Expert Praises ‘Advanced’ Thinking Of Shaftesbury GP Practice

Abbey View Medical Centre is pioneering community initiatives not usually found in GP practices. Alfred visited and heard how a new choir, LGBT group, affordable food store and an electric tricycle could all reduce demand for doctors’ time.

Staff at Shaftesbury’s Abbey View Medical Centre launched ‘Health Champions’ back in October. The first aspect of the project that visitors on Tuesdays might notice was the free cuppa, cake and chance to chat with volunteers. That special welcome has now been extended to Thursdays.

Jane Dawes

Groups to support people with identified medical conditions have also been set up. “For between 40% and 50% of patients that we see, the GPs can’t change anything clinically for them. They are not managing their conditions,” said managing partner Jane Dawes. We chatted at Wednesday’s buffet reception upstairs at the health centre. Visiting health experts, practice staff and patient groups came together to informally discuss why the health centre has gone down this seemingly unusual route.

Jane introduced me to visiting health expert Martin Fischer, whom she described as ‘inspirational’. The Health Champions project has been encouraged as part of a radical rethink, promoted by the NHS ‘Altogether Better’ initiative that Martin has worked with for a decade. “We thought we would try and work with practices to change how they saw the world, which would then change how they organise the working life of those in the practice and the outcomes for citizens,” said Martin.

He stressed the importance of bringing together patients who face the same health challenges. “Lots of people who feel socially lonely, isolated and low turn up at the general practice even though there’s nothing wrong with them. It is because it is one of the few places where they get seen as a human being. That leads to massive over attendance,” said Martin.

Martin Fischer

As people from all backgrounds use GP practices, Martin believes they offer the perfect venue for support groups. “Rich people, poor people, people of all sorts of ages and all sorts of diversity. If you can connect people and rebuild that in partnership with the practice, it changes what the practice pays attention to,” he said.

Opening up the Abbey View Medical Centre to patient groups has required a change in mindset amongst the staff but Jane says that the GPs are on board. Enthusiastic volunteers have come up with several new ideas and Jane says an additional staff member has been recruited to oversee, manage and launch these new projects. These ideas have added to staff workload, but Jane hopes that the groups will eventually stand alone.

Jane offers the Walking for Health group as a successful example. “If you invest in this type of work, it will reduce the demand on the practice by 30%. It will free us up, so our doctors, nurse technicians and paramedics will spend time on longer appointments with people who have complex health conditions rather than the ten minutes that we are all used to,” said Jane. She says that people with similar health issues are ‘better able to support people because they get it’.

Jane spoke with passion and enthusiasm as she listed some of the Shaftesbury-centred projects which have either started or will launch soon. “We have a mindfulness and relaxation group. We have fibromyalgia, chronic fatigue and chronic pain support groups. We are about to set up a veterans’ group. There is a community allotment and wildlife garden on practice land and we are looking at a respiratory choir,” said Jane.

She’s seen evidence that suggests that singing can help patients with respiratory conditions. “It’s a great exercise for the lungs and improving breathing. It’s not so much about the singing. It’s about the social connections. You make friends, start going out, start doing more. You start to feel better,” she said.

Abbey View Medical Centre

The practice hosted its first lesbian, gay, bisexual and transgender group meeting on Tuesday, for similar reasons. “It’s coming together and sharing experiences. It’s underrated how powerful that is,” said Jane, who explained that there are several young transgender patients who have to travel up to forty miles for informal and emotional support.

“Because of rural transport issues, we thought it would be helpful to set something up more locally. We are working with Gillingham Medical Practice to set up a group which will run from Shaftesbury, Gillingham and Sturminster Newton,” she added.

The health benefits of perhaps the most radical new idea are obvious – the practice team is planning to launch a food store to make sure that Shaftesbury residents don’t go hungry. “We have spoken to people who haven’t eaten for three days. And the children have not eaten for three days. Hidden hunger is everywhere and it’s not just the quantity of food, it’s the quality,” said Jane.

