COIN Meeting May 2024. Paul Thomas

At the May 2024 COIN meeting – https://www.youtube.com/watch?v=EQS2dUNkxms – I presented ideas about how Carers could catalyse community-oriented integrated practice (COIP). This translated into a paper for the Journal of Holistic Healthcare and Integrative Medicine - https://bhma.org/product/crisis-co-creation-community/ and a paper for the British Journal of General Practitioners - https://bjgp.org/content/74/746/416 

The need for community-oriented integration for health and care is well known. 134 countries agreed this at the 1978 Alma Ata conference when it was called Strong Primary Health Care. A main obstacle is how to achieve it.

COIP can be achieved by applying theories of organisational learning and 4th generation evaluation. These work with the dynamic nature of living life forwards, different from so-called ‘laboratory science’ that sees only snapshots of stories-in-evolution.

Cycles of collaborative learning and coordinated change in shared developmental spaces are essential. They allow focused actions and complex co-adaptation to feed off each other. They solve problems and build trusted relationships at the same time. 

One obstacle is, when things are going well, many don’t see the need to collaborate. Difficult real-life situations can open their eyes. Generalists, including GPs and Carers, often experience this complexity, so are well-placed to lead the development of COIP at scale.

However, real-life difficulties can have the opposite effect, causing harm from avoidance and projection of anxieties onto others (e.g. onto Carers). Harmful behaviour in caring situations is common and needs skilful management. Carers and professional teams need skills to do this – the same skills needed to manage harmful behaviour more generally in society.

One in ten of the population is a Carer. This is an enormous resource that is often poorly valued. Relatively minor changes in existing policy could release the potential of Carers to facilitate healthy deaths, save NHS resources and become part of the ‘glue’ in society that develops and maintains compassionate communities. 

Carers need training and action learning sets to learn these skills. They also need family-oriented team-care to protect them from harm.  Existing practitioners of different disciplines can do this if they choose to collaborate. It might also help them to rediscover the joy of healthcare practice - so often lost when working alone and when protocols dictate actions.  

To achieve this at scale, primary, community and social services must agree to form teams around the shared developmental space that is the home where there is a Carer. Shared developmental spaces in Neighbourhoods need boundary-alignment with others - Primary Care Networks, Schools, Councils….  And opportunities to ‘play’ within them.

Arts organisations have an important role in enabling ‘play’ - creative interaction that develops identity and comm-unities.

Ongoing creative interaction builds teams and communities. It incrementally transforms whole systems. This idea can be applied in many different situations to improve health and care; even inside families. Locally, it can involve pharmacists, undertakers, faith groups, corner shops and many others – they are all there, waiting to be invited to the party.