Changing the conversation about health

The Green Dreams Project CIC

CoM Tags:

community, GP

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The Green Dreams Project provides local, community-based solutions in East Lancashire to unemployment, isolation and reduced quality of life.

The project prioritises those who other agencies have been unable to help. Our uniqueness is the triad of support that we offer: tailored coordinated care; marrying health needs with social needs; the creation of meaningful group activities.
We do this by employing project managers and linking them to individual GP practices. They spend time with each patient to define the barriers to enhanced quality of life. A programme specific to each patient can be designed to address these difficulties.

Read an interview with Dr James Fleming here

Green Dreams were a runner up for the College of Medicine’s 2013 Innovations Award.

Year established
Number of staff
6 Full time, 3 part time, + many partners and stakeholders
Number of users
Is there a charge to users?
What makes your project sustainable?
We contribute to and manage local social assets. We have no capital outlay. We measure outputs against cost. Our volunteers stay with us, and all the projects we have initiated are still running. We do not duplicate services and are very careful not to tread on toes.We have collected substantial evidence of participants’ improving health: when their medical notes are looked at by their own GP the physical and mental sequelae of their previous situation no longer need drug treatment or a sick note. This has helped us make the case for further funding.We work with countless other people to spread our message, over 50 stakeholders, local medical groups and many more, which also attracts further funders.Our numerous gardening and ecotherapy projects create environmental sustainability.
User demographics
We work in East Lancashire, serving practice populations in 7 towns. Anybody over 18 can have access to the service. There are knock on effects for their children and other dependents and family members.
There is a gap in services for those who are unable to self-refer and engage with other agencies but who need multi-agency help. As far as we are aware the work that we do has never been done before quite in the way that we do it.The innovation lies in the triad of care that we have designed. This is 1) tailored coordinated care, 2) marrying health and social activities, and 3) development of the community. It only works if the full triad is utilised, otherwise you cannot tap into local social assets or build links with the community. Unless care is local, people will not engage and unless their barriers to change are addressed, it doesn’t work.Our biggest problem was doing something new that had not been done before, which was fortunately supported by local GPs. We were also lucky to have an extremely supportive and innovative PCT (now CCG), and a culture of innovation at our local Lancashire Care NHS Foundation Trust.
Patient-Centred, whole person preventative approach
Team-working is integral to Green Dreams. Doctors support the physical and psychological elements of care, and Green Dreams and other stakeholders contribute to societal aspects. The fundamental principle at Green Dreams is that if your life is bad, you are likely to feel bad. Rather than tackling the end result of this, we try to tackle the cause whether this is low self-esteem from lack of paid work, or poor housing, or inability to coordinate the different agencies to effect change.This builds resilience and allows us to empower beneficiaries as we facilitate self-directed progress.Our work improves relationships and we have evidence in our last evaluation that it also improves compliance with medical care, which builds physical and mental health. We act as advocates for patients and are quite prepared to go with them to court hearings, medical evaluations, or other daunting experiences if that is causing great hardship, to allow their voice to be heard.Those who volunteer with us in many cases improve their chance of work; the scheme also helps to tackle social isolation. Finally, we build healing environments in the local community. This helps to create pride in the community, allows us to tap into local social assets, builds links with others and provides opportunities for group work and artistic expression. Examples of this are our gardens and our outdoor theatre.

Evidence informed practice/audit and evaluation
Dr Fleming undertook an MSc in Primary Care to discover whether it was possible to measure quality of life-related work in General Practice. This involved study of identity, existentialism, quality of life definitions and parameters, and mental illness with a particular emphasis on those thoughts that did not quite fit into DSM criteria. He then visited other practices, consulted the community and formed a project with the help of the PCT. Since its inception it has been built on repeated self-evaluations until the project could afford to pay for an outside agency to undertake a non-biased evaluation of our service (University of Central Lancashire). Read the University of Lancashire report here. Read the specific outcomes data.We also asked our 100 GPs to look in the medical notes of the patients who had been to Green Dreams, to see if there were any benefits of our work. This research is independent of Green Dreams and demonstrates that we reduce prescribing, reduce appointments, reduce emergency admissions, reduce thoughts of self-harm, reduce dependency, and much more.We issue quarterly patient monitoring forms, measuring patient satisfaction and feedback, WEMWB, plus GP monitoring forms. The independent research about Green Dreams from the University of Central Lancashire is ‘overwhelmingly positive’.
Multi-disciplinary collaboration, communication and professional practice
All patients referred to Green Dreams from whatever source see their GP first. This allows the GP to make sure the patient is stable enough to work with Green Dreams and also begins the process of regular communication between the project and the GP. This is done in the form of feedback forms.We will happily see patients in their own homes if they are housebound or unable to leave the home.Most patients are seen in a room at their own GP practice by Green Dreams. This provides for integration of the project worker into the practice so they begin to know all the practice staff. This improves communication. Consent is taken very seriously. In many of our practices we have been granted access to the GP held computer notes to enter information about what we are doing.Non-conventional therapies are used but only if the GP thinks there is no medical alternative. All staff with patient contact are previously trained either as doctors, nurses, social workers or job centre staff.

Clinical supervision is provided every two weeks. This incorporates CPD. We have a competency lead training matrix to design our own CPD. This is necessary as the work is unique.

We have a monthly project operations group to involve staff in the management of the project. This is because they work in different areas, are experience healthcare professionals and we feel they have a lot to contribute in terms of visions and ideas. Procedures for promoting positive feelings, commitment and compassion are included in the appraisal and clinical supervision system.

We have three monthly board meetings.

We can demonstrate how we have made a difference to the local community very rigorously through our evaluations.

Contact details
The Green Dreams Project CIC The Town Hall Burnley Road Padiham East Lancs BB12 8BS t: 07703 842331 w: e: