Tim Williams: Hi Ollie.

Ollie: Hi Tim, it's lovely to be back in the studio with you again. Our dulcet banter as the peak leaders. ⁓

Tim Williams: Yes, nice. like the actually being thought of as a leader in that. I like that. I like that. You've, yeah, we were back together because you you've been swanning off, Oli. You've been abroad, you know. ⁓ sorry. Yes. So working away from home, surfing, I think working on your surfing, was that it?

Ollie: ⁓ working away, yeah, working away from home, yeah. As many of you know, in Health Coaching and Beyond, we mix up conversations between the two of us, chewing over hot topics and latest news and emerging ideas, but also bringing you conversations with thought leaders and people we admire in the field of health coaching and beyond. Well, a mixture, think it's good to have balance, isn't it? And it's also good to have things you're working on, isn't it? been trying all my life learn to surf. And I think, you know, now in my 50s, I think before I'm too old, ⁓ it's now never. ⁓ But I am enjoying learning a new skill. It's great. And it is really exhilarating to actually catch a wave surfing. So I'm a bit addicted. This week, it's Tim and I in the seat again. There's been so much talk about neighborhood models in the emerging reorganization of the NHS. Although sometimes it can be a bit dry to talk about models, we try and get under the skin and we have a chat. to think about how neighbourhood working can add real value.

Tim Williams: Yeah, nice one. Well, I was talking to someone and I said, you're away. And I said, oh yeah, but he's picking up on his emails. goes, it doesn't sound like he's got quite the work life balance sort. said, don't you worry about that. think he's doing all right. I was thinking he's doing all right.

Ollie: what we think is missing amongst the bold ambitions. We draw attention activating people, professionals and systems and how this may be the key component in successful neighbourhoods. Yeah. Well, it's amazing what you can do now, isn't it? Where you can log on from, you know, and just sort of like juggle it a bit. But yeah, I do appreciate how work allows us to be flexible. And that's great, isn't it? I having flexible work and you can pursue your passions. It's great. But you yourself, you've been to the coast as well, haven't you? Maybe not Sri Lanka, the East Coast of England. How does that match up, Tim? Of course, this leads us to discuss how health coaching delivered by coaches and other person-centred roles are such an important asset to maintain in this new approach. ⁓ As always, we hope to get you thinking. We always welcome comments on your podcast channel, YouTube, LinkedIn, or via email. Hope you enjoy the conversation.

Tim Williams: Runswick Bay, well actually, I have to say, it does seem to have its own kind of little microclimate. We had amazing weather. I know we're having good weather at the moment, are we? Even in Sheffield, we're having good weather, but it was just beautiful. And in fact, we booked a kind of a sauna on the beach, know, one of those kind of horse box sort of saunas right next to the sea. It was almost like a little bit too warm to go in the sauna, but it was...

Ollie: Yeah.

Tim Williams: It was so lovely because as we got in there then the sea was kind of just lapping around there so you literally had to step out of the sauna and then you're straight into the sea for a quick dip and then back into the sauna. Really good experience. I really loved it.

Ollie: Well, you would have hated Sri Lanka, know, with the sort of bath temperature water, because it wouldn't have been cold enough for you, of course. You you need a really good cold plunge, Tim, don't you?

Tim Williams: Well, exactly, exactly. You definitely need that. ⁓ And again, I might, in fact, was talking, know a podcast coming up and Callum was saying, yeah, you know, it's really important, I think, for us healthcare professionals to kind of talk about the health things that we're doing. said, so that's permission then just to talk about cold water swimming nonstop. He's like, yeah, of course.

Ollie: We're gonna get stuck records, aren't we? I'll talk about surfing, you'll talk about cobalt or something, but you're right, I think it is really important, isn't it, for us to have things that fire us up and get us enthusiastic and keep life interesting beyond just work. But obviously we have a passion for work as well, don't we? And we're gonna talk about neighborhoods, ⁓ which seems to be the kind of light, you can't get away from that theme to do with the NHS and anything ⁓ that's looking these days, you? ⁓ I know you're super fired up about neighbourhoods too, aren't you?

