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“The impact is palpable” – How upturning healthcare is serving East Surrey  

January 16, 2024   By Dr Gillian Orrow

Dr Gillian Orrow is a GP and co-founder of Growing Health Together, an East Surrey initiative which helps Primary Care Networks collaborate with community members and local organisations to improve health and prevent disease. She reflects on three years of flipping the way healthcare is done, and why it’s an approach that holds lessons for the wider NHS.

It is with a mixture of delight and disbelief that I contemplate the upcoming third year anniversary of Growing Health Together. From humble beginnings as an idea raised in the surgery coffee room, it has since grown into a model which is embedded across the local health system and foundational to its vision. It’s given me the pleasure of working alongside hundreds of citizens and colleagues in East Surrey as we grow health together.  

From pushing pills to connecting communities

As a GP, patients used to come to me every day with different stories but the same message: the healthcare solutions on offer weren’t getting to the root of their problems. Meanwhile, they knew what was causing their health issues and what a solution would look like.

“I wouldn’t be depressed if I had more friends,” they would say. “My children wouldn’t be obese if I knew how to cook,” “My diabetes would be manageable if the pavements were less cracked and I could cycle to work”, “My daughter wouldn’t have asthma if there was less air pollution.”

After years of hearing accounts like this, I had to ask myself – is it enough to just be pushing out pills or should we go out to improve things?

“I had to ask myself – is it enough to just be pushing out pills or should we go out to improve things?”

They first step was to set up conversations to find out what others in our community thought. We held meetings with headteachers, the council, faith groups, community members, as well as one-to-one conversations with people on the street. We met incredibly passionate people who could see massive potential to improve things in our area but who had no means to access resources to put their ideas into practice.

The idea behind Growing Health Together is to help bridge this gap, providing resources for community members to to co-create improved conditions for community health. Help could be in the form of funding, mentoring, connecting people, or finding physical space. It started off as work I was doing free of charge in my spare time with the support of colleagues. Then, my Primary Care Network (PCN) began funding me to incorporate it into my working hours, and three years ago, NHS Surrey Heartlands funded us to turn it into a proper programme. Today there are five PCNs in East Surrey who are working in this way – upending the way they deliver services to grow health, hand-in-hand with their communities.  

Inclusive golf, GP outreach and a gift economy

“At its most magical, Growing Health Together has provided skeleton infrastructure to unleash what may be described as a gift economy.” 

Over the past three years initiatives as diverse as these have begun to flourish in the neighbourhoods of East Surrey: peer support groups for carers, creative arts sessions for refugees, community food-growing for families, inclusive golf for autistic people, perinatal support for South Asian women, citizen science water quality monitoring and African cultural events, which offer food, belonging and outreach health checks.

These initiatives, and many more like them, are typically led by members of a community they look to support. The role of Growing Health Together has been to make it easy for health to be created at this local scale. We have welcomed a mosaic of diverse contributions, connecting people, places, organisations and resources so that great ideas have come to life for the benefit of our wider community, and for the health of our local environment, recognising that human and planetary health are one and indivisible.

At its most magical, Growing Health Together has provided skeleton infrastructure to unleash what may be described as a gift economy.  The gifts offered typically map well against the checklist of ‘fundamentals’ universally required for health and well-being. For instance, improved opportunities for people from different backgrounds to be physically active, to connect with nature and one another, to eat fresh food, to develop a sense of meaning and purpose, of confidence, control and contribution. In my view these gifts are vital supplements to services offering money, housing or other types of professional support.

Health and well-being networks are now being established across East Surrey in order to act upon the issues and opportunities identified by local people to improve health and well-being at a neighbourhood level. These networks are tackling issues that simply wouldn’t have been possible without those of us living and working in an area coming together.

The role of the professional has also changed, as we have invested in community-facing roles. These have allowed professionals, including a very small number of GPs like me, to spend time outside of the surgery. Getting to know people and communities on their own terms, building trust and making space for their insights, agency and power to be expressed and respected. 

Inverting assumptions: from scarcity to abundance

The premise of this work is simple: we invert the foundational assumptions of healthcare. Rather than start with diseases and how to fix them, we start with the evidence base on health and the conditions in which it is created.

Such a starting point, we have discovered, changes everything. From a state of plentiful symptoms being treated by a small number of health professionals; to plentiful actors in a community co-creating the common – and finite – conditions fundamental to health and well-being. Put simply, it is shifting health from a concept of scarcity, to one of abundance. And with it, shifting long-entrenched patterns and perceptions around power and agency when it comes to our health.

A palpable impact

“Yes, things are still hard. But we have a sense of possibility, hope, invigoration even. This feels no small feat within the NHS against the current national and global backdrop.”

