on.

So to free-up GP time, and in turn take pressure off primary care in hospitals, wouldn’t it be nice if patients could access a different service for these non-medical issues, a place where there is a friendly face, where there is some expertise, and where patients can trust the help and services on offer. A place where non-medical issues can be discussed triaged and solutions found or sought.

These places do exist. At the moment they are provided around England by a wide variety of charities, third sector organisations, and community businesses.

However, it is patchy. Some areas have many of these organisations and some have very few. Some organisations have very high standards, but some will struggle to provide the service to which they aspire. Some of these organisations will be well networked into the health system, and some will not.

At some of the workshops I have attended recently, we have been looking at the barriers and the issues that stop some of the third sector, community businesses and charities becoming a more formal part of our NHS.

Questions of trust, and the quality and consistency of services can weigh heavily on a patient. If organisations use volunteers, then the service provided may not be at the standard a patient – or indeed a GP – may expect.

Nevertheless, some organisations get it right and can work well in the system. Cancer charities and hospices already provide a trusted service embedded into a network of cancer care or end-of-life care from the NHS.

So maybe in the future we will look to create a Community Health Service (CHS).

The breakthrough in building healthy communities can only come when we understand that doctors, medicine and hospitals play a minority role.

A CHS would invest in our local providers; help train staff and volunteers, and let GPs and nurses lead the way services are developed. It would report outcomes in a clinical scientific way, provide high-quality care (and outcomes) around key issues like low-level mental health, self-management and social isolation.

The CHS would have General Community Practitioners GCPs who would work with GPs and GP practices to provide the support around the 30-40% of appointments that are non-medical. The GCP would spend time (longer appointments) with the patient to try to understand and unlock the barriers that were causing the social issue. This can be debt, social isolation, low level mental health issues, sometimes undiagnosed issues as well.

The GCP should have clinical training and should not only be aware of the networks around but also able to track the patient, so accountability can stay with the GP practice.

This idea also works in the space between adult social care and health – where commissioning for these projects could be done jointly. As the needs here in this area cross the boundaries of health and social care – perhaps this is the space where the joined-up approach – so often talked about can actually start to happen.

The Community Practitioner can be employed by the GP practice or by the community associations and should have a network of support workers – drawn from the local community to provide the help and support people need to deal with these social issues that blight many people’s lives – particularly in deprived communities.

There is plenty of academic research and case studies about how this type of Asset based approach can be more effective – see Cormac Russell and his ABCD approaches, see Professor Mark Gamsu at Leeds Beckett University and the work Locality is doing with the What Works Wellbeing Centre and The Leeds Institute of Quality Health care (Duncan Ross Leeds University) and work done around new approaches to health and the value of Co-production. Professor Jane South and the team at PHE have produced a guide to community-centred approaches to healthcare.

In Leeds, we at New Wortley, provide a place-based community health service: Robin Lane practice in Leeds as well through the innovative Love Pudsey Charity. In London, there is the Bromley by Bow example. There are others as well.

There are triple benefits here:

1. Better outcomes for patients
2. Pressure is taken off primary care as some of the 30-40% of non-medical appointments are taken up by the community services
   
3. And an economic benefit in terms of health investment being targeted directly into communities to build capacity within communities to create positive supportive health networks that encourage self-care, community solutions and develop/ create jobs and training opportunities in areas of high need.I believe this is a prize worth fighting for, to help save the NHS, create capacity in the system and stimulate economic growth in deprived challenged areas.

This blog is was originally published by Locality and the Bill pitched his vision for a Community Health Service at the Locality conference this autumn.

As part of the legacy of the RSA partnership with NHS England on Health as a Social Movement programme, the RSA is launching a Fellow-led network to help facilitate social action in health and care at our high profile Health and Care Engage on 19th February in the Great Room, RSA House, London.
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