Spotlight on our Frome Rural Health Hub

Nestled in the Mendip Hills is a busy livestock market in Frome, alive with farmers from our rural community buying and selling their livestock. The arena is busy with the sound of auctioneer chants, cows mooing, farmers bidding, and chatter as everyone catches up with others in their community.

Amongst the blur of wellies and overalls, is a uniform you might not expect to see – the nurses dress which belongs to its wearer, Lottie.

Lottie Cruse is a district nurse team lead at our trust, and one of the nurses who works at our Frome Rural Health Hub. As a farmer’s wife, Lottie knows better than anyone that farmers will often find a vet for their animals far before visiting the GP for their own health!

Busy and unpredictable schedules, responsibility, and lifestyle are just a handful of the reasons that the farming community are often some of the hardest to reach individuals through traditional health service channels.

As a solution, and part of our mission to ensure healthcare is accessible to all, our Rural Health Hub is an NHS initiative set up to provide convenient drop-in health and wellbeing checks for farmers and other agricultural workers every fortnight.

The results have been outstanding, and provided many heartwarming cases. Lottie shares her reflections on the Hub and the incredible work her and the rest of the team have achieved.

“My farming background has been really helpful when I am working at the health hub, as I am able to relate to the farmers and understand the pressures that come with their unique lifestyle. Beginning discussion on topics they are comfortable talking about, such as cows and other livestock, allows patients to feel comfortable to open up about their health concerns, and I can then direct them to the appropriate services.

“We provide routine observations such a blood pressure, blood sugar, cholesterol and prostate screening. I can also talk to them about leading a healthy lifestyle with weight and alcohol.”

As well as health check-ups, an important part of the service is mental health. Zoe, a mental health practitioner from our Talking Therapies service, also works at the health hub, and shares some of the common themes she encounters:

“Mental health and stress support is really important for this community, as typically, farmers are at higher risk of suicide and mental health and have access to means to end their life. A lot of what I see is bereavement or stress, especially when the weather has been bad, causing threat to their livelihood. Farming is also a 24/7 job, and a lack of breaks can increase stress levels and be an extremely isolating environment.

“By being at the market, we hope to appear more convenient and approachable to the farming community. We encourage them to speak with us and if they are suitable for extra support, we can refer them to a relevant service, such as Mindline.”

Lottie continues: “I often find I can be sat with patients having a chat for 40 minutes! They feel really comfortable to open up and share their worries – this is something they wouldn’t have the time to do or maybe wouldn’t feel comfortable doing at their GP practice”.

While everyday at the clinic is different, the team have identified common themes and worries among the farming community and adapted their service to meet these needs.

“The stress and irregular eating and drinking patterns that come with farming can also cause effects on blood pressure, which is an issue the clinic sees regularly.

“Cholesterol is a big one too – the patients always ask ‘have you got your cholesterol machine because I want that tested’ - the two main concerns are prostate and cholesterol.

“Sepsis is also a big threat, as famers can often encounter injury in a mucky environment. We listen to their concerns, and amend our health checks to cater for them, like the introduction of prostate screening.”

As well as physical and mental health services, there is also a podiatry service offered at the Frome Health Hub – particularly important for those who neglect their feet in wellies all day! These appointments can be used to identify other conditions like diabetes, which could have gone unnoticed if they hadn’t dropped into the clinic while at the market.

The team have been focusing on raising awareness and have seen great results so far.

“I have been giving talks to the National Farmers Union to raise awareness of the health hub, and the engagement has been amazing! I didn’t think I’d be able to keep a room of men engaged talking about prostates, but I was so pleasantly surprised. They asked so many questions, shared success stories of catching things early, and wanted to hear more about it. This proves they are concerned about their health, but their lifestyle doesn’t cater for them to visit mainstream access to healthcare. Thanks to our health hub, we can provide that reassurance and hopefully catch things early that could have previously gone unnoticed.

“Awareness through media has also really worked – we previously did a feature on BBC Points West, and when I visited a farmer’s home that day, he recognised me from the TV! It goes to show that by spreading the word, people in the rural farming community will know about our services and have more confidence accessing healthcare.

“We have also had returning farmers from quite some distance, and this goes to show that the ease of coming to sell or buy animals but also get to visit a healthcare professional is really valuable to these people.

“A really proud moment for me was when we were visited by a 16 year old - he had heard from his friends about the hub, and felt he should come and get checked over just in case we could catch something early. That awareness from such a young age is really important and goes to show that our messaging is working and we are breaking barriers.”

While visiting the hub, a patient had the following to say about his experience: “I am semi-retired now, so I come to the market to connect with my farming friends. I heard about the clinic through my friends and initially came to have my feet done. I find it really convenient because if I ring the GP and they give me an appointment for 6 weeks on a Friday, that’s not suitable. As a farmer I can’t know my schedule that far in advance, as it is dependant on weather and other factors. I can drop into the health hub in my dirty clothes and they don’t mind!”

The idea for Rural Health Hubs originated in 2017 when Catherine Hawk, who runs the auction centre at Junction 24 in Bridgwater, approached the then Somerset Partnership. Catherine shared that her late father, Derek Mead, wanted a health hub at the Junction to support his close colleagues and friends who had various health issues. Very sadly, Derek was fatally injured in a farming accident, but Catherine wanted to carry on her father’s wish, so made a link with the Lions Club in Western-Super-Mare and other country markets to see if they could raise enough money to start a clinic.

Come 14 April 2018, the first clinic was opened by Princess Anne, and the rest is history! More clinics opened and we now have three in total across Somerset.

With the future of the service looking bright, the team have some big plans. "We would really like to increase awareness that we are here," Lottie adds. "I’d hope that this would then increase numbers, and as a result we could increase the number of clinics we can run in a month. In the short term, I would also like to increase the amount of remote testing we can offer to enhance the package we already provide.”

Jane Fitzgerald is our neighbourhood service lead, who helped set up the first Rural Health Hub. She said: “It is about taking measures to help prevent people ending up in hospital, and supporting them to lead a healthy lifestyle. We are working now to expand our dermatology offering at the health hubs – farmers are not great at using factor 50 sunscreen, so I think this is an important development to introduce.”

Keep an eye out near the end of the year for an exciting spotlight on the Frome Rural Health Hub, which will feature in the national Readers Digest!