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A chance to think outside the box

Putting GPs in charge of commissioning could throw up some truly innovative ideas, says Dr Karine Nohr

With GP commissioning just around the corner, I wonder if there is the chance for some innovative healthcare practice. Here are a couple of examples from my experience.

In 2004, our practice undertook two major initiatives into the development of healthcare at community level. Firstly, funded by having gained the status of a PMS practice – we recruited a community health development nurse.

Since then, she has been involved in a huge array of projects. Although based in our practice, she spends most of her time forging community links and working with community groups and local regeneration teams, seeking funding for local groups and recruiting patients for them.

One of these groups, (Foxhill Forum), chaired by our senior partner, oversees 57 community and voluntary groups in the area; the other (Healthy Cross) provides a multitude of classes, from ‘confidence building’ to exercise classes, computer literacy and much more, and is staffed primarily by volunteers.

The community nurse has rented rooms in a local church for a crèche and uses community centres and school rooms to run activities. She has since been likened to a second-hand car sales person when it comes to raising cash for events.

The community nurse set up the COPD yoga group, which is described below and has now run successfully for a few years. She also organised a very successful and enjoyable ‘Art for Health’ project, with an exhibition that took place last summer. She has done a lot of work with children around art and exercise, usually during the school holidays, with an undeclared agenda of promoting parenting skills. She has run a pilot project of a Healthy Eating Cafe, and has worked with children and parents in families predisposed to obesity.

She also undertakes health promotion activities around smoking cessation, using spirometry to screen for COPD as a way of catching the disease early, and gently raises the issue of smoking. She supports the running of the Practice NLP-based slimming group. Alongside the Practice Manager, she also works with the practice Patients’ Group.

Finally, she supports patients who are lonely and isolated, perhaps taking them out to a cafe when they are reluctant to leave home after a divorce, bereavement, or just because life is getting too much. She is on a commission basis at the local lunch club – one pudding per patient!

The second major initiative was initially lottery funded. Surehealth, a healthy living project that was set up by a (now-retired) partner. This was aimed at improving access to complementary therapies, in areas of social deprivation. The two strands of Surehealth include managing chronic conditions with interventions that include yoga and tai chi.

Initially, we also provided appointments with a herbalist and a masseuse. Although these were successful, we found it impossible to sustain one-to-one work financially and so the services of the masseuse and herbalist had to be withdrawn, but the classes have become self-sustaining, with some classes integrated into existing care pathways.

The health benefits of the classes have been wide-reaching. The yoga for COPD class, for example, has not only lead to improved exercise tolerance, but has had a huge impact on self-esteem and social isolation. Many patients prior to attendance were housebound but improved confidence from social interaction and becoming part of a local community, as well as the physical benefits, has lead to major improvement in quality of life.

Other classes currently include yoga for pregnancy, stress management and mindfulness meditation. If any patients from surrounding areas would like to attend a class at Surehealth, they are welcome. Visit or call 0114 249 6511.

Dr Karine Nohr is a GP in Sheffield

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