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Five questions with new Council member Dr James Fleming

Dr James FlemingDr James Fleming, GP at Padiham Medical Centre in East Lancashire describes the College of Medicine (CoM) as a “hotbed of innovation”

  1. What attracted you to become a Council member of the CoM?
    I was initially attracted because of its founders and leaders, all of whom are inspirational in the way they break boundaries in healthcare. They have gone out of their way to support me in the community work that I do and seem to have endless energy for others. I learned from them that the College is interested in looking at the person as a whole, medical, psychological, spiritual and social. This is what I try to do in Padiham, where I work. I try to support the town in which I work, the local healthcare system and help those patients who existing services cannot help. The College fits with these ideas and is a hotbed of innovation which I can learn from. Hopefully I can also contribute something as a Council member because of the experience I have of working in this field.

The College is interested in looking at the person as a whole, medical, psychological, spiritual and social. This is what I try to do in Padiham, where I work.

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Collaborations with other groups in Padiham mean that gardening can be used as therapy or a route back into employment.

2. One of our principles is that we must go beyond conventional practice and embrace a wider range of potential treatments and health initiatives. Your Green Dreams Project seems in line with this. What did success initially look like, what outcomes are you seeing and what challenges have you experienced?
Success is empowering a patient to change, who wants to change, so that their quality of life can improve, a patient who up until that point was unable to find support with existing services. Add-ons to that are varied along the lines of our outcomes (housing, finances, mental health, jobs, community asset building, group work etc.).

On a day-to-day basis I feel terrible about the way some people have to live when others do not have to struggle like that, and am always trying to find ways to address this through my community work.

We look at outcomes in many different areas of health and social care (72 outcomes), with 9 tiers of data capture to try to remove bias (independent GP reports from GP’s whose patients we were seeing, patient satisfaction, outcomes data, stakeholder reports, case studies, locality health data, our own global narrative, group work data and cost benefit analysis). All of this has been put into quarterly reports.

Challenges to this work have been countless. The most important one to me right from the start was making sure that what we did was of benefit to the patient and the community, and that it was safe and well governed. From the start I always said that if we ever discovered that it didn’t work, I would be obliged to stop doing it. Fortunately this did not happen. This generated a constant cycle of back room support and reflection – training, outcomes measurement and feedback, risk management, quarterly reports, governance, data capture, finances, protocols, website, promotional literature, meetings, public speaking, business cases, relationships with stakeholders, recruitment and interviewing. The hardest part was capturing outcomes in a meaningful, but non-intrusive way, and designing a work stream that benefitted the patient. Until I was in a position to employ a manager, 3 years after we started, this was almost impossible.

One thing I have learned is that no-one wants to live badly, and given the right opportunity and circumstances, everyone, without exception, would like to live well.

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A theatre in the local park created by the Green Dreams project.

3. What more do you feel can be done by healthcare professionals to ensure that the physical, mental and spiritual health of individuals and communities is prioritised?
I think there should be closer working between healthcare, social care and the third sector to try to address as many patient needs collectively as possible. I think there should be more recognition of the fact that no amount of counselling or medication is going to remove a significant social problem like rental housing that is not in a fit state to live in or the terrible gap that exists for so many people between access and achievement in education and the modern job market.

4. A large number of doctors admit that they have prescribed pills even though they don’t think it would make a difference to the patient, because they didn’t have another solution. How can we go about changing this mind-set?
The only way to change this mind-set is to have an alternative, which is the precise reason I set up Green Dreams.

5. What difference do you hope to make through your role with the CoM?
I hope to use it to address inequality in opportunity in some way. On a day-to-day basis I feel terrible about the way some people have to live when others do not have to struggle like that, and am always trying to find ways to address this through my community work. One thing I have learned is that no-one wants to live badly, and given the right opportunity and circumstances, everyone, without exception, would like to live well. If I can provide a vehicle or influence to help facilitate that type of change, then I am doing what I am expected to do in the position that I am in as a doctor.