September 2, 2024 • 27 mins
In this episode, Rich Hurst speaks with the Health and Wellbeing Team from Tenbury Surgery (Taurus Healthcare), in Tenbury Wells. In line with the national campaign of ‘Know your Numbers Week’ (2nd to 8th September 2024), the podcast delves into collective experiences working as a Senior Social Prescriber and Health and Wellbeing Coach, addressing community health needs by setting up a hypertension (high blood pressure) group. Throughout the podcast, the practitioners highlight successes and learnings, as the group sessions evolved.
Key Definitions:
Hypertension relates to high blood pressure. Persistent high blood pressure can lead to serious problems like heart attacks or strokes. But lifestyle changes and blood pressure medicines can help people experiencing this stay healthy.
Social prescribing is a key component of Universal Personalised Care. It is an approach that connects people to activities, groups, and services in their community to meet the practical, social and emotional needs that affect their health and wellbeing.
Project background and successes:
The hypertension group has been running for over 12 months. With three cohorts progressing through the six-week lifestyle intervention that has now become a core service offered in their locality. This programme is regarded as an example of best practice and other Primary Care Networks (PCNs) are looking to replicate the work. The Health and Wellbeing team were invited to present the project at The National Association of Link Workers Annual Conference and received fantastic feedback. Additional Support: If you are concerned about your health, would like to check your blood pressure, or need advice on lowering your blood pressure numbers, please seek medical advice from a healthcare professional or access the website links below. If you would like to speak with a social prescriber, either ask for an appointment at your GP or ask for a self-referral form at your practice reception.
Links related to this episode: https://www.activehw.co.uk/ High blood pressure - NHS (www.nhs.uk)
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Rich Hurst (00:05):
Hello and thanks for joining the active best practice
network presented by activeHerefordshire and Worcestershire
and hosted by me rich Hurst fromgifted gab productions. In this
series, we've identifiedregional partners to share
common challenges and bestpractices intended for
professionals, communities andindividuals involved in tackling
(00:27):
and sustaining change in thehealth voluntary and community
sectors, with a particularemphasis on how physical
activity and movement cancontribute to prevention and
recovery. With these podcasts,we're aiming to support you, if
you're dealing with similarchallenges, and draw upon the
knowledge of expertise we've gotfrom strategic projects right
(00:49):
through to grassroots projectsall across the two counties of
periphonshire andWorcestershire, our podcasts
will cover everything fromcommunity engagement, social
prescribing, positive aging,flood defenses, physical
activity, clinical champions,funding, integrated care systems
and vcse partnership, workingplus girls engagement in sport.
(01:11):
We release a new episode everymonth, so make sure you
subscribe to be notified when anew one's out. And if you could
take time to review the podcast,we'd really appreciate it. So
let's get on with today'sepisode. In this episode, we're
sharing knowledge about thepower of partnerships in
addressing hypertension. Ourguests are from the health and
(01:33):
wellbeing team from tenburysurgery in tenbury wells in
Worcestershire. You'll hear fromCasey and Jen about their
collective experiences workingas a senior social prescriber
and a health and wellbeing coachaddressing community health
needs by setting up ahypertension high blood pressure
group. And through the podcast,they'll tell us about successes
(01:56):
and learnings as those groupsessions evolved. Hypertension
relates to high blood pressure.Persistent high blood pressure
can lead to serious problemslike heart attacks or strokes,
but lifestyle changes and bloodpressure medicines can help
people experiencing this stayhealthy. Social prescribing is a
key component of universal,personalized care. It's an
(02:19):
approach that connects people toactivities, groups and services
in their community to meet thepractical, social and emotional
needs that affect their healthand wellbeing. The hypertension
group that Casey and Jen willtalk about has been running for
over 12 months, with threecohorts progressing through a
six weeks lifestyle interventionthat has now become a core
(02:42):
service offered in theirlocality. It's regarded an
example of best practice withother primary care networks
looking to replicate the work.And the team were invited to
present the project at theNational Association of Link
workers annual conferencerecently, and got some great
feedback. So let's get you tothe conversation and meet Jen
(03:04):
and Casey.
Jen (03:05):
I'm Jennifer, known as Jen. So previously I was a
nutritional therapist and acoach, and I've been working for
the NHS for nearly two years nowas a health and wellbeing coach,
and I work predominantly withpatients, one to one, supporting
behavior change, looking at kindof longer term sustainable
(03:26):
change with lifestyleinterventions so entirely non
clinical. Okay,
Rich Hurst (03:32):
cool. Thank you, Casey. Say hello to everyone.
Hi.
Casey (03:35):
I'm Casey. I've worked for primary care network for
just over four and a half yearsnow, as a senior social
prescriber, my role is slightlydifferent to Jen's. In I'm
supporting people to link intothe community and to help manage
their health and well being so.It's very personalized care
approach which is very similar.We take everybody as an
(03:58):
individual and look at what theyfeel would support them to help
manage their health and wellbeing. And like we've mentioned,
community is, is the bit reallythat I rely on to be able to do
that role as a social prescriberGood I'm
Rich Hurst (04:11):
glad you brought us onto that, because I want to
focus on this specific project.Now we're talking about a
project in in tenbury,specifically, Jen, just, just
take us to what drove or whatwas required here when you
first, first stumbled upon this.How did it all
Jen (04:26):
Is entirely my fault, so I really wanted to run a group
program. There's, you know, alot of literature out there that
suggests this is the wayforwards to be able to support
more people in in one go, if youlike. But also that that peer
support element, which, youknow, Casey, is very much an
important part of that. But forme, I really wanted to run a
(04:49):
group. So I literally did callher the clinical director, and
said, I want to, want to run agroup. How do we do this? What
do you want to do it on? Andyou. He really wanted to focus
on hypertension, because that'sreally important for the
temporary area. And then Ibasically ran with it from
there. And got Casey on boardalmost immediately. And then
(05:12):
between us, we created theprogram. The Clinical Directors
had, you know, some some input,but really we we've run with it,
Rich Hurst (05:20):
and what were your what were your goals? From the start.
