Prof Andy Brooks
Clinical Chair
NAPC
Anna Darling
Clinical Director / Advanced Nurse Practitioner
Purbeck Primary Care Network
In this episode of the NAPC podcast, Andy Brooks speaks with Anna Darling, Clinical Director at Purbeck PCN, about leading an integrated neighbourhood team in a rural coastal community. Anna shares how open collaboration, community engagement and a focus on prevention have driven real progress, from innovative staff engagement and a multi‑agency short film, to tackling childhood obesity through schools and partnerships.
Hear how Anna and her colleagues brought together over 28 organisations, built genuine buy‑in across sectors and created sustainable initiatives that connect services and residents. She also reflects on the realities of the role, including time pressures and system challenges, while offering practical advice for others starting their neighbourhood care journey.
This conversation is a powerful example of what can be achieved when local energy, partnership working and a “get on and do it” mindset come together.
Transcript
Introduction
Andy Brooks
Welcome to an NAPC podcast. I’m Andy Brooks, a GP and the clinical chair of NAPC. I’m really pleased to be joined for this podcast by Anna Darling. Anna is a nurse by background and is also clinical director at her PCN Primary Care Network in Purbeck in Dorset. Welcome Anna to the podcast.
Anna Darling
Thank you. Thank you for letting me join.
Andy Brooks
It’s great to have you. I’ve been hearing all sorts of great things that you’ve been doing in Dorset. But before we get into those things, I introduced you as being a nurse and clinical director. Perhaps you could tell us a little bit about yourself?
Anna Darling
Yep, so I’m a nurse practitioner by background. Most of my experience was working in the acutes and then I did some work with a community hub. I became clinical director at Purbeck PCN, it was about three years ago. So I work as clinical director for the PCN and then I also work as a nurse practitioner with the enhanced health and care home team. And then 18 months ago, I was asked to be one of the leads for our Purbeck integrated neighbourhood team.
Early system context and opportunity
Andy Brooks
Excellent. So perhaps looking back at the early days of your work, I think we’ll get into the stuff that you’ve done in a moment. But could you describe what it was like working in the system in the early days and what was it that sort of got you thinking, ‘oh, I could do something here?’.
Anna Darling
With Purbeck, it’s got a really strong community. So we have really sort of successful and ambitious voluntary organisation. and really passionate residents. When we were first approached about this sort of option of an integrated neighbourhood team, I felt that we were in a really good place to put ourselves forward. We also had monthly meetings with the council and our community and mental health provider Dorset Healthcare. We already had a structure in place that I felt that we could build on. and everyone was really keen to put ourselves forward. In Dorset, we were put in the first wave to go forward as an INT. We’re about 34,000 patients. Our PCN has six GP practices. We’re a rural and coastal community. We have got older population. So one of our biggest sort of challenges is social isolation and transport.
Getting started
Andy Brooks
Thanks, Anna. And so you’ve came into this role, you applied for the national programme. What sort of things did you set about doing?
Anna Darling
We decided to have a staff engagement meeting first and even that started off a little bit complicated where you’re trying to work out who to include, how big to go. We decided to have an open invite and invite any of our staff members who were interested in integrated neighbourhood teams. Then it opened it up to actually if there was any voluntary organisations or PPGs that wanted to come. So we hired a village hall. We had just over 50 attendees. We initially had the first part of the meeting was just hearing everyone’s experiences, what they thought was working well, what the challenges were.
And then the second part of the meeting, we sort of had a condensed team where we sort of reviewed the information, looked at what the challenges were, where there were opportunities and we developed some priority areas for our INT to initially look at because I think we didn’t want to just do lots and lots of meetings and lots of planning. We wanted to start moving from an early stage. So that’s why we set the priorities based on the staff feedback. And then one of those priorities was community engagement. So we could then hear the voice of the public about what they would like sort of included in our INT work. So that became one of our that became our sort of most important priority from the staff engagement work.
Priorities
Andy Brooks
So that’s really interesting there. It’s not only kind of what you did, but how you did it was really important. So an open meeting, 50 people in a village hall, as you said, and a clear thing about listening to what people wanted. And then you said one of the early engagements was community engagement. You mentioned some of the other challenges or priorities. What sort of things did you come up with in that first meeting about the challenges and priorities?
Anna Darling
We had some sort of wicked problems that I think everybody has, which was IT, communication, duplication of work. So we took a list of all the problems that were affecting all the teams and we handed those to our INTs or project team, our Dorset project team. And then our Purbeck INT looked at the local priorities. So we’ve sort of had a A2 pathway. We had the local approach and then we had, the fact that our IT modules don’t speak to each other is an ongoing problem, prescribing issues. So we could hand up the problems that we needed support with and then we could focus on what we could actually make a difference to in Purbeck.