Tim Williams: I have to say I've looked at the documents and I have to say I was a little bit depressed because it felt to me like it was all about structures and still about kind of targets which kind of felt like, you know, almost like stepping back in time really a little bit. I suppose I'm ready to be enthused, Ollie. And I know you've been at a conference recently, was quite, probably gave you quite a lot of energy because it was the Trailblazer conference. So this is. national trailblazer scheme. this is GPs working in areas of high deprivation. And I think you were invited to go and talk about health coaching and activation. think that was the piece. So I'd love to hear how you got on with that because you're only just back from that.

Ollie: Yeah. Yeah. It was great. And I mean, the fantastic Rachel Steen, who's a local GP, know, early career GP in Sheffield. she puts so much energy. She started the whole thing off. She's organized it. She got together sort of 40 or 50 graduates from the Trailblazer scheme. So much energy seeing, seeing young GPs who have enough enthusiasm and mental headspace to think about outside the box and think about different things was, was really refreshing and quite inspiring really. they were sharing their stories about projects they'd been doing and extra stuff, not going above and beyond. So it was great. But Manal Bakai was talking at the meal the night before. And for many of you know, Manal is a real powerhouse as well, another GP from London who's been leading the NHIP, the National Neighborhood ⁓ Health Improvement Program. It's on the back of having eight years at NHS England. She's done digital stuff and all sorts of leadership roles. She's really phenomenal. So was a real privilege to hear her reflections on how that programme's going and what's worked for neighbourhoods and what hasn't. she started with was sort of saying, you we've been trying to do neighbourhood work ⁓ for decades, 50 years, probably. You we've known working in communities and working collaboratively in places. is the way to go and the way to engage people. know, the wantonness stuff around, you know, fully engaged population is so important for the survival of good healthcare. And she commented sort of around what she thought hadn't worked so far, which I thought was an interesting place to start. And, you know, saying that, you know, whatever we say, we still tend to drive measures around sort of very medicalised and sort of hospital-based, you know, sort of outcomes. So, you know, people turning up to A &E, people, you know, having sort of unscheduled care. access to appointments, know, sort of the medical things like blood pressure and sugar scores, you know, the neighborhood model sort of talks about the eight care processes for diabetes and, they're all very medicalized. People expect change to be linear, they expect programs to happen and for change to gradually sort of like progress. And she commented it's very unlinear, know, ⁓ neighborhood workings about building relationships ⁓ and that takes time and often doesn't return, know, benefits quickly because relationships take a while to build up, trust takes time to build. So it's not linear. She also talked about how we still have silos of data and information. So we're still not sharing across health and social and voluntary and health and even within health departments, primary care to secondary care, know, so there's a challenge there. And, you know, her big thing really was that still sort of culture. you know, sort of like professional culture is still orientated around the sort of medical successes, you know, and that professional incentives, finance still cluster around, you know, people being experts in their field. And there really just isn't that kind of, I guess, recognition that we have to move towards that proactive preventative person-centered care and the sort of skill set and the, you know, the sort of professional status with doing that well. is still not kind of recognised in the system. That was her comment, which I thought was really insightful that, you we have to, as a system, build those skills, but really celebrate those people that do it well. And at the moment, they're still sort of under the radar, I think, almost sort of fighting despite the system.

Tim Williams: Well, ⁓ lots of talk, isn't ⁓ in the documents, also, yeah, what I'm hearing from there, lots of talk about ⁓ yes, most people listening will be thinking, yeah, we've been trying do this. And I suppose maybe some of those structures enable this a little bit more, maybe. ⁓ But ⁓ it doesn't actually get to the core of what's needed. You change the structures, you can move things around, but actually, it doesn't necessarily... Unless you change the conversations, it doesn't change the outcomes.