Jen (05:24):
I wanted to be able to offer a lifestyle intervention.
Obviously, it's got a clinicalhook, being hypertension, so
there is that clinical element.But I think coming from a
nutritional therapy background,I really wanted to bring that
holistic approach. So I'm surewe'll talk about the different
themes, but being able to, youknow, not just look at
(05:46):
medication, which is theclinical side, obviously, but
also stress management andsleep, etc, and bringing people
together to be able to supportone another, and not feeling
like you're alone with yourdiagnosis, and that actually
there are things that you can doto make it, you know, to make a
change. So that kind ofempowerment of people, yeah, and
(06:08):
then obviously we've had all theother aspects the community
side, which has been fantastic,and embedding that, you know,
within our local area, and thehand holding that goes alongside
that to really encourage peopleto utilize their community.
Rich Hurst (06:24):
Casey, from your point of view, what was, what
was exciting about beinginvolved in this, from from what
you knew was available and what,what the potential was.
Casey (06:33):
So initially, you know, just doing one to one work all
the time, it's nice to havedifferent elements to your job.
And I like group work. You know,get doing the youth work kind of
side of it. I like working withpeople. I like that interaction.
I like the peer support. Sovariety, for me, is interesting
anyway, within the job, to keepit interesting. And I mean, I
thought it was a greatopportunity. We're very lucky in
(06:55):
temporary that it's a verysupportive community, I think
because it borders structure andHerefordshire, they've been very
good about looking after eachother. So we've got lots of
services, great communityinfrastructure. We've got
community development officercalled a community connector,
because they're called differentthings in different counties,
and so we already had theconnections to be able to build
(07:17):
upon and we also felt followingcovid Really, people weren't
back out there using thecommunity and facilities very
well, because we've been doingthis for a year and a half now.
So you know, a lot has changedin that time in the area, and a
lot more groups are now beingrun and being set up. So it was
helping people get back outthere, helping people to
identify what they wanted in thecommunity, do a bit of community
(07:38):
development within that, andworking with the community
connector, and then kind ofbuilding resources for people in
the future, so not just for thishypertension group, but for
anybody to access. And that'ssomething that we kind of find
that they're spreading the wordwith their family, with their
friends, and more people arecoming and using the community
just from attending this group.
Rich Hurst (07:58):
Yeah, and those are fantastic results, and we'll get
on to those eventual benefitsyou discovered. I want to kind
of, I suppose, go back a littlebit, and after this was started
up, what did your initialassessments tell you about what
was needed and what thechallenge might be? Jen,
Jen (08:14):
we did an exercise called hopes and concerns for the
group, but also, you know whatthey might learn, so how they
might feel being a part of it,but also actually the
information they might get fromthat. And I think the thing that
we really wanted to capture andsupport was, you know what they
wanted to get out of the group,but also their concerns about
(08:36):
being part of a group, becauseit is scary. You know, you don't
know anybody else when you'rewhen you're joining something
like that, you know, it's a bigstep to to say, Yes, I'm going
to come particularly post, youknow, post covid. So I think we
really wanted to make sure thatwe address some of those
concerns. And one of the biggestones, I think, Casey, I don't
(08:56):
know what if she'd agree with meon this, but is that people
wanted information that theycould understand, and that was
one of the biggest things thatcame across, is that actually a
lot of them didn't understandtheir diagnosis or how to manage
it or the literature. So for us,it was really important that how
we created the program and ranit was very much personalized,
(09:19):
and that we were reflective andresponsive in the moment and not
scared to do that. I think wereflected after every single
session. How can we tweak this?What do we need to do? What will
work for this group? What can wetry that will help them, you
know, come together as a group,but also address the
individual's concerns? Did thatanswer your question or not?
Rich Hurst (09:40):
No, yeah, it does. It makes me think about a few
other things around thepersonalized approach that you
had to take, and how much likeyou say, you had to tweak, you
had to adapt case, just, just onthat before, before we go into
that, just, can you, can yousort of reflect on what Jen was
just saying there about whetherthose were the same experiences
for you as what was needed.
Casey (10:01):
So initially, Jen knows this, what I wanted to do was
create an environment thatpeople felt comfortable in, to
be able to learn. Because havingan invite from a GP surgery
feels, I think people thoughtthey should come because the GP
had invited them, which isgreat. I'm very privileged to be
able to offer somebody that andto get the buy in. So we had
(10:21):
great, great uptake, great buyin. But for me, you're not going
to learn if you're stressed, youneed to feel happy, you need to
feel comfortable, you need tobuild those relationships with
your peers. So me and Jen, wewanted to make it fun. We wanted
to make it interesting. Wewanted to every different
learning style we had. We had,you know, kinesthetic learning.
So they got to take their ownblood pressures, and the GP
(10:42):
would check they were doing itright. We got people to get up
and about and do a mindful walk,you know. So it's all about
building in the experience forthem, to enable them to take on
that information that Jen spokeabout in in a way that was
appropriate to them. So thatwas, that was really important
to me, and also it's hadbrilliant feedback that people
(11:03):
have actually enjoyed it, andthey never thought they'd enjoy
coming to the crew. So we'relike, well, that's great. We're
glad that you had fun, becausethat's it, because you're going
to learn if you're having fun.Yeah. So we wanted to take that
forward, and I was just going tosay, I think, you know, we've
done three now, so we'rebuilding each time, and we're
only tinkering with the programnow, whereas at the beginning,
we changed each week. We learnedand we developed it. And I think
(11:23):
we've got more confident. Imean, the groups got more
confident with us as well. Sowe're members of the group,
rather than just facilitating,which is what we want by the end
of the program, becauseeverybody's bringing their own
skills and their own knowledge,and we want that to be shared.
