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Practice profile: Green dreams

25 August 2014

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An award-winning project that reaches out to isolated patients and those who are held back by simple obstacles builds community spirit

James Fleming, the GP who founded the Green Dreams project in Lancashire jokes that it might sound like a gardening group, but in fact it’s an innovative and prize-winning support service for people with social problems.

“I didn’t think too much about it I just liked the name,” he admits.

“When we started it was just a tiny little project at the surgery and suddenly it’s all over the place and we’ve still got this slightly daft name that we can’t change now.”

From the tiny little project in his own surgery in Padiham, near Burnley, James’s scheme has now helped more than 1,000 people across East Lancashire in a myriad of ways.

Talking to him, one of the most refreshing aspects of his work is the straightforward and clear-thinking nature of both the project itself and his reason for creating it.

It provides a host of support and advice on housing, training, life skills, confidence, debt, isolation, and a range of other problems that can leave individuals struggling to cope with life. 

“I started it because I wanted to provide more resources for the town where I work,” he says.

“There are all sorts of reasons for being depressed, and to tackle some of the many causes, like having housing sorted out, getting back to work, retraining, maybe counselling, you had to go to five or six different agencies and most were self-referral. If you wanted help with substance misuse or employment, for instance, for my patients in Padiham you would have to get the bus into Burnley and that costs a lot of money to make all the different journeys.

“It would take a lot of motivation and staying power to get through this type of change and if you had that kind of motivation and financial backing you probably wouldn’t be in this situation in the first place.

“I thought it would be better to get all the services in Padiham, the town where I work. I tried to get other agencies to do this but couldn’t, so I decided to do it myself.”

As a GP he could only see patients for 10 minutes, so James decided the simplest thing would be to send them to someone with more time, who could sort out their paperwork, reassure them that they knew the benefits process and that if they could get them off benefits it wasn’t going to affect their finances, talk to their landlord to get their house sorted out, and so on. And then the patient could start doing things that might make them happier like going to work and earning money.

James applied for an NHS innovation award in 2010 that provided funding for a year, and won it. Now the service is commissioned by East Lancashire Clinical Commissioning Group (CCG), and the project’s team is staffed mainly by former nurses, job centre managers, and social workers who know their way around the often labyrinthine health, social care, and benefits system.

It tries to keep as many of its services as possible in-house because the need for patients to navigate through the many agencies involved was part of the problem.

“There’s a lot of provision in this country already for people who are out of work and feel isolated, but there are people who are so low and have so little self-esteem that they couldn’t interact with the job centre at all. They couldn’t do group work, they couldn’t get themselves on training and the last port of call was to go to the doctor to get themselves a sick note so they didn’t have to do it,” James says.

The Green Dreams Project offers tailored, coordinated care to such people, which could last for two hours or 50 hours. It is, says James, not counselling and not mental health treatment, but help and enablement.

The idea is to sort basic things out that have been hampering people for years because they can’t get past a particular obstacle. If someone can’t read they’re not going to be able to navigate their way through all the paperwork associated with modern life. They need to learn to read, 

which sounds easy, but it’s going to cost them time and money, and it 

also takes confidence to walk into a room and say ‘I can’t read, can you teach me?’

The Green Dreams Project provides whatever is needed to help that person to go in the direction that they want to go, away from the dissatisfaction that they are suffering from, James says.

The project only takes referrals from GPs, now from a much wider part of East Lancashire, and its aims are threefold: to provide the bespoke and unlimited care for patients; to offer community work for patients in the project to boost self-worth; and to measure the effect of their programme.

Patients’ progress is comprehensively assessed in both health and social terms, whether they stop taking antidepressants, their number of hospital visits, or whether they get a job.

“What we see time and time again, though, is that people just stop going to their doctors,” says James.

“We take patients on for however long is needed, but it tends to be between three and nine months. 

And it tends to come to a natural end because things have worked out and the patient just chooses not to come any more. I don’t like this idea of having ten sessions of something, 

our service is there for just as long as it takes.”

The problems that the Green Dreams Project tackles are essentially to do with confidence and self-esteem, rather than intelligence, James says.

“For instance, we don’t tend to have many homeless people in this area, but we do have some appalling housing circumstances. We’re quite good at getting people rehoused, which can make a huge difference. Imagine having to get up for work when you can scoop up the damp off the walls with your hand.”

Some patients attend project schemes all day, and others drop in for a couple of hours here and there – whatever’s needed. 

These schemes offer bingo, theatre, restoration work, and art to give people a sense of worth and community cohesion.

The project’s latest scheme, for instance, is a group for first world war veterans, all of whom are in their nineties or beyond, and many of whom feel isolated and lonely. They will be working with the Padiham archive to discuss how the town has changed, consider their memories of the war, and simply to re-engage with their peers.

“I think one of the most important things that’s come from the project is that it has really opened up the community to our GP practice,” says James.

“It can be really easy to do your job, get in your car and go home, but I think the project gives a sense to the staff who work here that they are doing more than they need to do which is really quite satisfying.”

James has had more than 300 patients thanking him personally for the project’s efforts, and even locals who haven’t benefited from the programme come to praise the work of the Green Dreams Project. 

“People aren’t saying to me ‘you’re so great’ but they’re just so pleased that this project is doing so much for the local community,” he says.