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Practice champions and the Programme for Integrated Child Health (PICH) 15 May 2015

In May 2015 the Connecting Care for Children (CC4C) team and three of our practice champions led a workshop at the Programme for Integrated Child Health (PICH) monthly children and young people (CYP) learning seminar. This was a fantastic opportunity to demonstrate the potential benefits of co-production and patient engagement that the practice champions initiative can deliver, but also an excellent opportunity to use the expertise in the room to brainstorm the future projects and value the practice champions can contribute.

PICH is the first integrated child health programme in the UK and was developed to help paediatric and general practice trainees to better understand and start practising integrated child health care. It provides a framework and inspiration for interested trainees to develop these competencies in collaboration with their current place of training.

What’s behind CC4C?

Public and patient engagement is a key component of the CC4C model that focuses on the paediatric population, and aims to tackle the disproportionally high rate of paediatric unscheduled care use in north west London (NWL). The key part to this is the practice champion initiative, which is modelled on the experience and expertise of similar initiatives, both locally and nationally, such as NWL’s Community Champions Project and the award-winning community health champion model pioneered by Altogether Better in York. Altogether Better was established in 2008, and since then has engaged over 18,000 volunteers as community health champions, who have in turn reached 104,000 others. Evaluation of their work has demonstrated positive behaviour change, improving health, more appropriate use of healthcare services and decreasing hospital admissions in adult populations.

What are practice champions?

The project has recruited, trained and supported a group of patients, young people, parents and carers of children, to become practice champions. Trained practice champions volunteer their time to work with patients and staff at their local GP surgery. They lead patient engagement and co-production by providing other patients with peer support, signposting and education, facilitating self-management of care and offering a bridging role between the GP and the local community. They are empowered to develop confidence and capacity to become equal partners and work with healthcare professionals to improve the quality of care and reduce workload in the practice. Their goal is finding new ways to improve the uptake of services offered by the practice and to help to meet the needs of patients and the wider community.

Practice champion training

Our first practice champions were recruited in July 2014 and since then approximately 30 champions have been recruited to three GP practices. After recruitment they underwent a two-day training course introducing them to the role; educating them on current health issues, health inequalities, and making changes; and introducing them to team and confidence building exercises. A launch event was then arranged where the practice champions were introduced to the other members of the team at the practice, including the paediatricians who work with CC4C in the outreach clinics.

The practice champions meet approximately twice a month to discuss areas of shared interest and develop projects to set up groups within their community. Successful projects have included coffee mornings for new and isolated mothers, alcohol awareness sessions for teenagers, homework club, and Zumba classes. They also help the practice evolve new models for service delivery, and improve the knowledge and understanding of their community in order to improve the way in which they access healthcare locally.

The work of the PCs is equally beneficial to the practice, the patients and the champions.

How do the practices benefit?

By working with the champions the practice has a channel through which to promote health and wellbeing, including uptake of preventative measures, such as immunisations and screening programmes. They identify the health needs of the community, allowing the practice to allocate resources and treat the whole population. Both practice managers and GPs have reported positive feedback regarding the project (“it definitely improves relationships”; “champions are proactive and upstream, preventative, clinics are reactive”; “helps us help our patients”; “one of the most enjoyable aspects of their jobs”). Altogether Better has seen a dramatic impact from the projects, with one practice reporting an 18 per cent increase in list size and a 9 per cent fall in the number of consultations requested.

How do the patients benefit?

By empowering practice champions the local community and patients are offered an opportunity to ensure that health services are targeted more effectively. Peer education allows children, young people and their carers to develop a greater understanding of what the health system has to offer and how best to access services. Behavioural change is shown to be more likely to take place and to be sustained when it is promoted and supported by peers rather than professionals. Evidence also suggests that being in a group of people in a similar situation allows people to adopt a way of managing their condition that leads to better outcomes.

How do the practice champions benefit?

By improving their confidence, the champions achieve improved health and wellbeing, as well as increased knowledge and awareness of health issues. One champion who has written a blog post for CC4C reported her reason for taking part as “it allowed me to give back to the community”, and in describing the benefits of being involved she explained how champions “get an opportunity to be part of something big”, and “I find my volunteer work more of a hobby than work”.

This is what we explored during the workshop:

1. method for increasing the exposure of the practice champions (t-shirts, photo boards, booth/communal area in waiting room, social media, and attendance at practice multidisciplinary team (MDT) meetings)

2. what is important for the practice champions to focus on (what the GP does well, areas for improvement, knowledge and understanding of local community and their needs, areas of interest, access to other organisations and community resources, engagement with other practice champions and community champions, and difficulties navigating the health landscape)

3. reasons to be a practice champion (make patient voice heard, belief that GP should be the centre of a community, want to contribute, and good training and experience for CV)