So I think we're not going inthere with big egos that we're
doing something amazing that'snever been done before. We're
going in again, we can learnfrom you just as much as you can
(11:44):
learn from us. And this is ajoint collective responsibility
about managing your own healthand well being with us, the GP
surgery on the community. So Ithink that's, I think it's our
attitude, really, you
Rich Hurst (12:00):
we'll get you back to this episode of the active
best practice network shortly,but first a nod to our previous
episode that is worth catchingup with if you're interested in
how to empower communities andget the most out of their
assets. The podcast is with Lucybird, who's a community builder
(12:20):
at Droitwich community voluntaryservices, about finding places
where community activities canmake a difference, helping them
to set up and eventually run bythemselves. Alongside her is
Lucy chick, a Senior PublicHealth Practitioner at
Worcestershire county council,who's worked in public health
for over 10 years. They talkabout starting to work more with
communities and asset basedcommunity development, helping
(12:43):
and empowering thosecommunities.
Lucy Chick (12:45):
It's not always easy. And some areas, you know,
we've we use the term sort of gowhere the energy is, which is
bit cheesy, but it's true. Youknow, quite unusual in this
role. A lot of communitybuilders have a very focused
community, whereas I had droitrich, and I think it's about 15
villages surrounding it that wework in. And you know, I
(13:08):
approached all of them when Ifirst got there, just sent a
message out to the parishcouncils and trying to find that
sort of go to person to startwith. And the ones that reach
back, that's where I went. Soit's just going where there's
they can see something thatcould happen and helping them to
make it happen.
Rich Hurst (13:25):
So go back and have a listen to that in our previous
episode on communities. Andremember for that and all the
other podcasts that are comingup in the series, make sure
you're subscribed to get our newepisode every month right. Let's
get you back to this episode ofthe active best practice network
with Jen and Casey.
(13:49):
I want to just pick up onsomething you said there about
the big changes you made asopposed to tweaking. Now, was
that a lesson learned? Asopposed to thinking you had to
change everything after week oneand then that make? Did that
make it more difficult to makeit consistent, as you went on?
Jen (14:02):
So I think we, I think we were just open to the fact that
we don't have all the answers,and the group is going to be
different every time, and thatit's okay to try something in it
for it not to be something thatyou're going to take forwards.
And actually, what about itdidn't work or could be done
differently. So if anything thatwe tried that we didn't take
(14:26):
forwards, I don't see those asfailures. I think they're really
useful learning opportunities.And actually, we made some, I
mean, we sort of split outcertain themes, we changed the
timings of the weeks. You know,there was quite a few things
that we adjusted from Cohort Oneto Cohort Two, like Casey said,
(14:46):
we're now just on tiny tweaks,and because we know the kind of
the feel of what we're doing. Ithink that's the other thing
going into something like this,you don't know how it's going to
feel. And I'm very much, Isuppose, a kinesthetic person in
that respect, in that I like toknow how something feels. And
(15:07):
you obviously you don't havethat when you first start
something. So one of the keythings that we learned was we
really needed to have lots ofpractical elements for the fun
side of things, for kind of theknowledge retention, for getting
everyone to, you know, to worktogether. And that's something
that we built in from Cohort Twogoing forwards, and that's had
(15:31):
really good feedback. So thatwas one example of something
that we changed, and was quite abig element required a whole
sort of restructure of everysession plan, because, believe
it or not, there is a plan.
Rich Hurst (15:48):
And what about other lessons that you learnt along
the way, especially in thatfirst that first cohort?
Casey (15:53):
So I think one of the things Jen's kind of spoken
about was that we split some ofthe topics out, so we did have
stress and sleep together, andthen we pulled them apart,
because actually, stress is verysignificant in managing blood
pressure, you know, and so issleep with every condition.
That's the one thing about ourthemes, really. They kind of
relate to well being, not justhypertension. So they were an
(16:15):
hour and a half sessions. Wemade them two hours. We made
sure we had a break so thatpeople could have social
interaction in the middle, thosewere kind of significant points,
and then the the bonding of thegroup really. I mean, we wanted
that to be one of the keytakeaways for them, that they
built connections with otherpeople. So at the beginning,
what we find in in the firstcohort that people almost had a
(16:38):
bit of a trauma response tobeing diagnosed with
hypertension and notunderstanding why. So we made
sure we had, like, much moretime for people to talk about
their emotions and how it feltto be able to deal with those
emotions and feelings as we kindof went through the weeks. So
that's something we learned veryquickly from doing week one. And
so we've embedded that time, Isuppose, into every session for
(17:02):
more of that peer support anddiscussion. And
Jen (17:05):
we also made the group smaller. So, you know, we've got
a cohort of, say, 12. That'slike the maximum that we would
we would have in the group. Sowe split the groups up, and
every week we move them aroundso they had an opportunity to
speak with different members ofthe group on smaller tables, and
we would then facilitate thosetables. So like Casey said
(17:26):
earlier on, we were part of thegroup, you know, we would share
and join in with that kind ofgroup dynamic and encourage
people to to get involved ifthey felt comfortable to you
know, and that it was also okayif you didn't want to speak or
you didn't want to write, youknow, but we were there to help,
help that process. But I thinkwe definitely learned having
(17:47):
small, smaller groups was areally good thing to introduce,
and that's something that wewe've embedded going forwards.
Rich Hurst (17:55):
Talk to us a bit about support and and working
multi agency kind of has, has,I'm sure, benefits and
disadvantages or challenges. ButJane, I know you're a big
advocate of the multi agencywork, and especially What's that
that's gone in here. So talk tous a little bit about that and
how that's helped.
