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.
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.
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!