Local initiatives
Andy Brooks
So that’s interesting. There’s stuff, as you say, people always talk down there about IT and estates and duplication and stuff, but that didn’t seem to get in the way of you wanting to really crack on and do some things for your local team. So I like the idea of getting other people to help with those some of the problems. And then in terms of those things that you wanted to do locally, what sort of things did you decide that you wanted to crack on with this really engaged team?
Anna Darling
So our priorities were comms and engagement and particularly the community engagement, estates, buildings that we already had and how we sort of utilised them and how we could share better. We had frailty, mental health and wellbeing, obesity, which we had obesity as a project heading based on the data that we’d received for our population per bear. But really we were using it as an umbrella term for health prevention, looking at healthy eating, increasing physical activity. And then we also had pharmacy, so looking at building better relationships between the community pharmacies, hospital pharmacies and our PCN and practice pharmacists.
Successes
Andy Brooks
So again, that’s quite a broad range of things, isn’t it? Mental health, community health, also thinking about broader primary care, not just about general practice with the form of pharmacies. Be great to hear Anna about which one or all of them would you like to share with us about some of the stuff that you’ve done, how you did it, what successes you’ve had?
Anna Darling
So I’m one of the leads for primary care in INT. We’ve got a Dorset Healthcare locality manager as a lead, mental health lead. and Dorset Council lead. We split the roles so we all had working groups for each of the priorities so we could sort of share the workload. I’ve been leading on their comms and engagement and their obesity projects and we’ve brought in another one so we’ve got a cancer priority as well. With the comms engagement, I think the first thing we heard from our staff engagement meeting was that the staff in the room didn’t know each other and they didn’t know some of the services that were available in Purbeck. So we thought if the staff don’t know what’s available in Purbeck, how are our residents and our patients going to know what’s available?
Communication and engagement
Anna Darling
We sort of looked at options of how we could share this information better. And what we were really aware of is not trying to keep pulling clinical staff out of meetings to attend sort of engagement events. So we decided to have a short film about what’s available in Purbeck. So we had 28 teams involved in the film. We did short 2 minute clips of each film where they introduced their service, where they’re located, how you can get referred to them. And then the production company put them into a short film, so it was about 30 minutes long.
So it’s been really useful because we can share the film and you can see everything that’s available on per bit, but we’ve also been able to use the short clips so services can use them themselves and we can use them on social media. We can send the links out to patients. So if we’re referring to a social prescriber, we can send them the link so they can see the short clip about our social prescriber.
Film premiere
We then had a premiere of our film. So we had it at the local theatre and It was really nice because I think what we hadn’t appreciated at the start was that actually this was our first project as an INT and actually included 28 teams right from the start. So we had all the sort of buy in from the teams who were really engaged with doing it. We had no DNAs on the day of filming, everyone showed up.
We also include our community hospitals in the film and our family hubs. So all of those teams were wanting to come and watch the premiere at the theatre. So we thought, well, we’ll take this opportunity. Can you have a stall and can we make it a sort of wellbeing and health event? So we had the room next door to the theatre. So we had a sort of a joint film showing and a health and wellbeing event. And it was brilliant.
It was really nice for the staff to be able to promote their service and sort of be proud of the work that they’re doing. It was really nice for patients to be able to watch the film and then go and see the health professional that they might want more information from. And it was really good for sort of staff being able to meet each other and sort of there was lots and lots of sort of connections made and sort of plans made just from sort of that one day event.
Patient resident survey
During that showing, we launched a patient resident survey to find out about their views on the services in Purbeck, what was working well, what they felt was lacking. So we launched that for three months.
We did a annual sort of meeting where we just, it was invited, it was staff and public were invited where they could sort of hear what we’ve been doing over the last year and what our plans are going forward. And following the success of that, we’re going to do the public meeting where we update everybody annually. We’re going to do that again in the autumn and we’re going to continue with that annual health and wellbeing fair. because everybody who did it in October is keen to do it again. So while we’ve got some momentum, we’ve booked in our next one for January.
Obesity work
Anna Darling
The obesity work, it was a lot actually. It was really nice. We set up a working group and we had participation from the health visitor and school nurse, public health, National Trust, the local sports centre, our PCN staff. So it was really nice. We had lots of views and lots of different information coming through. Looking at the data, we had a higher than Dorset average level of obesity in our schools data from the reception year and the year six.
