Feature

Sharing a very good practice

It’s not often that demolishing a shopping centre is the cue for people to become partners in planning. Chris Drinkwater explains

General practice in the inner city has never been easy and over the last few years it seems to have become more difficult as the general sense of alienation has increased. High levels of unemployment and crime result in stress for both patients and doctors, and in one sense the urban disorder in Tyneside in 1991 was the culmination of this sense of alienation. Yes, it was only a small minority of the population that rioted and yes, the media aggravated the situation. But the fact that it happened suggests that there was a breakdown of normal social control mechanisms, and for those who took part it was certainly a way of getting noticed.

Apart from urban disorder, two other things were happening in Newcastle in 1991. Our practice coronary heart disease (CHD) prevention programme was grinding to a halt and the city council were preparing a bid for the Department of the Environment’s City Challenge initiative. Running a successful CHD prevention programme from a shopping centre less than one third occupied and containing a newsagent’s, a video shop, a chippy, a pub, an off-licence and a betting shop together with the medical centre was never going to be easy. Fortunately, the City Challenge bid was successful and part of the proposal was to demolish and redevelop the shopping centre site.

At an early stage a decision was taken to view the loss of the practice premises as an opportunity. Rather than just rebuild the surgery, here was a chance to try and do something bigger and involve local people in the process.

The first step was to convene an ad hoc group which later became the project team. This group had representatives from the priority area team, a local community development project, the FHSA, the community unit, social services and leisure and recreation services: it agreed that the project’s overall aim was to provide a focus for an effective dialogue between providers of health and social care and the local community about the ways in which their health needs should be met, both in terms of preventative strategies and service delivery.

But this wasn’t just an abstract concept, this was about demolishing a shopping centre that was almost universally loathed and empowering local people to become active partners in creating a resource that would really meet their needs. The approach clearly touched a chord with the Northern regional health authority and we received a generous grant to run a feasibility study.

This enabled us to employ a part-time project manager, a part-time research worker, and to commission two consultancies who were used to working with the local community. These groups and people undertook an extensive consultation exercise with the local community, with local providers of health and social care including other practices and with service managers. A local architect was commissioned to use all the views and ideas to produce plans for a building.

What we found can be grouped under three headings: views on health and health services; views and priorities for service development; views on building design.

Health and health services

There was a high level of long-term health problems and a general feeling that people could be healthier. The most commonly identified causes of poor health were low income, unemployment and poor health education, a perspective reinforced by finding that more jobs and less crime were the two things that would most improve the local area. As far as health services were concerned there was a high level of satisfaction, together with a minority view that there should be a greater range of services available locally, including voluntary sector support services.

Views on service development

This was perhaps the most interesting part of the process: the danger was that we would simply get an unrealistic wish list. Most of the discussion took place in groups, and there was an eventual consensus on six main priorities for inclusion in the resource centre:

• social areas - drop-in/café for social and healthy eating
• information and advice on health and welfare rights
• informal counselling for issues such as personal and family problems, drugs, alcohol and crime prevention
• fitness provision such as gym/weight training/aerobics
• alternative health therapy services
• child care services and play facilities

Views on design

This produced a wealth of detail, ranging from general preference for a traditional looking building to specifics about delay time needed on automatic door closers to enable people to get through with a buggy. It was also useful to have confirmation that people liked their GP to have informal room arrangements, and they preferred a curtained-off couch in the same room to separate examination rooms.

All of this was put together by the architect, who produced detailed plans which formed the basis for further discussion. The final specification was costed at £1.5m and we have now secured a commitment of £1m jointly from Newcastle City Challenge and the Northern regional health authority. Clearly more work needs to be done to modify our original proposal so that we can build within the money available. We also have to meet the project appraisal criteria of City Challenge. In other words we need to be accountable, and most importantly of all we need to produce a building that generates a sense of ownership and meets the needs of the local community.