Introduction by Croakey: Understanding the histories of people and place is critical for providing primary care – a lesson that Dr Tim Senior has taken from working in the Aboriginal community controlled health sector in Australia, as well as from visiting general practices in London.
Among the many observation from his investigations in London, one quote stands out: “Don’t tell me what you do. Tell me who you work with.”
The article below is published as part of a Croakey series arising from Senior’s Churchill Fellowship, investigating GPs and primary care teams working in marginalised communities in the UK and Ireland.
Tim Senior writes:
I was greeted by an unexpectedly beautiful sight when I arrived at the Bromley By Bow Centre, a community organisation in London.
Close to a hundred people were in the grounds – parents, children, enjoying themselves in the summer sun. A man was blowing large bubbles, entertaining young children. Kids were kicking footballs around, others on the playground, there was face painting, and arts activities.
There were people of all backgrounds, together, having fun, being included. In itself that felt like a political statement when at the same time far-right rallies were occurring across England, countered by anti-racism protests.
I was so wonderfully, unexpectedly delighted because, in coming to the UK, I had missed NAIDOC Week in Australia, and especially the celebrations that had taken place a few weeks before at Tharawal, where I work.
The atmosphere I encountered at the Bromley By Bow Summer Festival of Wellbeing last month was exactly the atmosphere I was familiar with at community events at Tharawal, in NSW.
What I saw here was health and wellbeing in action – local community coming together in shared gardens, taking part in creative and fun activities. I stopped to chat with the staff welcoming people at the entrance, and explained that I was a GP working in Aboriginal and Torres Strait Islander health in Australia.
We chatted about our services and the ideas behind them about what health was, and found much common ground.
Holistic approaches
As I’d arrived early for my meeting with Dan Hopewell, Director of Knowledge & Innovation, I stopped to take in the atmosphere while eating pizza from one of the vendors.
After the event, I chatted with Dan, standing in the gardens. He had been involved since the very early days. The Bromley by Bow Health Centre is a conventional NHS General Practice in the grounds of the Bromley By Bow Centre, and the two work very closely together.
They bring an holistic approach to health, where NHS healthcare can be combined with art or gardening groups, with advice on setting up a business, with language or computer skills training.
This holistic approach comes from the story of the service. Bromley by Bow wasn’t set up as a health service, that came later. The origins of the Bromley by Bow centre are in a run-down inner-city church in 1984.
Andrew Mawson was the minister appointed to lead the small elderly congregation. The congregation decided that the church building should be opened up for use by the local community, and from there art groups and dance classes were formed.
Over time, more groups joined and were co-ordinated from the centre, playing a large role in regenerating the local community. It was in 1997 that the health centre joined the project, and they took on the parkland next door.
The church is still part of the buildings, joined on to newer buildings, deliberately designed so people can walk through the grounds into the park and be part of the community, without barriers.
For me, this origin story is significant, as the values of community regeneration and community building that guided the initial establishment are still evident in the Centre’s health work. It doesn’t come from a health service deciding what health looks like.
It comes from the community itself, and I think this is why it felt so similar to my own working context – Aboriginal Community Controlled Organisations (ACCOs) being set up from within communities, not imposed from outside.
Values at work
I realised that these origin stories are important. On another day, elsewhere in the east end of London, I had visited Maria Hayfron-Benjamin, Acting Co-Lead for Community Based Medical Education, and Dr Jenny Blythe, a GP and Honorary Clinical Senior Lecturer at Queen Mary Medical School.
Blythe teaches and works in the East End of London, in areas of deprivation. This part of London has always been known for its poverty, and for being home to migrants in England, and as a result was the source of political activism and social reformers.
The practice that Blythe works in is older than the NHS and was established as a church organisation to provide medical care to those who couldn’t afford it. These values are carried over into the work it continues to do.
Queen Mary University of London arose from the founding of four institutions, all set up within deprived communities. Saint Bartholomew’s is the oldest, and was even known as “The House of the Poore in Farringdon” after the dissolution of the monasteries.
The London Hospital Medical College was set up for everyone, but especially “manufacturers, seamen in the merchant service and their wives and children.” Westfield College was set up in 1892 to provide higher education for women, and Queen Mary College was set up to provide education for the poor.
This informs the community-based medical education provided to medical students here, as work in deprived communities is the normal work that they see in practice.
Interestingly, another part of their origin story, I was told, was the way the teaching hospital took in Joseph Merrick, better known as “The Elephant Man”, after a life of display and abuse.
My time in London was intellectually stimulating. I was able to meet Dr Tamsin Ellis, leading the work in greening general practice, and see the combination of practical action and advocacy.
I attended a workshop by the Hammersmith and Fulham Deep End group, led by Dr Chad Hockey, which explored in detail ideas around system change, networks and community, as well as the importance of peer support within this.
I met Dr Lili Risi, whose own origin story came through the fight against apartheid in South Africa, which informs her fierce intellectual approach to equity. One of the things she said stuck with me: “Don’t tell me what you do. Tell me who you work with.”
None of us are independent of the people around us and the organisations we form.
I met Dr Iona Heath, who has long been a hero of general practice for me, as she writes so beautifully and clearly on what GPs do. (If you’ve never read The Mystery of General Practice, then stop what you are doing and read it now!)
Histories of people and place
What do I take away from such a varied set of meetings, in such a disparate city as London?
I’ve met so many people, and heard so many perspectives and ideas that inform and enhance the generalist work of primary care.
None of these come from a vacuum, however. They all arise from our life journeys, and the organisations where we work all come from an historical context, with values that continue through their work, even as the times change.
I’ve been fortunate to have the opportunity to travel and hear the stories of these people and organisations, and they places they grew from.
We need to understand these histories of people and place better to provide primary care.
Longitudinal, continuity of care occurs over time, becoming part of those histories. Primary care is a practice of place, becoming part of the geography of an area.
While I may have missed the NAIDOC Week celebrations, my time in London has taken me back there all the same.
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