Ollie: Absolutely. Well, that is what we want to get on and talk about, isn't it? But I think what may be encouraging, I always try and look glass half full, is that the rhetoric is in the right direction. You know, this whole idea about moving from hospital community, moving from reactive care to preventative, proactive care, ⁓ that's definitely articulated, isn't it? And we're really clear around the kind of, ⁓ you know, the sort of the ethical, the economic, the kind of person arguments around ⁓ We know now. that is the way to go. We just don't know how to do it, I think. I think that's where we're up to. And I think, you know, again, what Manel reflected, which I really took home, was that the things that, you she's been leading these 43 projects around the country, she's been visiting sites, she's been pulling in data from stuff that's worked across the world, really. And, you know, hearing her reflect what she thinks really does work, you know, is you really do need to have community-led approaches. with flat hierarchy where you listen from people at the coalface and you really do integrate across health, social and voluntary sector and give them an equal power to articulate what happens. Use lived experience and peer support to really lead how you design the services, not just expect the senior consultants or the kind of senior GPs to be the ones that make all the decision making. ⁓ So that was really interesting to hear that. And she just pushed again towards, you know, have to have measures that bring in the whole system, the whole wider determinants of health. So you really need to align things that, you know, bring in an attention on social isolation and housing and, you know, poverty and, you know, as well as health, of course. So you need to bring it all together. And on that theme, you know, you need to organize politically and sort of locally. So whether that's local authority or whether it's even the kind of government departments across those areas. you health and wellbeing needs to be seen as part of, you know, work and pensions, but also the housing, the business sector, the kind of sport and culture. It all needs to think about how they coordinate their measures and their focus around these community place-based approaches. And, you know, it was great to see her still enthusiastic that when she sees that happening, It works and it creates an energy within the people working in it, but also it starts to produce really good outcomes.

Tim Williams: Yeah, so she shared some of those stories, I imagine, she kind of, and I suppose, I suppose what I'm wondering is like, what does that actually look like then, you know, on kind of a Monday morning ⁓ in general practice or in these neighbourhoods when they're working well, what does that look like?

Ollie: you've got sort of a commitment to long term approach, I think that was definitely a feature of those sort of things. ⁓ And you've got, you've got ⁓ real ⁓ to partnerships that are meaningful, purposely relationships across those different groups, I think. So ⁓ what does that mean on a sort of nine to five for a GP? ⁓ I guess, ⁓ I mean, and I'll draw on this from my own PCN point of view and also from talking to a brilliant service up in Stockport. All these things have informed me really. I think it's around having access and capacity to just beyond just the normal general practice. So, you you can be a GP sort of, you know, doing 10 minute consultations, making diagnoses, referring onto hospitals. ⁓ But if you haven't got a wraparound sort of person-centred team, ⁓ then you just have, you lack the capacity to do all this extra stuff, I think. So Stockport, so impressed, the Viaduct team up there led by Natalie Hyde, you know, they've got a team of 60 now, which includes social prescribing link workers, health coaches, care coordinators, but also now they're bringing in the Workwell pilots as well. So they're looking at how you support people in workplaces and return to work schemes like, you know, how you get people sort of who are on Fitnotes to sort of... start to engage in thinking about keeping them well and getting them back to work and so on in a much more proactive way than we've been doing to now. So they're bringing it together and they have those, the GPs there have access to those teams. They know how they work and they know how to sell them if you like, sell the benefits of them to patients. And it just adds a whole new dimension to the sort of the way that a system can work. And I think that's the sort of stuff that... It doesn't build overnight, but if you're committed to it, you can build those things. And ⁓ certainly our experience at PCNs been that ⁓ these new roles compete with other roles. compete with whether you have more pharmacists, more more GPs now. And that does reinforce the medical model, ⁓ but you need to hold faith that the medical model is not enough on its own that you need to have these ⁓ other systems alongside you. And think when you've got both, ⁓ you've really got a powerful

Tim Williams: Yeah. And do think there's energy for that? Because I suppose I noticed you kind of said nine to five GPs. And I suppose what I was thinking is like most GPs I know kind of were doing seven to seven, you know, or even longer sometimes. So I suppose that's what I'm hoping. I suppose there's capacity, there's energy enough to bring in these kind of changes in way people do things. Because I suppose when people are under pressure, they and I'm the same, you you tend to revert to the stuff that you've always done. ⁓ and rather than take on new things. I don't know what you think.