Jen (18:14):
I think there's, there's multiple benefits. You know,
everyone brings a different setof expertise and skills. They
have new eyes, you know. Sospeaking about lorea, for
instance, from activeHerefordshire and
Worcestershire, you know, weasked her to reflect with us on
the session, on how she felt. Wefacilitated it, you know,
(18:35):
getting that feedback from otherpeople who aren't, you know,
sort of directly involved inevery week by week. That's been
really crucial, but also beenable to bring in the different
venues. You know, there's,there's multiple reasons for
that as well. So there's kind ofintroducing people to their
(18:55):
community. Some people you knowhave lived in the community for
50 years and never been intosome of the venues, so, and
there's groups running in thosevenues, so that working together
has it allows the participantsto access their community, for
the community to also havethere's a, you know, there's an
economic ripple effect here aswell, because we're hiring these
(19:18):
venues, you know, and then ifthe participants then use the
venues for themselves. So forinstance, we've started using
the pavilion this time, which wehaven't used before, and you can
hire that out. You know, it'sall those sort of things. And
then obviously, with lorea andactive heritage and
Worcestershire and joining thatin with the leisure center, you
(19:43):
know, she's been able to accessthree month free passes for our
participants to use use theleisure Center, which has been
fantastic. And we've had reallygood feedback about that. So I
think it's, it's really, reallyimportant for so many different
reasons, so economically. Mesocially, and also for that
(20:04):
whole kind of reflective part,and having an outside, outside,
you know, pair of eyes to kindof give you some of that less
bias feedback that we might giveeach other
Rich Hurst (20:17):
can happen. It can happen. Of course, it can.
Casey (20:19):
Oh, we don't.
Rich Hurst (20:24):
and talk, talk about the successes of this. Then, I
mean, you mentioned there thatthe gym membership passes, you
know, do you measure it withways you see that? Okay, well,
people will use those and thengo on to stay with the gym.
Where are those successes? Whatare the successes that you've
seen so far?
Casey (20:40):
Okay, so what we're trying to do is track this
better, like in all honesty. Sofrom the group that we've just
recently had, we've got seven, Ithink it is regularly attending
the gym with their passes, whichis really good. And what we're
going to do is see once the freethree month membership finishes
(21:00):
is how many people continueusing the gym. So we we're doing
that now. We haven't tracked itbefore. We've only got anecdotal
evidence of people telling usthat they're using it. However,
the gym isn't the only exercisein temporary so we've got quite
a lot of people that are nowgoing to a Tai Chi class that is
run at the pump rooms, from usgoing to the pump rooms,
delivering a session in it andtelling people what goes on
(21:23):
within that room. And then, forthe library, example, there's a
choir, you know, there'sknitting that goes on in there
that. So each venue that we'veused, we've introduced them to
that venue and what goes on inthat, that center, or that kind
of room. So we would lovesomebody to tell us how to
measure this, the communityripples is really hard to kind
(21:46):
of quantify. However, for me,that's me doing my best work,
because that's going to lastforever. You know, seeing
somebody one to one is great andreally supportive of that
person. But if I can supportsomebody to go to a group and
help build it, become avolunteer, then that's there for
that, for everybody else to useand utilize. So yeah, any tips?
(22:08):
Welcome.
Rich Hurst (22:10):
And what about you, Jen as well. What are you
looking for as you go forward?Then that will, that will
signify success.
Jen (22:17):
So I think you know, Casey alluded to this. It's you
obviously need to be able toshow that all this time and
effort you're putting in isactually having an impact. And
that comes back to impactmeasures, and some of those are
quantifiable, and some less so.So we've, you know, we're trying
to gather information that's,you know, that the anecdotal
(22:40):
evidence, the ripple effects,but also we're tracking blood
pressure, not surprisingly, andthat's something that we've
tweaked this time. You know, wewere taking their BP at sort of
point of diagnosis and then atour six month review. So
following the program six monthslater, we have a conversation
with the participants. We're nowtaking into account their VP at
the start and the end of theprogram to give us more data,
(23:02):
because, you know, a lot ofthese participants have been
diagnosed at slightly differenttimes. So I think this data will
help us to be able to hone in alittle bit more. And
potentially, there's anopportunity here to look at the
data for people who didn'tattend the program and see how
(23:25):
those two data sets compare. Sothe people who did this is sort
of slightly more daunting for uslooking at this kind of data,
but it also, you know, isshowing, or you hope to show,
some correlation, you know, youcan't necessarily show that it's
causation, because, obviouslythey are taking medications as
well, but that's something thatwe're trying to hone all the
(23:49):
time, and taking, you know,advice on that, on on how we can
measure impact. We've alsocreated our own self reported
questionnaire in order to beable to capture the knowledge,
confidence and skills of theparticipants going into the
program across the differentthemes. So the sort of clinical
side of managing your bloodpressure, understanding the
(24:10):
resources, but also sleepmanagement, stress management,
nutrition and physical activity.So we've created our own bespoke
questionnaire for that, and whatwe've seen from cohort three, so
we're just going through thedata now, is actually an 18%
increase in that from the startof the program to the end. So
(24:31):
we're really pleased with that.We're also using a validated
wellbeing measure, and 50% ofthe patients have seen an
improvement in their wellbeingfrom doing the program. We've
also had a zero dropout rateover three cohorts, so we're
quite proud of that. And fromCohort One and two, between
(24:54):
point of diagnosis and six monthreview, blood pressure has gone
down for all participants. So Ithink we've had some really
good, quantifiable and more ofthe sort of qualitative
feedback. And it's, you know,this is now sort of spreading
beyond our area, so we've gottwo other areas that are looking
(25:17):
to take up the program, which islovely. And, you know, we're
looking to develop it a bitfurther with the next cohort,
and maybe creating a bit of apeer support group to run
alongside this one. Because oneof the feedback, piece of
feedback we heard from oneparticipant, I've been telling
(25:37):
all my family and friends howamazing this is, you know, and
some of those have gothypertension, and they want to
know why they can't join and thereason being is that we take
newly diagnosed hypertensives,so from the last three months.
