Dr Justin Walker – Team Up Derbyshire
Dr Justin Walker is a senior partner at the Stewart Medical Centre in Buxton. His special interests include mental health, dementia, paediatrics and surgery. He is a member of the Ageing Well leads group of Team Up Derbyshire and is the clinical lead for anticipatory care.
What is your role with Team Up?
I've been a GP for 17 years now, and a paediatric surgeon before that. I have long been interested in the influence of the non-physical determinants of health and became passionate about mental health very shortly after I became a partner at this medical centre, where we experienced a personal tragedy among one of our colleagues. I got into mental health commissioning, and shortly after that, became deeply passionate about dementia. I did a lot of work in dementia care and was asked to move into a role that considered the whole of frailty. This then led into a role with Team Up Derbyshire as the clinical lead for anticipatory care, a concept which is about as exciting and revolutionary as anything I’ve ever come across in my almost 30 years in the NHS. I’m convinced it is the right way to go, even if it takes a generation to achieve.
What is anticipatory care?
I don't think the term means much to anybody at the moment. It’s about being person-centred and being able to see the crisis coming and solve it before it happens. It reminds me of the movie, Minority Report, where they prevent crimes before they happen. It’s about having more tools in your toolbox than a prescription pad and computer referral system – it’s about linking up with, for example, a dog walker, a decorator, somebody who will hold someone’s hand and have a cup of tea with, someone who solves the loneliness. It’s about having the right toolkit of solutions and the right multi-disciplinary team working with you.
Why hasn’t the NHS done this before?
It has been due to the NHS previously being a fragmented system – a patchwork of disconnected silos, all concerned by their own (financial) bottom line. The brilliant thing about the NHS Long Term Plan (published January 2019) is that it is the first tacit acknowledgment that the element of competition within the NHS was never going to work. People simply want a good service; they don’t want to choose between services. The Plan was inspirational, from the top down we were getting direction that truly appreciated what good medicine and good care would look like.
What is happening locally/nationally?
It is still early days. We have the three pillars of the Ageing Well programme – community urgent response, enhancing health in care homes, and anticipatory care, and Derbyshire has always been on the leading edge of this work. The other strands of the Ageing Well programme are probably more advanced as they are not so revolutionary. Care homes work was sped up due to the impact of Covid-19 and community urgent response has been brought into focus by Team Up and the whole collaboration between health and social care. What you find is when people leave community urgent response, they end up going round in circles, so we need to find a way that when people do leave urgent care, they don’t end up right back at the front door again soon after. This aim will generate a desire to look at innovative and multi-disciplinary solutions, led by local clinicians who really understand their population, and that is where anticipatory care will come in.
What are the initial next steps for anticipatory care?
I think we will piggy-back onto the community urgent response service and try to find out ‘how do we find these people who are revolving around the urgent response service and support them before a crisis happens?’ I would like to see each primary care network (groups of GP practices working together) and place areas (teams from across health and social care) produce one side of A4, writing down bullet points of what anticipatory care could do for them. We would then need to look at such things as resources, data and evaluation of impact. I think I’m in a good position to straddle the aspirational, but sometimes quite dry, anticipatory care talk and the day-to-day life of a jobbing GP.
How will Team Up help you and your general practice?
It is evident from multi-disciplinary team meetings that the social workers don’t really understand the way that we work, and one can only assume therefore that we do not understand the way they work. There are very different issues in these sectors in terms of capacity, consent and payment. We have to genuinely get used to being co-workers and acting as a collective. We need to understand each others’ jobs and language. This will all make it easier to provide a good foundation for an anticipatory care programme.
How are primary care networks responding to the challenge of delivering Team Up Derbyshire?
It is variable, there are some primary care networks (PCNs) who are very innovative and looking for the funding to make the most of their ideas, and some who are a little bit behind. It is all about shared learning and trying to make sure that whatever works well in one PCN could be replicated in another, subject to their local needs. In places like Erewash, Chesterfield and High Peak there are people leading the way and demonstrating what can be done. Hopefully others, in the health, social care and voluntary sectors, in other areas will see things being done well and seek to emulate that.
Away from work
Favourites
· Holiday destination: Fontainebleau
· Film: Children of Men (2006)
· Book: The Philip Pullman trilogy
· Music: The Sky was Pink by Nathan Fake
· Sport: Snowboarding