Ollie: Well, I think that is a big thing. In fact, that was something we're now really highlighted actually, is that, you know, if the workforce is exhausted and burnt out, they won't take on something new and imaginative and they won't come up with ideas. They'll just keep their head down and just get through the day. And, you know, I guess that is a little bit of the climate at the moment, isn't it? It's a global climate almost, isn't it? You know, and it's really tricky, but, you know, ICBs are being sort of really decimated in terms of structure and management and leadership. General practice has been brow beaten for a long time, hasn't it? I think they felt like there's a relative funding. Yes, we invested in PCNs, but the day-to-day general practice has been underfunded, particularly related to hospitals. Huge amount of money gone into hospitals the last 10 years, much less into general practice. I think it's something like 21 % increase in investment in hospitals and about 5 % in primary care. So yeah, you're looking at a system where people are short on energy and enthusiasm. I mean, Manal talked about boundary spanners, those people that naturally do get the kind of ⁓ the values across these integrated teams. Those sort of like, they tend to be the really intuitive people, people don't they? The leaders that know how to bring teams together and they know how to see the benefits of different parts of the system. So I think in the, it's working well, those people are recognized and supported. ⁓ But you have to, in our PCN, I know I'm waffling on here, but in our PCN, over the last seven years I've been leading it, I've seen how important it is to look after those people doing the innovative work. And we tend to ask them out of 10, ⁓ how meaningful does your work feel and how manageable does your work feel? ⁓ As playing real attention to how the teams are feeling. ⁓ And we put team leaders in place that really focus on that and talk to their teams and make sure they're okay. And then you have to act on that, you know, and very often people will say, my look, my work is really meaningful. I really believe in what I'm doing, but it's not manageable at all. And you know, that we have to be sensitive to those sort of things. Cause if the workforce hasn't got energy, you're absolutely right. It won't happen.

Tim Williams: Yeah, and that is one of the indicators that we need to, that the neighbourhoods are focusing on, isn't it? It is about kind of kind of wellbeing and looking after staff as well as kind of looking after the patients, isn't it? I think that's one of their areas of focus.

Ollie: completely. In fact, if I was going to be optimistic, the most optimistic bit about the National Neighbourhood Framework that came out in March, and the King's Fund has done quite a lot of commentary on it, isn't it, which we could come to in a minute, but they talk about some sort of national goals, you know, and some of those are still quite medicalised around, you know, accessing appointments and money and, and obviously, you know, sort of, you know, wanting to get better outcomes in the core major diseases, you know, the long term conditions, you know, and there's some there's some really, you know, ambitious ideas there. But the number five goal where you're talking about patient and staff satisfaction, how do people feel about the service? I think those are the sort of things that we really should concentrate on. And it actually talks about the importance of staff feeling able to do good work. And there's a line in there that really stuck out for me. ⁓ talking about ⁓ taking a ⁓ we take a proactive approach where the patient feels in control of their care. And just good to that written down. as a headline, but equally, how are we gonna achieve that then? What's the methodology for achieving that? So, you know, there is a steer towards staff, you know, looking after staff, making sure patients are in control, but I think there's still a lack of how we're gonna do that.

Tim Williams: How are going to do it? And also, I suppose, how are you going to measure that? think that those two things are important, aren't they? And I know there was talk of kind of person, they called it that person activation, you know, but I imagine it's a kind of similar kind of things that we are really familiar with. And we've talked about a lot about people's confidence, knowledge and skills to manage their own health and healthcare. I suppose that's ⁓ one measure. But it'd just be interesting to kind of think how, ⁓ yeah, how are you going to do it, but also how are going to measure it?

Ollie: Yeah, absolutely. And I think again, this is where, you know, what gets measured matters, doesn't it? You know, people pay attention to the stuff that you can monitor and see if you're making improvements. And to some degree, what gets mandated as the key performance metrics, isn't it? And I think, again, it was lovely to hear Manal say, I hope it wasn't just because I was in the room, but you know, to say her reflection is that this concept of activation, whether that's people. patient activation, person activation or system and community activation, ⁓ staff activation, where your focus is on are we enabling people to have more skills, knowledge and confidence to do things for themselves? ⁓ Have we got an empowering system? ⁓ We have to have markers in there because Manal's reflection, my reflection is that that is the stuff. that really shifts the dial. There's no point in reorganizing systems, multi-neighborhood providers, single-neighborhood providers, integrated health organizations. You can talk about how you structure it, but unless you change the actual conversations and the dynamics of how people feel about themselves as patients, public or professionals, you're never gonna shift actually the outcomes of what happens. So yeah, I think we do have to dive in on that. Been tuned into that for a while, haven't we, to be fair?