So there's a lot of people outthere who aren't accessing this
information. So potentially,going forwards, we might be able
(25:58):
to bring in, you know morepeople, so that ripple effect
that's happening, we can dosomething about that in a
different way.
Rich Hurst (26:08):
So our thanks again to Jen and Casey, and we hope
you enjoyed the chat and foundtheir examples and experiences
really useful. And hopefully youcan benefit from some of those
takeaways. And also, if you wantto get your blood pressure
checked or need advice on thingslike lowering your numbers and
getting medical advice. There'smore in the show notes. To find
(26:28):
out more about what activeHerefordshire and Worcestershire
do, go to the website activehw.co.uk, there's a new episode
of this podcast every month, somake sure you subscribe and keep
an eye on active Herefordshireand Worcestershire's social
channel for more details. Thankyou for listening, and we look
forward to welcoming you backinto the active best practice
(26:49):
network again very soon.
Hello and thanks for joining the active best practice
network presented by activeHerefordshire and Worcestershire
and hosted by me rich Hurst fromgifted gab productions. In this
series, we've identifiedregional partners to share
common challenges and bestpractices intended for
professionals, communities andindividuals involved in tackling
(00:27):
and sustaining change in thehealth voluntary and community
sectors, with a particularemphasis on how physical
activity and movement cancontribute to prevention and
recovery. With these podcasts,we're aiming to support you, if
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knowledge of expertise we've gotfrom strategic projects right
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will cover everything fromcommunity engagement, social
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and vcse partnership, workingplus girls engagement in sport.
(01:11):
We release a new episode everymonth, so make sure you
subscribe to be notified when anew one's out. And if you could
take time to review the podcast,we'd really appreciate it. So
let's get on with today'sepisode. In this episode, we're
sharing knowledge about thepower of partnerships in
addressing hypertension. Ourguests are from the health and
(01:33):
wellbeing team from tenburysurgery in tenbury wells in
Worcestershire. You'll hear fromCasey and Jen about their
collective experiences workingas a senior social prescriber
and a health and wellbeing coachaddressing community health
needs by setting up ahypertension high blood pressure
group. And through the podcast,they'll tell us about successes
(01:56):
and learnings as those groupsessions evolved. Hypertension
relates to high blood pressure.Persistent high blood pressure
can lead to serious problemslike heart attacks or strokes,
but lifestyle changes and bloodpressure medicines can help
people experiencing this stayhealthy. Social prescribing is a
key component of universal,personalized care. It's an
(02:19):
approach that connects people toactivities, groups and services
in their community to meet thepractical, social and emotional
needs that affect their healthand wellbeing. The hypertension
group that Casey and Jen willtalk about has been running for
over 12 months, with threecohorts progressing through a
six weeks lifestyle interventionthat has now become a core
(02:42):
service offered in theirlocality. It's regarded an
example of best practice withother primary care networks
looking to replicate the work.And the team were invited to
present the project at theNational Association of Link
workers annual conferencerecently, and got some great
feedback. So let's get you tothe conversation and meet Jen
(03:04):
and Casey.
Jen (03:05):
I'm Jennifer, known as Jen. So previously I was a
nutritional therapist and acoach, and I've been working for
the NHS for nearly two years nowas a health and wellbeing coach,
and I work predominantly withpatients, one to one, supporting
behavior change, looking at kindof longer term sustainable
(03:26):
change with lifestyleinterventions so entirely non
clinical. Okay,
Rich Hurst (03:32):
cool. Thank you, Casey. Say hello to everyone.
Hi.
Casey (03:35):
I'm Casey. I've worked for primary care network for
just over four and a half yearsnow, as a senior social
prescriber, my role is slightlydifferent to Jen's. In I'm
supporting people to link intothe community and to help manage
their health and well being so.It's very personalized care
approach which is very similar.We take everybody as an
(03:58):
individual and look at what theyfeel would support them to help
manage their health and wellbeing. And like we've mentioned,
community is, is the bit reallythat I rely on to be able to do
that role as a social prescriberGood I'm
Rich Hurst (04:11):
glad you brought us onto that, because I want to
focus on this specific project.Now we're talking about a
project in in tenbury,specifically, Jen, just, just
take us to what drove or whatwas required here when you
first, first stumbled upon this.How did it all
Jen (04:26):
Is entirely my fault, so I really wanted to run a group
program. There's, you know, alot of literature out there that
suggests this is the wayforwards to be able to support
more people in in one go, if youlike. But also that that peer
support element, which, youknow, Casey, is very much an
important part of that. But forme, I really wanted to run a
(04:49):
group. So I literally did callher the clinical director, and
said, I want to, want to run agroup. How do we do this? What
do you want to do it on? Andyou. He really wanted to focus
on hypertension, because that'sreally important for the
temporary area. And then Ibasically ran with it from
there. And got Casey on boardalmost immediately. And then
(05:12):
between us, we created theprogram. The Clinical Directors
had, you know, some some input,but really we we've run with it,
Rich Hurst (05:20):
and what were your what were your goals? From the start.
Jen (05:24):
I wanted to be able to offer a lifestyle intervention.
Obviously, it's got a clinicalhook, being hypertension, so
there is that clinical element.But I think coming from a
nutritional therapy background,I really wanted to bring that
holistic approach. So I'm surewe'll talk about the different
themes, but being able to, youknow, not just look at
(05:46):
medication, which is theclinical side, obviously, but
also stress management andsleep, etc, and bringing people
together to be able to supportone another, and not feeling
like you're alone with yourdiagnosis, and that actually
there are things that you can doto make it, you know, to make a
change. So that kind ofempowerment of people, yeah, and
(06:08):
then obviously we've had all theother aspects the community
side, which has been fantastic,and embedding that, you know,
within our local area, and thehand holding that goes alongside
that to really encourage peopleto utilize their community.
