Reducing demand by collaborating with people and communities

In our blogs on meeting complex needs we identified the challenge of people who turn up in Primary Care who are struggling with life. No GP appointment can help them. To help people struggling with life you need to recognise their assets, and make the most of the assets in your community to generate a network of local people (volunteers) who can help each other, lead by practice/patient/community champions who will nurture and value and grow the volunteers.

This is a really effective way to reduce demand, and is the impetus behind Social Prescribing. But developing an asset based approach with communities goes beyond the realms of referring patients to a social prescriber.

In fact during the Pandemic Primary Care has in places discovered the real power of ‘people powered health’ as communities stepped in to support those sheltering.

The starting point is a fundamental shift in thinking of people who have needs as having deficits that need fixing to people as coproducers of their health, and communities as assets, bringing the wealth of relational and talent assets to improve people’s self-esteem, coping strategies, resilience skills, friendships and personal resources (Foot & Hopkins 2009 p.7)

Some of the most powerful influences on behaviour change are family and neighbours, and a collective sense of self esteem, helping people believe that it is possible to take actions to improve health and well-being. (Foot an Hopkins 2009 p9)

Social prescribers can help that happen if they have skills in community building, and they should have. Without that SPs will be inundated with the need for appointments with people who need ‘connecting’ – and they will never meet the need. As we are seeing, SPs are finding that their appointments are filled quickly. Sucking up what should be the role of community building into the NHS won’t work. You can see more in my blog on the 3 things you should know about Social Prescribing in this section.

SP came out of fantastic examples of success. These had at their essence, community building; face to face appointments for people who need help navigating the system; support to be able to make personal choices; help with their coping strategies; and leadership of this combined system. Those transactional models that are emerging will increase demand and will not reduce workload. Just a reminder from the blog on SP

There has been progress in some parts of the NHS and Social Care in taking an asset based approach and working with communities to develop personal and community resilience.

For example in Leeds their Asset Based Community Development in Leeds (Kretzmann & McKnight 1993) is a key part of the Best Council Plan 2017-18 build capacity within communities to offer support to people with care and support needs.The small sparks fund has catalysed significant projects and new supportive community activities in the City, with community connectors being a vital asset in helping vulnerable people live well.

The Carnforth Community is working on Self-Care through a whole range of co-produced initiatives.  helping people to care for themselves.

Ageing Well Torbay has demonstrated Self-reported visits to GPs have dropped by 32%, and loneliness rates have dropped by 46% across all the measures we use. 

Altogether Better is working with Practice and Community Champions across the UK with significant effect (Evaluation Report 2015 p4)

Nesta’s ‘People-Powered Health’ project looked at how to apply the ideas behind co- production to long-term conditions – one of the most expensive, least successful aspects of NHS work. Nesta’s calculations, based on a range of studies, were that People-Powered Health along these lines could cut NHS costs by at least 7 per cent and maybe up to a fifth (NESTA 2013) the initiatives ranged from full coproduction to peer support.

Whilst there are a plethora of projects and programmes which are popular locally, make sense to local communities, and in common sense terms must reduce demand, there is little systematic evaluation of the impact of these at scale in terms of the wider impact in the NHS. They are marginal to the mainstream of the NHS and will stay that way without evidence of the potential.

Our report on Volunteering in the NHS (Boyle, Crilly, Malby 2017)  showed that volunteers make a difference to:

• Patient outcomes and experience

• Resources (demands on health and care system)

• Workforce (providing additional capacity, and substitution)

• Organisational (culture and staff satisfaction)

• Community resilience

• Volunteer’s own wellbeing

Although the term volunteer does not best fit the emerging potential and capacity of people to gift their time. We produced a chart to show the types of roles that citizens are taking in the NHS (P16)

In our view there is enough tantalising evidence to say that this is how the Primary Care can work with communities to reduce demand.

Altogether Better (2015) Altogether Better Working Together to Create Healthier People and Communities. Bringing citizens and services together in new conversations. The evaluation report of the Altogether Better Wellbeing 2 Programme

Boyle D, Crilly T, Malby B (2017) Can Volunteering Help Create Better Health and Care? Helpforce. 

Deeny S, Gardner T, Al-Zaidy S, Barker I, Steventon A (2017) Briefing: Reducing hospital admissions by improving continuity of care in general practice. The Health Foundation. February. 

Foot ,J and Hopkins,T (2009) A Glass Half Full: how an asset approach can improve community health and wellbeing. IDeA, London

Horne, M., Khan, H., Corrigan, P. (2013) People Powered Health: Health for people, by people and with people. April. Nesta and Innovation Unit

Kretzmann, J P and McKnight ,J L (1993) Building Communities from the Inside Out: A Path Toward Finding and Mobilizing a Community’s Assets. Institute for Policy Research, Evanston, IL.

Leeds City Council. Best Council Plan 2017/18. Tackling poverty and reducing inequalities. 

Torbay Community Development Trust. (2020) Social Prescribing Ecosystems. Building value and purpose to improve health and wellbeing through the development of a social prescribing ecosystem Ageing Well Torbay Learning Series.