Health professionals across East Surrey continue to work exceptionally hard to deliver high quality clinical care within a challenging context, and the quantitative impacts of this upstream work on population health will take time to fully manifest. But there have been clear examples of positive impact on individuals and groups, particularly those affected by health inequalities. This is being explored further in an evaluation by the University of Kent.

But for me, an NHS doctor with 17 years’ experience, the impact upon the vitality of our local healthcare system is already genuinely palpable. Yes, things are still hard. But we have a sense of possibility, hope, invigoration even. This feels no small feat within the NHS against the current national and global backdrop.

Most people are no longer surprised to hear that evidence suggests the conditions in which we live our daily lives have a greater impact on health outcomes and their variation within a population, than healthcare itself. What is perhaps more surprising in view of this established evidence, is how little attention those of us working in the NHS have paid to the conditions outside our proverbial front door. Or to be more precise – since the stark deterioration in conditions of daily life for many of our population and for nature have become impossible to ignore – how we might help shape these local conditions for the better.

Big conversations and a mandate for change

I feel proud of the role Growing Health Together has played in catalysing a more community-oriented, even ecological approach to the NHS in East Surrey, in no small part thanks to the receptiveness and far-sightedness of our local system leaders and the generous input of so many local citizens, community leaders and partner organisations. Recently, this collective input has informed a new model for more localised, neighbourhood care in East Surrey, following on from publication of the Fuller stocktake report by NHS England.

The outline for this model crystallised during a series of workshops Growing Health helped to convene earlier this year, bringing together multiple perspectives on health and wellbeing at a local level. System leaders and front-line professionals, from headteachers through to social workers, sat side by side with community members and leaders encompassing people with different disabilities, nationalities, ages, sexualities, ethnicities and neurodivergence, and a great range of lived experience. People were invited to share issues affecting community health and wellbeing, and  potential solutions. From the discussions at these workshops a clear consensus emerged: community members wanted to be able to access what they needed to live a happy, healthy life, as close to where they lived as possible, and they wanted to contribute to making the changes they wanted to see. These were typically non-medical in nature.

Following these workshops, the provider organisations of East Surrey Alliance board signed a far-sighted mandate:

“Through our transformation programmes, where we are designing or changing services we will look at how these can be delivered first at a neighbourhood level and how resource – both financial and workforce – can be used for health creation and upstream prevention as well as service provision”.

It is hard to imagine our system leaders signing up to such a mandate without having first heard the voices of our local community. It is also hard to imagine citizens having had the courage to share their sometimes painful, sometimes inspiring stories in such a forum.

The connecting role of primary care

“We are a rare institution that has reach and usually trusted relationships with a very wide proportion of our local population and professional leaders. Rather than manage these relationships in silos, we can use our privilege to support the connectivity of our local community,”

There is further to go to refine East Surrey’s neighbourhood model and create the kind of impact we and our communities long to see. But if we’ve learned one thing through Growing Health Together it is this: while changes in national policy direction are undoubtedly needed, when it comes to health creation, many opportunities are within reach. Locally we have seen just how much willingness there is for individuals, schools, charities, businesses, even landowners, to share their gifts with others to the benefit of communal wellbeing.

It is important to state these gifts couldn’t be shared unless relationships existed between the parties involved. And that is where primary care can play a unique role: we are a rare institution that has reach and usually trusted relationships with a very wide proportion of our local population and professional leaders. Rather than manage these relationships in silos, we can use our privilege to support the connectivity of our local community, aiding the flow of resources and communication across our neighbourhoods, rather like a mycelial network underpinning the health of a forest ecosystem.

“Offering challenge and joy in equal measure, I implore anyone excited by such a vision to give it a try.”

Our local experiences of re-rooting East Surrey’s NHS into the ecosystem of care and community that surrounds us has been enlivening. I have gained a glimpse that we can collectively co-design  a system that supports the health of people and planet at a local level. A system that is dynamic and continues to learn and adapt, just like nature. I have learned this process will require humility, patience and a relentless accountability to the communities we serve. Offering challenge and joy in equal measure, I implore anyone excited by such a vision to give it a try. Taking small steps to connect with, listen and respond to community members, particularly those who have been underserved by health services in the past, can unleash huge energy and potential for positive change.

The Growing Health Together initiative was founded by Dr Gillian Orrow alongside Katherine Saunders and Dr Michael Bosch. It was funded by NHS Surrey Heartlands, and received training support from C2  and The Health Creation Alliance. If you would like to find out more information visit: https://growinghealthtogether.org/ or follow @GH_Together on X.


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