Rich Hurst (06:24):
Casey, from your point of view, what was, what
was exciting about beinginvolved in this, from from what
you knew was available and what,what the potential was.
Casey (06:33):
So initially, you know, just doing one to one work all
the time, it's nice to havedifferent elements to your job.
And I like group work. You know,get doing the youth work kind of
side of it. I like working withpeople. I like that interaction.
I like the peer support. Sovariety, for me, is interesting
anyway, within the job, to keepit interesting. And I mean, I
thought it was a greatopportunity. We're very lucky in
(06:55):
temporary that it's a verysupportive community, I think
because it borders structure andHerefordshire, they've been very
good about looking after eachother. So we've got lots of
services, great communityinfrastructure. We've got
community development officercalled a community connector,
because they're called differentthings in different counties,
and so we already had theconnections to be able to build
(07:17):
upon and we also felt followingcovid Really, people weren't
back out there using thecommunity and facilities very
well, because we've been doingthis for a year and a half now.
So you know, a lot has changedin that time in the area, and a
lot more groups are now beingrun and being set up. So it was
helping people get back outthere, helping people to
identify what they wanted in thecommunity, do a bit of community
(07:38):
development within that, andworking with the community
connector, and then kind ofbuilding resources for people in
the future, so not just for thishypertension group, but for
anybody to access. And that'ssomething that we kind of find
that they're spreading the wordwith their family, with their
friends, and more people arecoming and using the community
just from attending this group.
Rich Hurst (07:58):
Yeah, and those are fantastic results, and we'll get
on to those eventual benefitsyou discovered. I want to kind
of, I suppose, go back a littlebit, and after this was started
up, what did your initialassessments tell you about what
was needed and what thechallenge might be? Jen,
Jen (08:14):
we did an exercise called hopes and concerns for the
group, but also, you know whatthey might learn, so how they
might feel being a part of it,but also actually the
information they might get fromthat. And I think the thing that
we really wanted to capture andsupport was, you know what they
wanted to get out of the group,but also their concerns about
(08:36):
being part of a group, becauseit is scary. You know, you don't
know anybody else when you'rewhen you're joining something
like that, you know, it's a bigstep to to say, Yes, I'm going
to come particularly post, youknow, post covid. So I think we
really wanted to make sure thatwe address some of those
concerns. And one of the biggestones, I think, Casey, I don't
(08:56):
know what if she'd agree with meon this, but is that people
wanted information that theycould understand, and that was
one of the biggest things thatcame across, is that actually a
lot of them didn't understandtheir diagnosis or how to manage
it or the literature. So for us,it was really important that how
we created the program and ranit was very much personalized,
(09:19):
and that we were reflective andresponsive in the moment and not
scared to do that. I think wereflected after every single
session. How can we tweak this?What do we need to do? What will
work for this group? What can wetry that will help them, you
know, come together as a group,but also address the
individual's concerns? Did thatanswer your question or not?
Rich Hurst (09:40):
No, yeah, it does. It makes me think about a few
other things around thepersonalized approach that you
had to take, and how much likeyou say, you had to tweak, you
had to adapt case, just, just onthat before, before we go into
that, just, can you, can yousort of reflect on what Jen was
just saying there about whetherthose were the same experiences
for you as what was needed.
Casey (10:01):
So initially, Jen knows this, what I wanted to do was
create an environment thatpeople felt comfortable in, to
be able to learn. Because havingan invite from a GP surgery
feels, I think people thoughtthey should come because the GP
had invited them, which isgreat. I'm very privileged to be
able to offer somebody that andto get the buy in. So we had
(10:21):
great, great uptake, great buyin. But for me, you're not going
to learn if you're stressed, youneed to feel happy, you need to
feel comfortable, you need tobuild those relationships with
your peers. So me and Jen, wewanted to make it fun. We wanted
to make it interesting. Wewanted to every different
learning style we had. We had,you know, kinesthetic learning.
So they got to take their ownblood pressures, and the GP
(10:42):
would check they were doing itright. We got people to get up
and about and do a mindful walk,you know. So it's all about
building in the experience forthem, to enable them to take on
that information that Jen spokeabout in in a way that was
appropriate to them. So thatwas, that was really important
to me, and also it's hadbrilliant feedback that people
(11:03):
have actually enjoyed it, andthey never thought they'd enjoy
coming to the crew. So we'relike, well, that's great. We're
glad that you had fun, becausethat's it, because you're going
to learn if you're having fun.Yeah. So we wanted to take that
forward, and I was just going tosay, I think, you know, we've
done three now, so we'rebuilding each time, and we're
only tinkering with the programnow, whereas at the beginning,
we changed each week. We learnedand we developed it. And I think
(11:23):
we've got more confident. Imean, the groups got more
confident with us as well. Sowe're members of the group,
rather than just facilitating,which is what we want by the end
of the program, becauseeverybody's bringing their own
skills and their own knowledge,and we want that to be shared.
So I think we're not going inthere with big egos that we're
doing something amazing that'snever been done before. We're
going in again, we can learnfrom you just as much as you can
(11:44):
learn from us. And this is ajoint collective responsibility
about managing your own healthand well being with us, the GP
surgery on the community. So Ithink that's, I think it's our
attitude, really, you
Rich Hurst (12:00):
we'll get you back to this episode of the active
best practice network shortly,but first a nod to our previous
episode that is worth catchingup with if you're interested in
how to empower communities andget the most out of their
assets. The podcast is with Lucybird, who's a community builder
(12:20):
at Droitwich community voluntaryservices, about finding places
where community activities canmake a difference, helping them
to set up and eventually run bythemselves. Alongside her is
Lucy chick, a Senior PublicHealth Practitioner at
Worcestershire county council,who's worked in public health
for over 10 years. They talkabout starting to work more with
communities and asset basedcommunity development, helping
(12:43):
and empowering thosecommunities.
