Compassionate Communities

Dr Julian Abel and Dr Helen Kingston

Last month I attended a seminar with colleagues from Powys Teaching Health Board, PAVO’s Community Connectors and our Health & Wellbeing team at Bronllys Hospital in South Powys. It was to learn about a new model of Primary Care working to provide health services. Compassionate Communities is its name and it has been operating in Frome in Somerset successfully for the past 3 years.

Dr Helen Kingston, a Senior Partner at Frome Medical Practice, and Dr Julian Abel, Director of Compassionate Communities UK, were travelling throughout Wales to spread the word. 

In brief, the three key messages, which I took away from the session

1. People – you, and me, our families and friends (the actual or potential patients or users of the health service), benefit hugely from this way of working. 
2. People – the ones working to provide the health service, from GPs, nurses and pharmacists – right the way through primary care services – are enthused, reinvigorated and actually enjoying jobs where their actions make much bigger differences to people’s lives. 
3. Money – is saved. Emergency hospital admissions drop drastically. 

The Compassionate Communities' approach is about joined up or “integrated” working. The focus is on people. The community in Frome appears to have been transformed. It looks like a genuinely supportive network. We all hope (but don’t necessarily expect) that people would rally round if we were struggling to deal with not just our health, the unexpected curve ball life had thrown, or even the mundane challenges of day-to-day life. In Frome it appears to actually happen. People help each other within this system. And, as a result, their health and wellbeing improves. 

Maggie Sims (Regional Partnership Board public representative) and
Andrew Evans (Assistant Director of Primary Care, Powys Teaching Health Board) listening to Julian

The original motivation – Julian tells us more

“We asked - how can we do what’s best for people? It’s common sense that if they are lonely they need support. Friendship. Love. Companionship. That’s what’s needed. Not a tablet.”

Julian described the essentials that are required for this kind of approach – specialist care, generalist care, compassionate communities and civic actions – and how these can affect health and wellbeing in local populations. It was all these components, working together, that led to the dramatic impact in Frome.

It is a whole population intervention – equally as valid to a teenager as a frail elderly person. The teenager might be bullied at school, cyberbullied at home, become depressed and have poor educational outcomes. Drug and alcohol misuse could establish leading to life-long problems. The solution in the context of Compassionate Communities is at school – the civic community, and at home – the community.

It is the union of the new model of primary care and the Compassionate Communities approach which brings about change. But, how you implement change is as important as the change itself. We are used to the permissions effect of top down change. This approach requires the people who do the work to implement change in a systematic way, determined by ground up change.

It is also about looking at people rather than the medical conditions they may have. “If someone is suicidal because of loneliness then their chronic lung disease might not matter to them,” said Julian.

It is about not having treatment rather than having treatment. It is about networks of support. Fifty years ago people would rally round to give extra support – but this response has been lost to some extent in local communities. Yet the resources at our fingertips are enormous, and our natural networks can extend up to five hundred people. So much is going on in communities that may be untapped. It makes sense to use that, to have a profound impact on people’s health and wellbeing, and because this is the focus, almost the unintended consequence is that emergency admissions drop. 

Dr Mary Hughes and Dr Sean O'Reilly from Haygarth Doctors' Practice

The Compassionate Communities approach in a little more detail – Helen tells us more

There are three main components to the model:

1. Clinical team and GPs. 
2. Community workers. 
3. Integration across the Health & Social Care sector. 

Previously staff in Frome worked in separate silos depending on the disease they were treating. They wanted to get back to basing care around what the individual needed – to improve care, and also their working lives. Helen described the anguish staff experience sometimes. A human being in need sits in front of them but they can only focus on just one small part of the story and have to ignore the rest. It is about recognising firstly that life is complicated – separating self-esteem from physical issues is not possible; and secondly that human relationships are powerful and in many instances, the most beneficial in maintaining and achieving health and wellbeing.

First on left: Freda Lacey, Senior Officer Health & Wellbeing Team at PAVO

Setting up a hub in Frome

The hub is the single point of access in the community. Staff - the primary care team (GPs and nurses), work alongside the new Health Connectors (akin to our Community Connectors). Volunteer Community Connectors (akin to Community Champions) are out in the community, they can be post people, the hairdresser, local shop keeper, milk person, taxi drivers, sixth form students, but have a route into liaising with primary care staff at the hub, if this is needed.

So, when people call, it’s not just about discussing medical matters, but also other things that are important to them. “We have turned life’s difficulties into a disease and medicalised everything and then use the medical model to manage it,” explained Helen.

There may be a window of opportunity in a crisis situation. It is about empowering staff to take a different approach. But, also, about meeting people where they are. “There’s no point telling someone about community groups if they have to work up courage to go and buy milk”.

Mentors work with staff to help them change their approach. Stories at team meetings can turn hearts and minds and people begin changing their way of working. Helen suggested finding key people in practices who are enthusiastic to work with initially, so the energy goes with the flow.

Mistakes will be made, but we can learn from them. It is about being creative in our approach.

Suzanne Iuppa, PAVO Community Connector, contributing to the discussion

The voluntary sector

In Frome, the paid Health Connectors (now mainstream, funded for three years) work very closely with an “amazing voluntary sector”. Health Connectors offer one-to-one appointments and do care planning (“they are the glue, but not necessarily the experts”). They recognise that 95% of the support that people need is around them in the community, and link them in. Some people may not be ready to accept help immediately, but Helen’s advice is “have courage and be persistent. They will come back when the time is right for them.” Many of people’s problems are solved outside the medical practice in this model.

Over 400 groups and services are listed in Frome’s electronic healthcare recording system so social prescribing is at their fingertips. When patients are signposted this is coded on to the system. The nature of the conversation changes with this website directory immediately to hand. (In Powys we have the online service directory infoengine, and although it is not currently linked in to the GP electronic system here, we are in discussions about this with a provider of this type of technical service).

Then there are over 600 trained volunteer Community Connectors (Community Champions). These are interested members of the public, whose role is not 1:1 work but to raise awareness of the service. In an ideal world, everyone would be a Community Connector or Champion! Each person signposts on average twenty times a year.

Building community resilience

Other options for people:

• Talking Cafés – drop-in sessions run by the Health Connectors. Anyone welcome. Signposting to other resources and places to make friends. 
• Health Connectors’ groups – peer support groups following 1:1 work. 
• Self-sustaining groups – leg ulcer, diabetes, macular degeneration, stroke support… and many more. 

Helen finished the session with a couple of detailed case studies which brought the Compassionate Community approach to life.

“Most small acts of kindness happen with individuals. It’s building that capacity. It’s about face-to-face relationships, and people caring for each other. About having that conversation that might not have happened.”

What do you think about the Compassionate Communities approach? Here in Powys we already have a lot of the elements of this model in place – we have our Community Connectors’ team, an equally amazing voluntary sector, and the online service directory infoengine. And work is well underway to further integrate systems and teams to do what’s best for people here too.

Once we know how this work progresses we’ll update you in another blog post. Watch this space!