FROM HUMBLE BEGINNINGS
The Bromley by Bow Centre was described by Lord Mawhinney, a previous health minister, as ‘one of the most impressive displays of social entrepreneurship anywhere in Europe’. It is a hive of energy, and the building, with its quirky architecture and lack of almost anything recognisably ‘National Health Service’, is undeniably intriguing. With its welcoming café and bright open spaces, it felt more like somewhere you might go to grab a coffee, catch up with friends, or even relax on a day off. Despite its humble East End beginnings, the centre is now an internationally renowned charity that receives visitors from around the world, most recently the Singaporean Health Minister as well as healthcare leaders from China, South Africa, and the Netherlands. I’m not sure if it’s because it’s the first sunny day in months or an afternoon off work, but there’s a palpable excitement among the GP VTS group. Could this be what our future looks like? I remain a tad sceptical though. One of us has to be.
AN AREA FAILED BY THE STATE
Tower Hamlets in North East London is one of the 20% most deprived local authorities in England, with just under 40% of children living in low-income families. It has a near 10-year gap in life expectancy between men in the most and least deprived areas of the borough.1 The Bromley by Bow Centre was founded by a local priest, his congregation, and local volunteers in response to the neighbourhood’s stark inequality in the mid-1980s. They formed a charity that went on to develop community services in child care, welfare advice, and adult learning, as well as opening a café and renovating the local park. By the mid-1990s it became clear that state-led health and social care was failing this community and change needed to come from the ground up. The charity built its own GP practice, and in 1997 was joined by two GPs, Dr Sam Everington and Dr Julia Davis, who began to deliver a new model of primary care focused on the social determinants of their patients’ health. With a list size of around 7000 patients and four GPs (FTE), the practice is the first in Britain to be owned by patients and rented to the NHS. The practice went on to set up the Bromley by Bow Health Partnership, which has grown to 110 staff over the years and now provides health care to over 28 000 patients across three surgeries in Tower Hamlets,2 one of which is also a walk-in clinic that sees 500 unregistered patients each week. By building on the unique relationship we as GPs have with patients, the goal is to empower and re-engage individuals in decisions about their own health care. Combining a community hub with a GP practice and a research centre, people are supported with a variety of integrated services.
HEALTH BY STEALTH
Set in the green oasis of Bob’s Park, the centre incorporates nature and the park itself in its health and holistic provisions for the community, with therapeutic horticulture aimed at adults with physical and learning disabilities as one of its flagship projects. Its vibrant aesthetic is the work of local public artists, promoting creativity to build individuals’ self-esteem and bring the community together. There appear to be endless opportunities to develop new skills and to help with returning to education and employment. The focus is on what is colloquially known as ‘health by stealth’. With social care teams and experts in key areas such as money management, welfare advice, and housing on site, this really is a centre for everyone and it has the tools to transform lives. With this ethos at its core, the centre has expanded to support budding social enterprises and local small businesses, contributing to the economic development and regeneration of East London.
SOCIAL PRESCRIBING
Where health outcomes are driven not by available health care but by levels of unemployment, income deprivation, housing, and social isolation, GPs need to be equipped with the tools to tackle this. The Bromley by Bow Centre champions ‘social prescribing’ as a way of doing this, effectively streamlining referral to in-house expert non-clinical services that support patients with non-clinical, root causes of poor health, allowing GPs to concentrate on the medical needs of the patient in front of them. With local practices working in managed primary care networks, there is evidence emerging of the positive effect on health inequality at a population level. In 2014, Tower Hamlets was the highest ranked CCG in the country for cholesterol and blood pressure control in patients with diabetes and heart disease.3
Having finished the guided tour, my head is filled with buzz words and exciting ideas, but I can’t help thinking, this is such a distinctive, innovative model, can it be replicated? As a centre moulded by both the assets and deep-rooted needs of its community, its uniqueness is its strength. So what can we do? Start small, experiment, and assume it’s possible. It’s an irresistible idea for a future GP. Maybe I’ll pop back another day.
The welcoming entrance courtyard to the Bromley by Bow Centre & GP practice. Image credit: Bromley by Bow Centre.
- © British Journal of General Practice 2018