Tim Williams: Yeah, and I suppose we would come, yeah, there's a couple of things. So one is about kind of activation and one what we know is people who are more highly activated in terms of the kind of patient activation, we know that they look after themselves better. know, they'd say they're more proactive in terms of managing their long-term conditions. They're kind of more likely to kind of engage in healthier lifestyles. They don't come to the GP so much. They don't get admitted to hospital unnecessarily. They don't pitch up at A &E. So... And we know that, and we also know that health coaching is a way to improve or increase people's confidence and skills, increase that activation. So why wouldn't we spend time building those skills in? So yeah, the structure is great, but it's the how, which I suppose that's the positive bit. That's the bit I'm kind of feeling most energized about is how do we get people across the system to have this skill set that they can use?

Ollie: Yes.

Tim Williams: in their context, I suppose. That's what I'll be thinking.

Ollie: Yeah, and to be fair, maybe the role of these sort of policy documents and, you know, sort of like, you know, top down drives is not necessarily to tell us how to do it. mean, Manal again talks about a sort of tight, loose, tight approach, which I think is really good. So tight about what we're trying to achieve upfront. is what we know we want to get care out of hospitals. We want to get more prevention, more proactive approach. want communities to be leading this. And then tight at the end around, you know, accountability to our comes and to things that we should measure and show that we've changed. But the loose bit in the middle is how you do it, can be flexible. certainly Becky Baird from the King's Fund, and she's a great commentator, talks about the need to keep that flexibility at neighborhood level. And that takes bravery actually from leadership because there's always a risk then that you have postcode lotteries and different things doing. know, better or worse in different places, but you have to have that flexibility for people to determine what works best for their population with the local experience and skills and people they've got. So you, you know, I think maybe it's okay that the stockings don't specifically say, right, you must use health coaching, you must use patient activation. in between the kind of like the policy sort of ⁓ rhetoric, we have to now pick up, you know, how are we going to achieve it? And I think, yeah, we would, strongly endorse from our experience that a focus on things like activation and the sort of things that change it are going to be really important.

Tim Williams: Yeah, I like that tight, loose, tight. That's something I'm to take away. so really, that's really, really good. I like it because actually people, yes, maybe people can't get this right, can they? Because if they give too much kind of directions like, you're telling us what to do and then there's not enough. It's like, ⁓ know, you just left this kind of wide open for us to kind of meander through and maybe not. You haven't been clear. Yeah. So I like that tight, loose, tight. Yeah, it's good. It's good.

Ollie: Thank And then that is where I hope people who are listening to this, hopefully the people who listen to this are enthusiastic around the potential for health coaching and that style of working. And it gives them some sort of encouragement, but also sort of permission that this is the stuff to do. And again, some of the King's Fund commentary talks about that, it's all very well talking about neighborhood approaches, but actually you need the skillset and the mindset to do that as well. And that isn't just intuitively there for people. know, leadership that knows how to, you know, boundary span and bring people together, but just the day-to-day skillset of how do you activate people? How do you activate staff? What are those sort of conversations that you need to be having? Where do you put your time and energy? I think those things, they are important. And for me, that is where health coaching skillsets come in. I think that's why we're doing what we're doing, aren't we? Because for a while we believed... This is the enabler. This is the thing that really will change the system long-term in a positive way. It's very much the carrot. They're good skills to have under your belt, but also they're really effective.

Tim Williams: They're really effective and they are, you know, that mindset that actually the person in front of you has the most important contribution to make ⁓ is a nice way to practice medicine, isn't it? That actually you're not then, it's not all down to you and that kind of heavy burden on your shoulders to kind of solve it all and sort it all. Actually, there are other people in the room who have a part to play. I think if when people... get that mindset and they get some of the skills that go with it, actually it can really energize the work that they're doing. It doesn't have to, you know, it doesn't have to, they don't have to change everything, but it's just in those moments, just taking the opportunity, just to change some of the language, you know, to ask a few more questions, but not maybe, maybe as well as, they're just instead of some other questions, instead of downloading a whole load of advice about something, just tuning in to what matters to that person. using those skills, it's just a nicer way to practice I think. I don't know, what do you think?