Lucy Chick (12:45):
It's not always easy. And some areas, you know,
we've we use the term sort of gowhere the energy is, which is
bit cheesy, but it's true. Youknow, quite unusual in this
role. A lot of communitybuilders have a very focused
community, whereas I had droitrich, and I think it's about 15
villages surrounding it that wework in. And you know, I
(13:08):
approached all of them when Ifirst got there, just sent a
message out to the parishcouncils and trying to find that
sort of go to person to startwith. And the ones that reach
back, that's where I went. Soit's just going where there's
they can see something thatcould happen and helping them to
make it happen.
Rich Hurst (13:25):
So go back and have a listen to that in our previous
episode on communities. Andremember for that and all the
other podcasts that are comingup in the series, make sure
you're subscribed to get our newepisode every month right. Let's
get you back to this episode ofthe active best practice network
with Jen and Casey.
(13:49):
I want to just pick up onsomething you said there about
the big changes you made asopposed to tweaking. Now, was
that a lesson learned? Asopposed to thinking you had to
change everything after week oneand then that make? Did that
make it more difficult to makeit consistent, as you went on?
Jen (14:02):
So I think we, I think we were just open to the fact that
we don't have all the answers,and the group is going to be
different every time, and thatit's okay to try something in it
for it not to be something thatyou're going to take forwards.
And actually, what about itdidn't work or could be done
differently. So if anything thatwe tried that we didn't take
(14:26):
forwards, I don't see those asfailures. I think they're really
useful learning opportunities.And actually, we made some, I
mean, we sort of split outcertain themes, we changed the
timings of the weeks. You know,there was quite a few things
that we adjusted from Cohort Oneto Cohort Two, like Casey said,
(14:46):
we're now just on tiny tweaks,and because we know the kind of
the feel of what we're doing. Ithink that's the other thing
going into something like this,you don't know how it's going to
feel. And I'm very much, Isuppose, a kinesthetic person in
that respect, in that I like toknow how something feels. And
(15:07):
you obviously you don't havethat when you first start
something. So one of the keythings that we learned was we
really needed to have lots ofpractical elements for the fun
side of things, for kind of theknowledge retention, for getting
everyone to, you know, to worktogether. And that's something
that we built in from Cohort Twogoing forwards, and that's had
(15:31):
really good feedback. So thatwas one example of something
that we changed, and was quite abig element required a whole
sort of restructure of everysession plan, because, believe
it or not, there is a plan.
Rich Hurst (15:48):
And what about other lessons that you learnt along
the way, especially in thatfirst that first cohort?
Casey (15:53):
So I think one of the things Jen's kind of spoken
about was that we split some ofthe topics out, so we did have
stress and sleep together, andthen we pulled them apart,
because actually, stress is verysignificant in managing blood
pressure, you know, and so issleep with every condition.
That's the one thing about ourthemes, really. They kind of
relate to well being, not justhypertension. So they were an
(16:15):
hour and a half sessions. Wemade them two hours. We made
sure we had a break so thatpeople could have social
interaction in the middle, thosewere kind of significant points,
and then the the bonding of thegroup really. I mean, we wanted
that to be one of the keytakeaways for them, that they
built connections with otherpeople. So at the beginning,
what we find in in the firstcohort that people almost had a
(16:38):
bit of a trauma response tobeing diagnosed with
hypertension and notunderstanding why. So we made
sure we had, like, much moretime for people to talk about
their emotions and how it feltto be able to deal with those
emotions and feelings as we kindof went through the weeks. So
that's something we learned veryquickly from doing week one. And
so we've embedded that time, Isuppose, into every session for
(17:02):
more of that peer support anddiscussion. And
Jen (17:05):
we also made the group smaller. So, you know, we've got
a cohort of, say, 12. That'slike the maximum that we would
we would have in the group. Sowe split the groups up, and
every week we move them aroundso they had an opportunity to
speak with different members ofthe group on smaller tables, and
we would then facilitate thosetables. So like Casey said
(17:26):
earlier on, we were part of thegroup, you know, we would share
and join in with that kind ofgroup dynamic and encourage
people to to get involved ifthey felt comfortable to you
know, and that it was also okayif you didn't want to speak or
you didn't want to write, youknow, but we were there to help,
help that process. But I thinkwe definitely learned having
(17:47):
small, smaller groups was areally good thing to introduce,
and that's something that wewe've embedded going forwards.
Rich Hurst (17:55):
Talk to us a bit about support and and working
multi agency kind of has, has,I'm sure, benefits and
disadvantages or challenges. ButJane, I know you're a big
advocate of the multi agencywork, and especially What's that
that's gone in here. So talk tous a little bit about that and
how that's helped.
Jen (18:14):
I think there's, there's multiple benefits. You know,
everyone brings a different setof expertise and skills. They
have new eyes, you know. Sospeaking about lorea, for
instance, from activeHerefordshire and
Worcestershire, you know, weasked her to reflect with us on
the session, on how she felt. Wefacilitated it, you know,
(18:35):
getting that feedback from otherpeople who aren't, you know,
sort of directly involved inevery week by week. That's been
really crucial, but also beenable to bring in the different
venues. You know, there's,there's multiple reasons for
that as well. So there's kind ofintroducing people to their
(18:55):
community. Some people you knowhave lived in the community for
50 years and never been intosome of the venues, so, and
there's groups running in thosevenues, so that working together
has it allows the participantsto access their community, for
the community to also havethere's a, you know, there's an
economic ripple effect here aswell, because we're hiring these
(19:18):
venues, you know, and then ifthe participants then use the
venues for themselves. So forinstance, we've started using
the pavilion this time, which wehaven't used before, and you can
hire that out. You know, it'sall those sort of things. And
then obviously, with lorea andactive heritage and
Worcestershire and joining thatin with the leisure center, you
(19:43):
know, she's been able to accessthree month free passes for our
participants to use use theleisure Center, which has been
fantastic. And we've had reallygood feedback about that. So I
think it's, it's really, reallyimportant for so many different
reasons, so economically. Mesocially, and also for that
(20:04):
whole kind of reflective part,and having an outside, outside,
you know, pair of eyes to kindof give you some of that less
bias feedback that we might giveeach other
Rich Hurst (20:17):
can happen. It can happen. Of course, it can.
