Dr Helen Kingston is a GP at Frome Medical Practice, Somerset. For 15 years, Helen and her team have been working hard to improve community health and wellbeing. Today, she talks to us about health creation.
Healthy childhoods and engaged communities are two critical aspects that lead to health creation. If the ideas of, and opportunities for, health and activity are made available from an early age, preventative measures are less likely to be required. This reduces stress on medical services and educates communities into how, where and why they can stay active and healthy.
Let’s talk about Neighbourhood Health. What did you see in the NHS 10 Year Health Plan, that you think is going to really make a difference and why?
The neighbourhood health plan is about having communities where we are supported, and have the knowledge, the skills and the opportunities to stay healthy. I think that’s going to be key to the future needs of our population.
In our area, community development workers are embedded into primary care. We have combined health coaches and link workers that are employed in primary care. They’re an integral part of the practice’s workforce as they help and support people to stay well and to find resources, without the need for medical intervention.
A lot of what was said in that plan was about moving healthcare into the community. For example, taking that stress off A&Es, 999 and GPs. How is this going to be done?
“The NHS has, in some areas, become very siloed”
I think we need to look at what’s already there. Linking those community resources into primary care really helped us to have different conversations with patients. So, it’s embedding those approaches into our routine work that is really important and being able to link and collaborate and work with other organisations.
The NHS has, in some areas, become very siloed. We need to break down those barriers, have good working relationships and not follow criteria-based care. We need to look at what’s best for an individual and then find a way forward with them.
Neighbourhood Health is asking us to pull together out of our silos into one team to look at a population approach at what our community needs most. We are at capacity across all of our services, but if we get things right for individuals first, focus on preventing the crises, then that can have an impact on how we use those resources wisely.
You used the word prevent there, which brings me onto my next question. We talk about shifting care from hospital to community, but we’ve also talked about shifting the mindset from prevention to creation. What would that look like?
“There are areas which are ‘food deserts’ where it’s very difficult to buy healthy food”
It’s about looking at the whole population and making things easier for people so we can move to a situation where it’s safer to cycle and it’s safer to walk.
Our infrastructure is designed around the car and can be unsafe for people to be walking and cycling. This promotes inactivity and people not being able to stay physically fit.
The same approach goes with the food market. There are areas which are ‘food deserts’ where it’s very difficult to buy healthy food. Ultra processed foods are cheaper to buy than fresh foods so we need to create an environment where actually the right choices are the ones that are easiest for people to choose.
Communities know what they want and what they need. If we pull together, we don’t need to medicalise all of the problems in life. We can come together to solve a lot of things without needing medicalisation.
If we’ve got a strong, cohesive community, that’s going to have a really positive effect on people’s mental wellbeing, sense of meaning and sense of belonging.
This starts at a young age. It’s about creating healthy childhoods as well as healthy adults.
Very much so. Every single age, you know, working age, children, teenagers and the older population as well.
Do you have any success stories you can share?
“Building on the enthusiasm and energy within our population to move to a more sustainable and healthy environment”
We’ve been really fortunate in Frome with the Green and Healthy Frome project. It’s been running for the last five years and it’s funded by the Climate Action Fund.
We have worked with the town council and Edventure, which is a community interest company in Frome, to take those different approaches to health and wellbeing. The council has been running a healthy home scheme to try and support people to insulate their homes and we’ve had a cycling scheme running under the council.
We have been working at the practice to look at our prescribing habits, to support people with courses, to understand better the ways to stay healthy holistically.
We’ve got some great future projects that are working from Edventure that are looking at different things including a food network and recycling of fabrics and textiles. So, it’s that combined approach, building close relationships, resources and the enthusiasm and energy within our population to move to a more sustainable and healthy environment.
What do you think are the most urgent and pressing matters? Is it simply reduced waiting times at A&Es? Or is it more educational-based about people understanding healthy food or healthy lifestyles?
“Our approach to our most high risk people and high users actually reduced the amount of emergency admissions”
I think it’s a combination. I think we need to take a population approach and make it easier for people to look after themselves and stay healthy.
We have a complex care team that works here with our housebound and nursing home patients. A health connector, clinicians, district nurses and older people’s mental health teams come together to look at those patients who we are not meeting their needs.
“One would hope with health creation that we create a society where people feel happier, feel more connected and better able to look after themselves and their families.”
We try as a team to look at how we can do things differently. We set up our original mental health services with three mental health nurses working in primary care and we were able to reduce the number of antidepressants.
We’ve had a complex care team, multidisciplinary meetings and palliative meetings since our scheme started. They happen twice a week looking at our recent discharges from hospital, looking at those people who are needing a lot of input to see how we can support them and their carers better.
We published a paper in 2018 that showed that our approach to our most high risk people and high users actually reduced the amount of emergency admissions that we were having.
Is there a particular metric that demonstrates your success? The number of vaccinations? a higher life expectancy?
What I would like us to measure are things like the Office for National Statistics’ wellbeing score. One would hope with health creation that we create a society where people feel happier, feel more connected and better able to look after themselves and their families.
The government has announced a new online NHS hospital service. So, at the click of a button on an app, you’ll be able to access everything and it’s set for a 2027 launch. What are your thoughts on this?
“I think the 10-year-plan can be an exciting way to amplify the work that is going across so many communities”
The details have not yet been shared but I think the experience we’ve had with NHS 111 is that these sort of services out of context can be quite risk averse. But it would be useful if it can help personalise care, then it will be very helpful.
I think, as a society, we probably do contact health services more than we used to. That’s partly cultural and partly online searches that pull up a diagnosis that includes something scary. I think also we are probably not looking after ourselves as well as we should do. We’re more anxious as a society. I think we spend too much time online and not connecting with real people who are physically present and often that can generate more demand.
Connection is important. Connection with each other, with nature. Staying active is really important and a good diet is important. We can achieve those things and move towards a healthier lifestyle which is more sustainable and is going to therefore need less resource from an already stretched NHS. I think the 10-year-plan can be an exciting way to amplify the work that is going across so many communities.
I think there are lots of areas of the country where there are some great things already happening. I think it’s really, really important that with the NHS plan we move forward, learn from those experiences, support them to grow rather than just superimpose another system that doesn’t take into account what’s already there