Ollie: Yeah, no, completely. Well, we've certainly found that ourselves, haven't we? And I think what I'm hopeful about this next five years of neighbourhood approach is that there's enough air cover now that this integrated sort of person-centred approach is what people want to do. And I just hope there will be enough patience to allow the stuff that's been started to really now bed in. you know, where people have got really good person-centred teams, they've got those wider skill sets in place and they're hanging on to them. ⁓ you know, just to give them time to bed in and to put in those measures. know, it's always a, I say it's a mixed blessing, isn't it? If you put in measures that people religiously sort of like, I know, slavishly just follow the numbers, you know, and tick boxes, you can unwind the kind of like, the mentality and the kind of mindset behind it, can't you? So, you know. something like the patient activation measure for instance, you if you force that into a system, everybody has to answer those 10 questions, you know, it can be a little bit cumbersome, it can be annoying, it can disrupt the flow. However, if you do, ⁓ you know, ⁓ make that that is a focus of how your system is orientated, it can have benefits. So, mean, ⁓ I like Jag... Munder is one question, the single question, Pam, around just asking people, how good do you think you are at looking after yourself at the moment? And then four responses, not very, okay, good and excellent. that's, or my favorite question is, tell me what you're doing to look after yourself at the moment. And the responses to that start to then guide how you put your energy in with someone. they're really not engaged at all, you're looking at really gentle ways of trying to bring them to the table and see the value of why it is worth them being a little bit more involved in looking after themselves. As opposed to the other end of scale when people are super involved and actually what they need is almost you just get out of the way or try and invite them in to support, be a peer supporter, be part of the system, celebrate what they've achieved. it is very different. The measures can drive outcomes, but they can also drive the way your system behaves as well. So yeah, I don't know where I'm going with that really, but I just do think. having that sort of, if not holding people specifically accountable to targets around a specific measure, you do need to have that ⁓ way of knowing whether or not you are activating people.

Tim Williams: Yeah, and it's holding those, you know, those short term targets ⁓ at the same time as these longer term targets, isn't it? I suppose that's the thing. And people who've been on our kind of on our health coaching courses, we use that kind of metaphor that we have a fruit tree for for for activation and the things that are easy to measure with the things above ground, you know, the fruit of the tree. But fruit trees do not bear fruit in six months or in in even maybe 12 months. Actually, the fruit kind of comes two years down the line. So it's keeping on keeping your eye on that bit at the same time as paying attention to the roots of that fruit tree. So what is it that does provide fruit in a couple of years' time? And it probably is attention to building people's confidence, building their knowledge and building their skills. That's what we propose. ⁓ But it is holding the faith that actually that's going to come down the line because you can't see it yet. I think that's the difficulty, isn't it?

Ollie: Yeah, that's a great metaphor. mean, we planted an apple tree in our garden just recently, you know, and it's a little sapling and you don't expect it to bear lots of fruit in the first couple of years. You know, I mean, you're not, you're not looking at it going, you haven't produced apples, you know, what's wrong with you? You're looking to see, you know, has it taken, is the trunk getting a little bit wider? You know, are ⁓ the leaves actually looking healthy? You know, is it starting to blossom? And you might see some very early small fruit, but it's not really edible. You know, it's not the size that you want it to be. And, you know, I've seen sort of it takes three or four years for an apple tree to start to mature, maybe even longer, sometimes 10 years for some of these kind of established ones before they're really strong and consistently giving you the fruit that you want. But so often, don't we, we hold ourselves accountable to write, come on, this apple tree must give us fruit within the first six months. If we haven't seen changes in flows in A &E and... We haven't seen people sort of like, you know, improving their blood pressure and getting, you know, losing weight. Then we haven't, we haven't achieved it, but it's just, you you just can't expect these things until you know that your apple trees are strong and have got big trunks and healthy leaves and, you know, proper blossom.