Casey (20:19):
Oh, we don't.
Rich Hurst (20:24):
and talk, talk about the successes of this. Then, I
mean, you mentioned there thatthe gym membership passes, you
know, do you measure it withways you see that? Okay, well,
people will use those and thengo on to stay with the gym.
Where are those successes? Whatare the successes that you've
seen so far?
Casey (20:40):
Okay, so what we're trying to do is track this
better, like in all honesty. Sofrom the group that we've just
recently had, we've got seven, Ithink it is regularly attending
the gym with their passes, whichis really good. And what we're
going to do is see once the freethree month membership finishes
(21:00):
is how many people continueusing the gym. So we we're doing
that now. We haven't tracked itbefore. We've only got anecdotal
evidence of people telling usthat they're using it. However,
the gym isn't the only exercisein temporary so we've got quite
a lot of people that are nowgoing to a Tai Chi class that is
run at the pump rooms, from usgoing to the pump rooms,
delivering a session in it andtelling people what goes on
(21:23):
within that room. And then, forthe library, example, there's a
choir, you know, there'sknitting that goes on in there
that. So each venue that we'veused, we've introduced them to
that venue and what goes on inthat, that center, or that kind
of room. So we would lovesomebody to tell us how to
measure this, the communityripples is really hard to kind
(21:46):
of quantify. However, for me,that's me doing my best work,
because that's going to lastforever. You know, seeing
somebody one to one is great andreally supportive of that
person. But if I can supportsomebody to go to a group and
help build it, become avolunteer, then that's there for
that, for everybody else to useand utilize. So yeah, any tips?
(22:08):
Welcome.
Rich Hurst (22:10):
And what about you, Jen as well. What are you
looking for as you go forward?Then that will, that will
signify success.
Jen (22:17):
So I think you know, Casey alluded to this. It's you
obviously need to be able toshow that all this time and
effort you're putting in isactually having an impact. And
that comes back to impactmeasures, and some of those are
quantifiable, and some less so.So we've, you know, we're trying
to gather information that's,you know, that the anecdotal
(22:40):
evidence, the ripple effects,but also we're tracking blood
pressure, not surprisingly, andthat's something that we've
tweaked this time. You know, wewere taking their BP at sort of
point of diagnosis and then atour six month review. So
following the program six monthslater, we have a conversation
with the participants. We're nowtaking into account their VP at
the start and the end of theprogram to give us more data,
(23:02):
because, you know, a lot ofthese participants have been
diagnosed at slightly differenttimes. So I think this data will
help us to be able to hone in alittle bit more. And
potentially, there's anopportunity here to look at the
data for people who didn'tattend the program and see how
(23:25):
those two data sets compare. Sothe people who did this is sort
of slightly more daunting for uslooking at this kind of data,
but it also, you know, isshowing, or you hope to show,
some correlation, you know, youcan't necessarily show that it's
causation, because, obviouslythey are taking medications as
well, but that's something thatwe're trying to hone all the
(23:49):
time, and taking, you know,advice on that, on on how we can
measure impact. We've alsocreated our own self reported
questionnaire in order to beable to capture the knowledge,
confidence and skills of theparticipants going into the
program across the differentthemes. So the sort of clinical
side of managing your bloodpressure, understanding the
(24:10):
resources, but also sleepmanagement, stress management,
nutrition and physical activity.So we've created our own bespoke
questionnaire for that, and whatwe've seen from cohort three, so
we're just going through thedata now, is actually an 18%
increase in that from the startof the program to the end. So
(24:31):
we're really pleased with that.We're also using a validated
wellbeing measure, and 50% ofthe patients have seen an
improvement in their wellbeingfrom doing the program. We've
also had a zero dropout rateover three cohorts, so we're
quite proud of that. And fromCohort One and two, between
(24:54):
point of diagnosis and six monthreview, blood pressure has gone
down for all participants. So Ithink we've had some really
good, quantifiable and more ofthe sort of qualitative
feedback. And it's, you know,this is now sort of spreading
beyond our area, so we've gottwo other areas that are looking
(25:17):
to take up the program, which islovely. And, you know, we're
looking to develop it a bitfurther with the next cohort,
and maybe creating a bit of apeer support group to run
alongside this one. Because oneof the feedback, piece of
feedback we heard from oneparticipant, I've been telling
(25:37):
all my family and friends howamazing this is, you know, and
some of those have gothypertension, and they want to
know why they can't join and thereason being is that we take
newly diagnosed hypertensives,so from the last three months.
So there's a lot of people outthere who aren't accessing this
information. So potentially,going forwards, we might be able
(25:58):
to bring in, you know morepeople, so that ripple effect
that's happening, we can dosomething about that in a
different way.
Rich Hurst (26:08):
So our thanks again to Jen and Casey, and we hope
you enjoyed the chat and foundtheir examples and experiences
really useful. And hopefully youcan benefit from some of those
takeaways. And also, if you wantto get your blood pressure
checked or need advice on thingslike lowering your numbers and
getting medical advice. There'smore in the show notes. To find
(26:28):
out more about what activeHerefordshire and Worcestershire
do, go to the website activehw.co.uk, there's a new episode
of this podcast every month, somake sure you subscribe and keep
an eye on active Herefordshireand Worcestershire's social
channel for more details. Thankyou for listening, and we look
forward to welcoming you backinto the active best practice
(26:49):
network again very soon.
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