Creating new models of community centred care

• Portfolio total project costs: £2,689,105163
• Total funding received from BIG: £2,689,105164
• Total number of beneficiaries: 2,531

Activities

Altogether Better built upon their previously successful approach of finding, developing and supporting volunteer champions to work in the community, and invited groups of champions to work closely with the NHS in General Practice, a specialist hospital service and across the system to address city- wide issues.

The aims were :

• To improve the wellbeing, particularly the mental wellbeing, of champions and all those who participated in the groups and activities they had developed
• To radically change the way that the NHS provides services by:
  • extending the range of offers that promote wellbeing and thereby reducing demand for professionally provided services
  • enabling people and communities to be active partners in their own health and care, co-designing and delivering services in new ways
  • enabling people to understand how to make more appropriate use of professionally provided services
  • enabling the NHS to move some way from providing attention to individuals to supporting groups of champions who provide support and attention to groups of local people
  • ultimately creating the conditions across the system that support positive mental health and wellbeing in the communities involved.

With support from Altogether Better and their local partners, people were invited to become Health Champions:

• By their General Practice

• By a specialist service for people with chronic fatigue

• On behalf of the system as a whole to tackle the city wide issues (young people in one site and ‘giving children a good start’ in the other).

Using whole system approaches and drawing on the principles of coproduction over 1131 Altogether Better Champions in seven localities across three regions, in 30 GP practice were nurtured as a group and encouraged to take action to improve local health and wellbeing with their NHS partners.

The Champions reached over 17,000 citizens indirectly and reached 1,400 participants through 216 activities, 175 of which have taken place regularly 165. The Young Health Champions worked across a wide geographical area to identify and develop ways for young people to more actively engage with and influence their own and their community’s health.

The asset based model enabled Champions to develop a wide range of innovative and creative activities based on their own interests, life experiences and local community need. Staff greatly valued their more engaged relationship with citizens and recognised that champions were providing a valuable contribution to the wellbeing of patients. 95% of staff involved would recommend the work and wished to continue. The Champions added capacity into the system and enabled professionals to focus on their core functions.

The work in General Practice is described in the Altogether Better video produced by Ecorys,  here:

https://www.youtube.com/watch?v=SiTlP16LtiQ

Participant/community impacts and sustainability

The introduction of Practice Health Champions brought about health improvements for both the Champions themselves and wider participants. The approach also brought about long term and embedded system change, by involving the Champions in service design and delivery.

As a result of the work:

• 87% (488) of Champions and 94% (286) of participants reported having gained new knowledge/awareness related to health and wellbeing.

• 86% (482) of Champions and 94% (286) of participants reported increased levels of confidence and wellbeing following their involvement in the project.

• 98% (550) of Champions and 99% (300) of participants reported being more involved in social activities/membership of social groups/social networks following their involvement in the project.

Becoming a champion proved to be life changing for some people and life improving for many. The changes were due to feeling more confident, having a purpose in life, making good friends, particularly with people they would otherwise never meet, and the capacity of this to lead to increased community cohesion and resilience.

“It’s really helped me get back on track… it was about isolated and lonely people… and I was one of them, basically left to rot. When you invited me that day, it saved my life.” (Practice Health Champion).

A range of outcomes supported the system change objectives with statutory organisations showing a greater recognition of the resourcefulness and generosity of citizens who use their services. This in turn raises the possibility of these organisations radically changing the way that they provide services. 95% of staff would recommend the work and wish to continue. New relationships between champions an organisations will be sustainable into the long term, becoming in the words of one GP “simply how we do things round here”.

The contribution of the champions to systems change was summarised by a Practice Manager as:

“The work that we’ve done in the practice has far, far exceeded my expectations in terms of the skills that they’ve brought, the enthusiasm, the time they’ve given, actually how they’ve just become part of the practice.” (Practice Manager, North East).

Altogether Better has secured funding to support the sustainability of the model and its transfer to a further 44 GP practices in other areas including London. Work will be sustained and extended in all 7 localities beyond the BIG funding period. In Bradford, all practices will continue with the PHC work and the CCG has commissioned work in a further eighteen practices. In Calderdale, the CCG has committed funding to work in a further five practices. In Sheffield current work will continue and the CCG and local authority funded another year of activity and are keen to mainstream the approach. East Riding will continue and have plans to extend. Shropshire CCG has confirmed a further three years funding for the project to recruit/support another 100 Young Health Champions per year. The approach is well-placed to support the NHS Five Year Forward View, which aims to engage with communities and citizens in new ways, involving them directly in decisions about the future of health and care services.