Tim Williams: Yeah, it reminded me of in supervision. remember one of the health coaches was talking about a patient they'd worked with and she was really disappointed. The patient was disappointed and they hadn't achieved the numbers. They had their cholesterol rechecked and it wasn't much different and their blood sugar was about the same. But actually the person had changed, completely changed their lifestyle, was really paying attention to what they're eating and how they were moving and doing a bit more exercise and things. But I was thinking actually, yeah, but that's paying attention to the numbers is not the only thing that matters here. Longer term, that person is going to be much better off for all of the things that they're doing. And so yes, we can get distracted by the numbers. We know they're important, know, they're kind of the tight loose tight, there needs to be some accountability, but it's making the case that actually those longer term ones are at least as important as the short term measures, which are, you know, dealing with, you know, 90 % of on the day demand.

Ollie: Yeah, yeah. Yes.

Tim Williams: you know, this time next year for GPs, which again, yeah, this could be a tough one to hold both, I suppose.

Ollie: Well, it's so frustrating, isn't it? We know this is a GP's, don't we? Just magically having 10 minutes in front of a GP doesn't change your outcomes in the end. It might be something that politically is quite compelling, do you what mean? Because people have got used to the fact that, you know, it's the GP that gets me better. But then that's almost sort of like supporting the wrong message, isn't it? Is that you're not dependent on seeing your GP to be healthy and well. You're dependent on a whole much wider... group of things and actually just single minded attention on access to GPs, I think really undermines the wider picture and the value of the wider, it gives the wrong message to patients, I think. And so asking people, what are you doing to look after yourself? Starts to shine the light on, there is things that you should do. if it's hard and it's difficult, let us support you and unlock your capabilities rather than just, giving you a medication, giving you a diagnosis, sending you off with a set of instructions of things to do. Yeah, they have their place sometimes, particularly when people are in emergency situations and need rescuing a serious human well, but most of the time that is counterproductive actually. And we need to be learning as a system that we are orientated towards enabling people, passing the power over to them. And the way to do that is not to sort of just pretend that, you know, access to GPs or access to consultant hospitals is the secret source. You know, we undermine ourselves by doing that.

Tim Williams: Yeah, in fact, it can sometimes I think get in the way, it? Of actually people, yeah, feeling comfortable and confident to look after themselves if they think the only answer, the only thing they can do is to kind of speak to a professional. But again, asking that simple question, so what are you doing to look after your health or what are you doing to look after yourself at the moment? Brilliant and easy to kind of put that into a consultation. I suppose the other thing that I'm really keen on is asking people what they think would be a really good.

Ollie: Absolutely.

Tim Williams: solution for them. ⁓ You know, I know people will say, well, I don't, that's why I'm here. You you tell me. And I know it's very tempting to go, okay, okay, well, I think we should do this. Whereas actually, if we knew the person in front of us had the most important contribution to make, what we might do instead is say, well, I've got some thoughts, but I'd love to hear what you think, because you're the expert in your own life. And probably actually you've been living with this condition for a long time. You know, what worked last time for you when you run into difficulties.

Ollie: Yeah.

Tim Williams: It's just asking people what they think first. It's not even that we can't tell them what we think, but it's just that little bit of asking so that people then to start to build their own confidence. Actually, you know, I went to see the doctor, but we went with the idea that I thought of.

Ollie: Yeah, yeah, yeah.

Tim Williams: Well then next time, guess what? You know, go with your idea first. Makes much more sense.

Ollie: Yeah, and we're really good at, you know, coaching style health professionals can build the quality of that person's idea, can't it? If that, you know, we're quite good at gently telling people if that idea probably isn't gonna fit for their situation when we understand it well. But if they've got a good idea we can build on, that's so powerful, isn't it? We can help them to deepen that and make that more meaningful, bring in other assets and resources and information they might be missing. And people learn, don't they? That's what I've realized is that, you you might find, you know, that sort of... when you're trying to perhaps have that what matters most to you conversation and people sort of say, well, I don't really know. I've never been expected to contribute into these conversations. But after a while, people get that. If a system's always operating like that, they get that, yeah, I'm gonna be expected to bring some thinking. I'm gonna be allowed to express my ideas and my concerns. And they are gonna dominate the direction of travel. Once people feel confidence in that, they're much more likely to speak up and they're much more likely to come up with useful ideas and... Let's face it, try some things out. Some things might not work, that's absolutely fine. But the fact that they are now feeling more in control and more autonomous and with more agency is a real enabler for them continuing to think well for themselves. And that's ultimately what we're trying to do with the system.

