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Dr Farzana Hussain (pictured left with practice manager Emma Forrester and link worker Ruby William) leads a knife crime reduction programme in Newham PCN, north east London. She explains how it’s working in her community
Knife crime is a significant challenge in urban areas. Latest figures from the Office for National Statistics (ONS) show there were more than 47,000 serious offences involving a knife in England in the year up to March 2022. Of these, 275 resulted in a death. London alone sees just under a quarter of these offences, with a death toll of 75 recorded in the year from March 2021 to March 2022.
At our practice, The Project Surgery in north-east London, which has a list size of 5,000, we have lost three teenagers to knife crime in the past eight years.
While this number may seem small when set against the ONS data, in our context it is more deaths than we’ve seen from childhood cancer, which is a leading cause of child mortality here.
Figures show that since 2011 there have been between 10,000 and 16,000 offences in London per year that involved a knife or sharp instrument, with a peak in April 2019 to March 2020 just as PCNs came into operation in July 2019.
We wanted to undertake a project that was wider than just a health model and identify young people aged 11-18 at risk of knife crime who we could proactively help at an early stage.
Our project, Identifying Risk Factors to Reduce Knife Crime in our Young People in Newham, began in March 2021. We used social media (Facebook, Snapchat and Instagram) to try to encourage young people in Newham to come forward for help as we know teenagers do not attend GP practices much.
We employed a specialist young persons’ link worker from West Ham United Foundation, a voluntary sector organisation linked to the football club, who has really connected with our young people and can direct them to various activities tailored to their needs – which include signposting them to tennis lessons or football practice and giving them personal mentors.
Practices and two local secondary schools have been given a simple screening tool, which we devised with the practices, public health and schools to identify these young people. Some common themes are emerging – early mental health issues and relationship-building issues.
The Complete Care Community programme is delivered by Healthworks with NHS Arden & GEM in Warwickshire, with clinical leadership from Professor James Kingsland OBE. It is a national programme that supports PCNs to identify and reduce local health inequalities. The programme encourages local networks to adopt a systematic approach to addressing the wider determinants of health inequalities including using data to inform action.
There are 46 demonstrator sites across all seven NHS England regions. The programme receives funding from the National Healthcare Inequalities Improvement Programme at NHS England and supports Core20Plus5, the national drive to reduce healthcare inequalities.
Our link worker has a full caseload of young people who would not have had any contact with services previously as they are not ‘sick’ enough for Children’s Adolescent Mental Health Services.
We are evaluating the young people’s experience with the service and also the experience of our link worker.
The project is part of a national health inequalities programme called Complete Care Communities. We are one of 46 demonstrator sites across the country. The programme focuses on the needs and health inequalities in different populations. We are the only knife crime project.
We were funded £40,000 for one year by the integrated care system (ICS) in north-east London as part of the national programme. We are measuring success by the collaboration between schools, public health
and primary care, and also the caseload of the link worker. Now, as the project is so successful, our ICS will continue to provide a small amount of funding.
Our link worker is funded through our PCN additional roles reimbursement scheme (ARRS) but the project does not meet the service specification of tackling health inequalities as it is far moreholisitic and includes the wider determinants of health.
The PCN ran regular meetings, especially in the initial phase, to co-design the simple screening tool that admin staff could use to identify young people who were at risk. GPs also identified at-risk individuals using their patient knowledge and hospital letters – such as a young person who attended the emergency department with a hand injury from punching a wall.
The relationships between the two secondary schools, the PCN and public health are really strong as we are all invested in a shared purpose. We also want to engage young people themselves in co-designing the next stage. We want to link up with the hospital, which has link workers for young people who present with non-fatal stabbings, and we want to link up with the London violence reduction unit.
The national programme will be evaluated by National Institute for Health and Care Research.
The outcomes we are aiming for are:
We want to embed this project so that it becomes a normal part of practice and use it as a template to look after all age groups with a lens wider than physical health. We aim to identify themes and learning across all 46 sites in the Complete Care Communities programme, which are all doing different projects to tackle health inequalities.
Clinical director Dr Saravanan Chellappan
Programme’s senior responsible officer Dr Farzana Hussain (former CD)
Practice The Project Surgery
PCN Newham central 1
PCN Location Newham, north east London
Number of practices in PCN 7
Number of patients in PCN 68,000
PCN hires (ARRS employed)
Recruiting Care co-ordinator Health and wellbeing coach