Her team is planning to work with Fair Share, an organisation that redistributes surplus stock from the big supermarkets. It would be operated as a business, but all of the profits would go back into the shop. This community supermarket won’t just sell ‘ambient’, or packaged and canned produce. “There will also be fruit and vegetables and fresh goods,” said Jane. “People pay a membership fee of £3.50 a week and they can then come and get £25 worth of food that they get to choose. It has less stigma. We often think that we are quite well off in North Dorset, but we have lots of rural isolation, rural poverty and lots of people in villages who are struggling. We are working with the Town Council and other organisations to get it off the ground.”

Jane says they are investigating premises for a potential base at the moment in either Sturminster, Shaftesbury or Gillingham. “You do need a quite substantial size of premises, and parking and easy access for deliveries. We are also hoping to have a van which will take that out to other areas,” she explained.

Jane says that the users of this store – the members – won’t be asked questions about their financial status. She doesn’t agree with means-testing. “You cut out a whole swathe of people who might be quite needy. People who have been made redundant. People who are on zero hours contracts and who have not had any work that week and who are struggling to eat,” she said.

Once the samosas and sandwiches were eaten, Jane led the party downstairs. A red hooded rickshaw was parked outside the health centre. This tricycle will operate in Sturminster Newtown. A retiring GP donated for its purchase for use specifically in that town. Jane’s team is now fundraising for Shaftesbury to have its own set of wheels. She demonstrated the bikes ease of use, and a rather wide turning circle, as she pedalled two passengers around the health centre car park.

The new electric tricycle

“It’s an electric bike and it’s quite a powerful one, although I’m not sure it will cope with Gold Hill,” she laughed. “I cycled it this morning around Shaftesbury without the electric boost and it is perfectly able to cope with normal hills.”

She says the bike will bring several benefits. “We have lots of patients around 3pm who struggle to get a taxi home, because taxis are taking children to and from schools. We will be able to use it to give patients a lift.” But the tricycle will also offer a fun experience. “It’s just about joy and offering a ride to people who either have a mobility issue, are old age, have a learning disability or anyone really who can’t ride a bike. They can get the wind in their hair. It’s a concept called ‘Cycling Without Age’.” Jane says she’ll soon start recruiting volunteer cyclists and they will be offered some training.

Broadcaster and health service commentator Roy Lilley was one of the two passengers who sat on the tricycle’s front seat as Jane pedalled. Roy has served on NHS Trust boards and his articles have been featured in most of the broadsheet newspapers. He had heard what was happening in Shaftesbury and wanted to see it first-hand. He was impressed.

Roy Lilley

“It’s fulfilled all my wildest expectations. It’s like there’s a community centre and somewhere buried in the middle of it, there is a GP practice. It’s become almost an irrelevant bit,” explained Roy. “I don’t think I’ve come across any practice that is so advanced in its thinking and so broad in the challenges it’s trying to resolve for the health of patients and people with a shared experience. I think this is unique,” he continued.

It’s too early to see if these projects do reduce the waiting time for non-urgent appointments, but Jane says staff have already observed some encouraging changes. “We’ve only been going for five months. I used to be called down every single day at least once, if not twice, to go and see patients who were in reception, complaining and quite aggressive. I haven’t been down in the last five months. We put that down to the fact that there’s a different atmosphere,” she said. “People are seeing that and feeling better about the practice. We have an urgent care team. We will always see anyone who feels they need to be seen or spoken to that day and waiting times are getting less and less.”

Jane pedals Roy around in the tricycle

And Roy says he has been inspired to spread the word about what he’s seen in Shaftesbury. “I write a regular column. It’s called NHS Managers. I have over 300,000 people as an audience each week. You can rest assured I’ll be featuring this in one of my columns and wherever I speak at conferences,” he said. “The topic is always about primary care and what innovations there are. I’m a disciple and an evangelist.”