How this PCN… cares for the Orthodox Jewish community

Springfield Park PCN is one of six networks shortlisted for PCN of the year. Dr Tehseen Khan shares how it is caring for the Orthodox Jewish community in Hackney, north London.

Springfield Park is in North Hackney and covers three practices with a total population size of 38,000. Nearly half (40%) of our residents belong to the Charedi Orthodox Jewish community.

There can be barriers around the way this community accesses healthcare information and Rabbis are often consulted for healthcare-related decisions.

On average, families have eight children and more than a third of Hackney’s children belong to this community. This also means that around 12% of this population is pregnant at any given time, which puts a high demand on GP services as there is a high consultation rate.

Preventative health service uptake is extremely poor: cancer screening and vaccination uptake is the lowest in the UK, with the uptake of childhood immunisations only reaching about 40% at one year of age. Consequently, we have had outbreaks of vaccine-preventable diseases such as measles affecting 300 children in 2018/19 and, recently, we’ve had a pertussis outbreak. 

Preventative care

Our practices are open on Sundays to offer preventative services such as scheduled and walk-in clinics for cervical screening and childhood immunisations. We also run pop-up vaccination clinics in a religious community centre on Thursday afternoons. The PCN funding for additional roles has been used to help improve childhood immunisation, Covid and flu vaccine uptake along with cancer screening rates. 

We have been running engagement and educational events in person since the easing of pandemic restrictions as we know that online webinars have no reach in this community. A health event in March 2022 led to 110 women from the Charedi community learning about common childhood illnesses and vaccinations. Subsequent events have offered comprehensive health checks, vaccinations and even a ‘bike doctor’ on site to fix children’s bikes and, therefore, attract families.

Cardiovascular disease (CVD) prevention is another focus area and our clinicians, particularly our strong clinical pharmacy team, have led us to achieve the best performance in blood pressure control in all of North East London integrated care system (second in London and ninth in the country). This is a testament to us using the population health management approach, focusing on those at the highest risk and using a holistic health approach when we talk about important health issues.

Collaboration

Our practices worked very closely together, sharing the best approaches to reduce variation and work on the three Cs of prevention hesitancy:

1. Confidence – providing education and dispelling myths about vaccinations and cancer screening. We set up regular face-to-face and virtual events to educate patients about prevention, including cardiovascular disease, cancer and vaccinations.

2. Convenience – offering clinics for vaccinations and cervical screening when it suits patients. The community wanted clinics available on Sundays, as patients observe the Sabbath, on Saturdays, so we fought to have our PCN’s Enhanced Access provision to fall on Sundays rather than Saturdays (as is mandated by the national PCN contract).

3. Complacency – using a central recall team and additional recallers employed by the PCN, calling patients to encourage attendance for all vaccinations and prevention services.

We worked with Public Health and Hackney Council to set up educational events, and the UK Health Security Agency (UKHSA) helped promote some of our community engagement events. 

Importantly, we co-produced the agenda, communications and strategy with the Orthodox Jewish community and engaged widely with the Rabbinate. A coalition of Orthodox Jewish organisations helped to deliver and promote events. A Covid vaccination pop-up was set up during the first round of the vaccination campaign, attended by the then health minister Nadhim Zahawi and London Mayor Sadiq Khan. The voluntary Jewish ambulance service Hatzola helped to vaccinate our patients, which helped improve confidence in the immunisation programme.

Action

In all our health strategies, we take a multisectoral and multidisciplinary approach. Our practice staff have been trained in motivational interviewing skills and many of our receptionists can now vaccinate for both flu and Covid. This has improved confidence and retention in our non-clinical workforce and helped prioritise making every contact count (MECC) conversations.  

We utilise all our Additional Roles Reimbursement Scheme (ARRS) staff to help with this agenda, as well as our multiple volunteer groups within the PCN. These volunteer groups have been set up by a Volunteer Centre Hackney manager employed as an additional role in our PCN over the past couple of years.  Our residents have set up more than 15 groups, including arts, ta-chi, gardening, and Orthodox Jewish men’s walking group. 

This was guided by our joint strategic needs assessment data, which indicated increased obesity in middle-aged men from the Jewish community. And so, with the help of the community, we set up a group that meets regularly and is open to all, including those outside the PCN.

One of the most successful groups is an English language learning group set up by one of our patients. This is helping to empower our residents to learn language skills and seek healthcare and employment, helping to impact their wider wellbeing. This was only possible by working with partners such as the voluntary sector and local authority.

Future

Our patients report positive impacts of the education and health events. Care is co-designed by them so it is delivered in a way that they want to receive it. Patients are proud of the services we provide and often tell family and friends who may live in neighbouring boroughs. As a result, we have had new patients register through word of mouth.

Staff also report feeling more satisfied and motivated at work due to the focus on wider determinants of health. For example, they can refer patients who are suffering from loneliness to a PCN-based group.

Our next venture over the next 12-24 months is to set up a PCN-based maternity and child health hub. This will help upskill our staff in managing common childhood illnesses and focus on prevention, such as vaccination. We are collaborating with the local paediatrics team at Homerton University Hospital and maternity services to build this project.

Dr Tehseen Khan is population health & health inequalities lead at NHS North East London and senior clinical advisor at NHS England.

The General Practice Awards are run by Cogora, the publisher of Pulse PCN. These awards highlight innovation in primary care across the UK. This article is part of a series on the shortlisted PCNs.