Good Conversations Matter

2015-09-01 13 48 12
Dr Peter Cairns General Practitioner and Tracey Lee Garden Kitchen Coordinator Wester Hailes Health Agency

Guest post by Peter Cairns, GP working for NHS Lothian in Wester Hailes, Edinburgh. He is Clinical Lead for both Wester Hailes Medical Practice and the NHS Lothian ‘Headroom’ GP Collaborative in Southwest Edinburgh.

I have been a GP in my small patch of Southwest Edinburgh for over a decade now. We used to have good local networks in the past, but as services became more pressured these relationships suffered. Soon GPs and nurses in primary care, only ever spoke to other GP’s and nurses. Social Workers spent most of their time speaking to other social workers, and the idea that, for example, our community council could be a key partner in the design of local services would seem a distant aspiration.

Unfortunately, it is very hard to make sense of any area’s needs, from a single viewpoint – e.g. as  a General Practitioner. As a GP I can happily deal with ill-health as it happens, but if I want to try and help patients make healthier choices around, say, breastfeeding or exercise, or deal with the issues that drive ill health in my area – for example unemployment, literacy or domestic violence, then I have to partner up with a wide range of local partners if I want our intervention to be effective.

The good news is that partnering up is not only more effective, but it is also a more rewarding way to work. Genuine collaboration develops its own momentum. Our key partners keep expanding as we grow our understanding of how to ‘join the dots’ locally to meet community need. From small beginnings we now actively collaborate with a wide spectrum of third sector, council and community partners including schools, libraries and local arts agencies. Spending time with these partners also broadens our understanding of what we could do better locally.

Wester Hailes Healthy Living Centre hosts the Garden Kitchen every Tuesday. It is a good opportunity for staff and local community members to meet and network.
Wester Hailes Healthy Living Centre hosts the Garden Kitchen every Tuesday. It is a good opportunity for staff and local community members to meet and network.

Where do we find the time for this collaborative work? Actually we are not often required as a GP practice to divert significant time and resource to these projects. Frequently it is just a little advice or a willingness to be involved,` that is required to get a project off the ground. It just makes sense to let local library services help with literacy in our Health Centre, for our local Healthy Eating Project to run a café using local produce on our premises, and for our local Arts Agency to co-ordinate local people producing the content for our Healthy Living Centre televisions to display!

What does often keep us busy is ‘failure demand’ – patients and people trapped in our systems because of an inability to deal effectively with their underlying needs. Often these needs are hard for a single service (e.g. GP) to directly address – a socially isolated older person for example. We are encouraging our teams to look around – who else could help here? Who is already involved doing some of this work, particularly third sector colleagues? By collaborating we improve outcomes for ourselves, our partners and our communities.

The project ties together several strands of our work promoting both healthy eating and networking locally. Much of the produce is grown locally, including in the centres garden, and the kitchen is staffed by community members from various local projects.
The project ties together several strands of our work promoting both healthy eating and networking locally. Much of the produce is grown locally, including in the centres garden, and the kitchen is staffed by community members from various local projects.

It takes time to develop collaborative working, and requires development of local leadership. Time and Space for these ‘good conversations’ to take place needs to be prioritised. However, only local relationships can really make sense of local need, and I hope I can persuade more of us to take a chance on visiting colleagues at a community centre, local school, community council meeting or whatever gap you identify in your area!

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Healthier Scotland

The Scottish Government is inviting you to have your say on what a healthier Scotland should look like in the next 10 to 15 years.

2 thoughts on “Good Conversations Matter”

  1. As the general underlying health issues continue to accelerate even further out of control, the “failure demand” inevitably becomes even more unmanageable. No amount of changing community health care structures improves or reverses the poor health epidemics, it will possibly, for a while, allow for more frequent testing and prescriptions this does not equate to better care or improved health. So if the goal is a “Healthier Scotland” there has to be a realisation that it won’t be achieved by this kind of structural change!

    Many of the underlying health issues are stemming from the metabolic syndrome, which on the whole are not being treated with methods that work. Some of the illnesses are being labeled and treated as life long progressive diseases, eg. CVD, pre and type 2 diabetes with patients being treated with advice which is the driver of the condition, which is why it becomes progressively worse and life long or life shortening as the case may be.

    As simplistic as it sounds the cheapest, quickest and most effective treatment for the metabolic syndrome is dietary change. Sadly the current NHS dietary guidelines contributes to the metabolic syndrome in around 70% of the population, which is one of the reasons two thirds of the population are overweight including children, Doctors, nutritionists, health care professionals and fitness instructors alike. Until this nutritional advice changes, obesity and the other metabolic conditions are set to bankrupt the NHS.

    The answer and the scientific evidence is clear and widely available it just needs the NHS and its employees to embrace and practice it. Sizable studies show if patients are given the knowledge they mostly embrace the change seeing the reversal of complications and symptoms while being able to dramatically reduce or in many cases completely stop medication. These interventions are the the kind of “Good Conversation” that needs to be had between health care professionals to create a Healthier Scotland and for the patients it is truly life changing.

    GPs will surely be frustrated, knowing the current statistics and projected levels of poor health eg. obesity, CVD, stroke, diabetes, dementia, cancer etc. Surely the penny must have dropped that prescribing expensive pharmaceuticals isn’t curing or reversing any of these conditions to the point where medication can be stopped or is restoring people back to good health. Prescribing medication just leads to additional prescriptions for the many other metabolic syndrome conditions which usually follow. Failure demand and failure to treat the metabolic syndrome are the same issue!

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