Primary Care learning from patients

Following their joint workshop ‘A novel collaboration to improve hypertension outcomes’ at the Population Health Conference on 14 June 2022, we asked Siân Howell (pictured, on the right) and Nadine Fontaine-Palmer (pictured, on the left) to tell us more about the partnership working between Clinical Effectiveness and Mabadiliko. 

Can you introduce us to Clinical Effectiveness and Mabadiliko?

Siân: I’m a GP in Lewisham and work in Clinical Effectiveness Southeast London (CESEL), a quality improvement programme by Primary Care for Primary Care.

Nadine: I co-run Mabadiliko CIC, a non-profit organisation that works to amplify the voices of the seldom heard and improve intercultural conversations across homes, communities, and workplaces.

Tell us about your collaboration?

Siân: Nadine and I came together as a One London Pathfinder Project looking at how data at scale can improve health outcomes, with a project focused on hypertension.  We know that data alone will not deliver improvements, so we designed a three-pronged project that includes:

• Data;
• Clinical effectiveness and;
• Patient and public engagement. 

The aim is to improve the detection and management of hypertension and reduce the inequalities we see in hypertension outcomes.

Vital 5 - hypertension and supporting normal blood pressure

Nadine: The main aim of the Patient and Public Involvement and Engagement (PPIE) work in this project is to listen to the views of targeted communities to understand what they need from primary care services in the treatment and prevention of hypertension.

This project has a big focus on reducing inequalities and building trust. We are specifically listening to Black African and Caribbean communities through a series of surveys and focus groups. Our findings hope to inform the other two key parts of the project.  

For example, we want to understand how trust can be built to improve the information that patients’ share with health services. In terms of Clinical Effectiveness, our hope is that our findings generate some tactical recommendations to help primary care teams support people in culturally sensitive ways. 

How has working together supported healthcare professionals and patients?

Nadine: Working with Sian in particular, I have been so encouraged by the genuine intention to do this work in a meaningful way.  There’s an openness to hearing what can be new or challenging insights from the community, and an appetite for new ways of working.  

We are able to share these great authentic messages with people who take part in our study, which builds both engagement and trust. 

Our equitable relationship has helped us think about how we better align our community-based PPIE language and processes with the NHS, so that the purpose and benefits of our work can articulated in a way that makes sense for all.

Siân: Using behaviour change methodology, well established connections with grassroot organisations, a robust methodology, and their collaborative spirit - Nadine and the Mabadilko team have shown me what good PPIE looks like. 

It is still a work in progress, but I have already changed my thinking and language after working with Nadine.  I have changed from talking about ‘difficult to reach groups’ to ‘seldom heard groups’ recognising that the way we contact our patients may reinforce inequitable access to services and contribute to inequalities in outcomes. 

Nadine and I have lots to learn from each other – and through our collaboration we are discovering new and more nuanced ways of delivering care.

What is next for you both?

Siân: We will take the learning from the Mabadilko Hypertension Care Insight Study and share this with GP teams through CESEL guides, education events and team visits.  I am optimistic that this will help those of us working in general practice rethink our language, approach, and systems, to offer more equitable care – crucial if we are to address the wide health inequalities that exist across southeast London.

Nadine: I’m a big fan of the quote “Improvement in healthcare is 20% technical and 80% human”. We are currently delivering other PPIE work for South East London Integrated Care System and Guy’s and St Thomas’ NHS Foundation Trust, with respect to Diabetes care and Heart Valve Disease.  We are in conversations with a number of trusts about similar work and we look forward to delivering these projects.  We are also consolidating what we have learned across all these projects so that we can cross-reference insights gathered and refine our PPIE approach. 

Find out more:

Clinical Effectiveness:  Making the right thing to do the easy thing to do.

Mabadiliko: We are passionate about creating workplaces and communities that are inclusive, emotionally safe and equitable for all.