Dr Sam Everington interview: A primary care optimist

GP Dr Sam Everington, who once slept on the street to demand NHS reform, talks to Neil Roberts about why he is thinking positive in the current crisis.

'I am always an optimist,' says Tower Hamlets CCG chairman Dr Sam Everington. 'In a crisis, there is always an opportunity.'

We meet in the CCG offices at Mile End Hospital, in London's East End, a day after the RCGP published its latest bleak research on GP funding.

While the former BMA deputy chairman and pioneer behind the celebrated Bromley-by-Bow integrated health and community centre recognises the crisis in the NHS and predicts that financial pressures will worsen, he also sees an opportunity for change.

Health reforms

A former Labour health policy adviser who initially backed Andrew Lansley's health reforms but later reversed his stance, Dr Everington says: 'I've never known so much interest in primary care.'

Dr Everington, who became a barrister in the late 1970s, made headlines as a trainee doctor in the 1980s when he led a midwinter sleep-out protest against the 84-hour working week.

He sealed his reputation as a crusading doctor in the 1990s, with a series of investigations exposing racist employment practices in the NHS.

'I'm a born campaigner,' he says. 'It's in my body and soul.' But, he adds, tactics have to suit the conditions.

'There are times when I've slept on the street, there are times I've been on marches, there are times I've had conversations behind the scenes with politicians. And you have to work out how you can be most effective in different circumstances.'

With politicians of all stripes eager to hear about what primary care can do, perhaps now is not the time for a GP sleep-out.

The word 'integration' is bandied around by politicians and policy wonks, but in simple terms, should mean moving care closer to people's homes, Dr Everington says.

Integrated care

Tower Hamlets, one of 14 integrated care pioneer areas, has attracted a great deal of attention from policy experts.

The award-winning Bromley-by-Bow Centre is now one of three practices in a partnership, itself federated with a fourth practice in one of eight federations operating across the borough.

Clinicians, he says, explaining his philosophy of integration and holistic care, should acknowledge that they are probably only responsible for 15-20% of healthcare, with 'social determinants of health' often more important than medical factors.

So Bromley-by-Bow houses 100 different projects, from benefits and employment advice to arts and gardening therapy, and offers access to 1,100 community organisations, to which GPs can refer patients.

Dr Everington believes primary care can use integration not only to emerge from the funding and workload crisis and improve care for patients, but as an opportunity to improve communities.

'Ninety per cent of the local community come through our door in a year - Tesco would die for such an opportunity. It would ask, what else can we sell them? I say, what else can we give patients?'

Commissioning

Dr Everington maintains that while clinical commissioning is rightly well supported, the huge reorganisation under the Health and Social Care Act was unnecessary.

Clinical commissioning has gone a long way to 'unleash' GPs' potential for innovation, he says, and urges politicians to involve secondary care doctors. He welcomes the moves to join up commissioning, repairing fractures created by the reforms.

What GPs bring to commissioning, he believes, is more than their clinical knowledge. 'We are, on the whole, people who are here for years, serving a community,' he says.

He sees that lifelong commitment to a community as something 'special' about general practice which current pressures put at risk.

Dealing with the 'massive stresses' on the system will require a 'massive shift of resources into the community'. But he rejects the view held by some that CCGs are hamstrung by organisational weakness in the face of hospital trusts.

CCGs are shifting resources, he says. 'We are holding the budgets, and that's a very strong position.'

But it is about working with hospital leaders who must recognise the wider interests of the community, he says. It is 'not good enough in the modern world' to take the 'dog eat dog' approach some hospitals adopted in the past.

Dr Everington believes that to get the most out of primary care, politicians need to ask a broader question than the silos they work in often allow. 'What is your deal for patients in the community? That would be the question for me,' he says. 'Because that is what we are fundamentally about in primary care.'

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