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10 - Co-production and the role of preventive infrastructure

Published online by Cambridge University Press:  11 April 2023

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Summary

Come with me for a moment to the Alvanley Family Practice, a small GP surgery in Stockport, where the Manchester mayor is opening a set of new allotments. David and Julie Ashton are ‘practice health champions’ at the practice and came up with the allotment idea. Stockport Council donated the land and a local builder provided apprentices to clear the site. The council's investment fund also provided £10,000 towards the allotment's hut.

This sounds like the kind of arrangement that used to be known as ‘partnership’ working. What is unusual is for GP practices to preside over the creation of new allotments – although, since the famous Peckham Experiment in the 1930s, not unprecedented. But there is also something about the informal style of Dr Mark Gallagher and his practice partner, Dr Jaweeda Idoo – without pomposity – calling their patients ‘friends’, as he did in his speech, that might raise a few eyebrows in professional circles.

Even so, in a period when general practice is struggling with dwindling general practitioners (GPs) and rising demand, Alvanley has bucked the trend. It has managed to reduce demand and at the same time to begin to nibble away at some of the causes of ill-health. It was not just a technocratic business of tackling rising demand either. The changes in the way their surgery works was partly a response to the exhaustion of the professional partners. “I remember, we had our heads in our hands,” Dr Idoo says now. “We had 200 letters to reply to and piles of test results. We were thinking of giving up. Then a few things happened.”

The problem was that the practice was faced with an increasing number of people coming for appointments who were struggling with life, or had needs that a GP cannot meet – primarily the social determinants of health – and it was looking for a new way of collaborating with the community to support it.

The doctors describe the events as a “perfect storm”, which led to the radical shift in the way things are done. The first of these was Dr Idoo becoming chair of the local GP federation and beginning to think practically about the long-term sustainability of general practice – not just theirs. The second was the arrival of a new business manager, Kay Keane, who was keen and ready to try out new ideas.

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Tomorrow's Communities
Lessons for Community-Based Transformation in the Age of Global Crises
, pp. 167 - 182
Publisher: Bristol University Press
Print publication year: 2021

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