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From face-to-face to side-by-side: building on the legacy of Julian Tudor-Hart

7th Sep 2018

Professor Sir Mansel Aylward reflects on the relationship between people and professionals in health and care, and how the pioneering work of Julian Tudor-Hart demonstrated the importance of reciprocal trust. How can we ensure that shared responsibility remains the bedrock of the NHS in the 21st century?

The village of Glyncorrwg in the Afan Valley may appear unremarkable to the untrained eye. It certainly shares much in common with many other valleys towns and villages (including my own hometown of Merthyr Tydfil) in terms of its social values and its proud history as a mining community. However, as unremarkable as it may appear, this village has made a globally important contribution to health and care as we know it today.

Through the work of Julian Tudor-Hart, who sadly passed away in July of this year, Glyncorrwg will be written in the annals of history as the birthplace of the inverse care law and preventative medicine as we know it today. But what can we learn from the relationship between the people of Glyncorrwg and Julian Tudor-Hart to transform health and care for the future?

The importance of shared trust

Julian was able to carry out such important work thanks to an extraordinary – and reciprocated – bond of trust with his community. Over many years, Julian was able to rely on the sustained cooperation of over 2,000 patients to participate in and inform his ground-breaking research which led to his fomulation of the inverse care law. This argued that people’s health is determined by their living conditions, and that those most in need of medical care are those least likely to receive it.

In A New Kind of Doctor, Julian himself described the “unglamorous slog” of building trust over many years and appointments, in order to move from “face-to-face to side-by-side” consultations with his patients who became equal partners in their own care. Their cooperation with Julian and shared responsibility was duly rewarded by better health, with Glyncorrwg recording a fall in smoking in the adult population from 56% to 25% over 25 years and a much lower death rate than other equivalent communities.

Continuity of care – how can we achieve it today?

Some would argue that Julian Tudor-Hart’s ability to connect with a community over a sustained period of time is owed (to a certain extent) to a particular time and model of care: the village GP who knew and was known by all in their community. Now shared practices, locum positions and flexible contracts mean that an individual may see many GPs within a few years of living in a community.  Although continuity of care may seem to be an aspiration of a bygone age, there are many ways we can still build trust and empathy in tomorrow’s health and care system.

The Bevan Commission’s recent report on A Workforce Fit for Future Health and Care advocated for ‘core health carers’, a role which reflects the holistic needs (environmental, physical, social and psychological) of an individual. Roles which span health and social care will be needed, with the necessary competencies to deal with the increasing complexities of aging and end of life, providing a continuity of care where life is cherished and not the bare minimum level of care for survival.

The ‘core health carer’ role puts the patient first and, as such, may offer a new solution to providing consistency of care in the 21st century, while remaining faithful to the pioneering approach of Julian Tudor-Hart.

The innovators walking in a giant’s footsteps

So who will carry the mantle for sustained community engagement and service innovation in the legacy of Julian Tudor-Hart?

The Bevan Commission is developing a generation of Bevan Exemplars who are trialling, refining and implementing innovative ideas across NHS Wales. Our Bevan Exemplar cohorts include many General Practitioners and professionals working in primary care who are building on Julian Tudor-Hart’s legacy in the 21st century. These include: Nefyn-based Arfon Williams, who used the skills of his practice team and patients to better prioritise and manage his practice; Tony Downs, based in Connah’s Quay, whose storytelling approach to chronic fatigue syndromes has vastly improved patient experiences ; and Chris Stockport in Prestatyn who works with a ‘Patient Panel’ for continuous feedback and to co-design primary care services.

There is no denying that the challenges of the future of healthcare look very different to its past. However we can continue to learn from giants like Julian Tudor-Hart and pioneer new, innovative ways to embed a culture of commitment and empathy in our services. The benefits of a reciprocal relationship between people, patients and healthcare professionals are clear; the only limiting factor is whether we will be bold enough to invest fully in redrawing this relationship.

As we know, Julian Tudor-Hart transformed preventative medicine forever from his garden shed in Glyncorrwg. Now is the time for us to sow the seeds for the next health and care revolution.

Professor Sir Mansel Aylward is the Chair of the Bevan Commission and the Chair of Life Sciences Hub Wales. He is Director of the Centre for Psychosocial and Disability Research at Cardiff University and Professor for Prudent Health and Well-being at Swansea University. He was previously the inaugural Chair of Public Health Wales.

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