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Tony Downes

Betsi Cadwaladr University Health Board

A Bevan Exemplar initiative led by Dr Tony Downes, a GP in Connah’s Quay, aims to provide support for patients who fall between health and social care services.

Many patients present at GP surgeries and hospitals with a range of conditions which are difficult to diagnose and treat, such as chronic fatigue and fibromyalgia. These conditions can fall between mental and physical health services, primary and secondary care services, health and social care services and various third sector agencies – making them ‘nobody’s patient’.

It is estimated that these patients account for up to 50% of hospital outpatient appointments, 10% of hospital admissions and up to 40% of GP appointments – at an overall cost of £3 billion to the NHS and £9 billion to the economy.

Linking physical symptoms to social trauma

The traditional medical model of health, which focuses on physical ailments, can often disenfranchise patients whose symptoms are complex and inextricably linked to their mental health.

The Quay to Well-Being cooperative is built on a social, prudent model of health and aims to replace a traditional GP partnership in Connah’s Quay. It puts the lived experience of the patient at the forefront of their care to link their physical symptoms with the effects of social or psychological trauma.

In addition to chronic disease management, the initiative aims to assist people suffering the effects of psychological trauma and a range of debilitating, persistent physical symptoms such as chronic pain, fibromyalgia, chronic fatigue and stomach and bowel symptoms. The cooperative will act as an intermediary well-being hub that encourages collaborative working and co-production with patients: providing education and training as well as treatments.

“Like a light bulb coming on”

Dr Downes’ unique model – built on the principles of prudent healthcare and inspired by origins of the NHS such as Tredegar miners’ co-operative – has already had a powerful impact on patients. One said: “A short explanation of how my mental and physical symptoms were connected and linked to my life experiences was like a light bulb coming on. Nobody has ever explained things like this which really helps.”

NHS professionals have also reacted positively to this approach of caring for ‘nobody’s patient’. One consultant rheumatologist (treating conditions such as arthritis and joint pain) reported that up to up to 70% of new patients in their clinics have no rheumatology condition, and often disclose adverse life experiences which the rheumatologist is unable to treat. The Quay to Well-being model provides an opportunity to catch these patients who are at risk of falling between services and ensure that adverse experiences and social trauma are properly explored and treated alongside any existing physical symptoms.

Now there are hopes that the Quay to Well-being co-operative model can be scaled up at a national level to care for ‘nobody’s patients’ across Wales.

The project was supported by the Bevan Commission’s Bevan Exemplar programme, which enables NHS professionals across Wales to test and try out their innovative ideas.