Tim Williams: Yeah, and I suppose I'm also thinking is these skills, these approaches that we can learn are really useful for cross professional working as well, aren't they? Rather than assuming that we've got all the answers because we're the medical people, actually, ⁓ when we have our meetings with our social care colleagues and folks in the voluntary sector as well, ⁓ and expert patients. as well, that actually we welcome everyone's views and there's that equality. And I suppose that's the other thing I think of that kind of common coaching language in all of those areas would really facilitate kind of neighborhood working when everyone, yeah, is speaking that kind of same language is that I haven't got all the answers. I'd love to hear what you think.

Ollie: Yeah, I think that beautifully articulates actually what the King's Fund were saying in some of their commentary, wasn't it? Is that the way that neighbourhoods work is so important, you know, that covers the way the healthcare professionals work, as we've talked about, but it also covers the way you put a focus on bringing communities together and helping them to feel like they've got a voice at the table, you know, you know, alongside that, how do you bring in the wider sector? you know, the voluntary sector, the local community groups, the local faith groups, the local schools and businesses, the local authority, the social services, you bring them together with an equal power dynamic. at first it can be messy and take time and feel cumbersome. I know I've been part of projects where people go, come on, we've got to get things done quickly. And that undermines that building that kind of equal power dynamic. But... In the end, it's like building a house on proper foundations, isn't it? You build a house quickly on rubbish foundations, it crumbles. And you just have to lay the proper foundations down. We know that about anything in life. So we just have to give ourselves time to do that. And when you do do that, you can build a really tall house that's gonna survive for a long time. there's two great sort of... papers from the King's Fund that I would encourage people to look at. They've got all their lead commentators, David Burke, I say, Becky Baird, a range of really good thinkers at the King's Fund commenting on the neighbourhood model. So those two papers that came out early April in the King's Fund I think are really useful around this as well.

Tim Williams: Great. Well, I we could talk about this. I'm really enjoying it. I don't know whether to kind of draw to a close or not really. I could keep going, Ollie. So I'm just going to check with you. So what do you think? Is there more to talk about or should we draw to a close?

Ollie: Thanks. I'm sick of the time, we've waffled on, haven't we? But hopefully it does get people thinking. And I do wish one would just big up those people that are doing this despite perhaps, like I say, the room and the space of doing this sort of stuff is limited at the moment. But those people that are finding energy to do this, it's incredible. I do think health coaching and person-centered care, care coordination, social prescribing, working, those personalized care teams. still are super, super relevant to this. And all the off-shields, the community support workers, the people that playing into that style, building on what the voluntary sector has always been doing, it is so, important. And just keep going, keep hanging in there, because you're going to be such an important ingredient of neighbourhood models.

Tim Williams: Yeah, great. And yeah, good, shout out for the voluntary sector who've been in this space for so long doing this, doing this work and kind of probably be like, ⁓ my goodness, they're finally caught up. They're finally caught up that this is the way that we need to work. ⁓ So yeah, hopefully, hopefully these teams will be able to work together really, really well for the good of the people that they are supporting, but also for ⁓ themselves. Because what we know is then when people are able to work in this way, they do find more meaning in the work that they're doing. yeah, I suppose I started the conversation feeling a little bit negative, but I'm very much more positive now having heard from you and having had this conversation. yeah, thank you for that, Ollie.

Ollie: too. Well, it makes me think, I think we should get Manal, we should try and get Manal onto this podcast. I think she'll be a great interviewee. And also I'm thinking about Alf and Jagmundra as well, because we wrote a paper together around activation and how you measure and support activation at different levels, know, at the person, the sort of community, peer support and system level. So I could see those could be hopefully good future episodes. So watch this space.

Tim Williams: Nice one. All right, nice to spend time, Ollie.

Ollie: Thanks, Tim. Cheers.