So we focused our efforts on primary school to start with. We got some funding, some local alliance group funding to have, there’s a gladiator from the telly called Steel who does school assemblies about health, mental health, eating well, physical activity, hydration. So he comes to school and does a health assembly. We’ve been able to get him booked in to come to 11 of our primary schools in November because we really just wanted to get the kids engaged and to do something that was sort of fun and interactive for them.
The plan was that would help us link in and develop the relationships with the primary schools. And with that, we’re sort of trying to do a local wraparound offer for that week where the Gladiator is coming. So we’re producing a magazine about what’s available in Purbeck and also putting some sort of health advice in the magazine. So that will go out to all the schools with the Gladiator.
Planet Purbeck
Anna Darling
And then the National Trust have kindly agreed to, they’ve got a organisation called Planet Purbeck. They have Purbeck Goes Wild and they set up activities for children, really trying to get them outside and then sort of bracing nature. So they’re going to arrange an activity week prior to the assemblies to really sort of get kids engaged, have a gladiator theme and really sort of get everybody sort of working together. We’ve got this project around November time which expanded our social prescribing service to include children and young people from the autumn.
We’re going to use that week to launch the children and young person social prescribing role within the primary schools. So it’s sort of brought everything together and hopefully should be sort of a fun event that everyone can sort of join in and we can sort of get the kids engaged, get the schools engaged. And during the assemblies, we’ve got lots of support from the teams involved. So the school nurses are coming, public health are coming. We’ve got some of the INT. So it’s sort of bringing everyone together.
Andy Brooks
Wow, you’ve certainly been busy.
Anna Darling
Yeah, it’s been a lot.
Andy Brooks
What an amazing, there’s loads of questions that I had if I could just pick on a few bit just perhaps going back to your kind of red carpet film premiere experience that sounds amazing and Also impressed that you’ve not done this as a kind of one-off. It seems that these programmes you’re kind of building in annual cycles of this is what you told us, this is what we’re going to do and building. And I think that’s really encouraging as opposed to what the NHS or broad of maybe public sector sometimes do is just one-off things and you seem to have built that rigour. That’s really good.
Holistic elements of neighbourhood care
Andy Brooks
You also mentioned in your obesity work about how you’re working with schools, how you’ve got a celebrity in to do assemblies and that I guess highlight some of the work around prevention and young people. So it seems that you’ve really embraced the kind of holistic elements of neighbourhood care. Would that be a fair reflection?
Anna Darling
Yeah, I think we’re really keen to make sure a lot of the work we’re doing with the INT is about prevention because it’s our opportunity to sort of really focus on this, but then bringing in the other parts of the 10 year plan to make sure that we do it well once rather than have lots of separate projects as we go along. But the real benefit is having all the teams working together and getting all the opinions from the start because you get so many more ideas and there’s so much enthusiasm to do this work that it’s actually going through quite quickly.
Secret to success
Andy Brooks
You seem to have really gone kind of where the energy is and engaged people. And sometimes people may say the NHS has been a bit guilty of kind of having passive agreement, but you seem to have got real genuine buy-in. What’s your kind of secret of success, would you say?
Anna Darling
Probably the best thing we did was have an open invite where we didn’t restrict who could come to the first meeting. We quickly realised that we were going to upset people if we said that the PPGs couldn’t come or some of the voluntary organisations that we were already working with. We ended up just hiring a bigger hall so everyone was welcome. So that was a good move, I think.
And then following that with the priorities, we opened up the invites, anyone who was interested in this area could come and join. And I was really impressed with how many organisations I thought maybe wouldn’t be interested in the work we were doing, were interested in actually had lots of ideas and it was on their to-do list to look at something. So we could actually do a joint project rather than everyone sort of working in silos trying to sort of solve the same problem. We could do it together and it’s much more enjoyable doing it together. You get a lot more ideas and you can share the workload. So that’s been our success.
Example
One example is with on the days of gladiators coming, we needed some support on the days to assist because we’re handing out the magazines, they get given a water bottle. I just needed some help. So I just sent the invite out to see anyone free. And actually lots of people wanted to be involved in it. So we’ve got public health, you know, the school nurses coming.
We’ve got lots of different health professionals joining in with that. So it’s a joint project. It doesn’t feel like it’s coming from the PCN or just INT. It feels like it’s everyone’s project. So I guess my advice would be don’t be afraid to open up the invites because people do want to get involved. I don’t think, in my opinion, I feel I may be adding to their workload, but they already have that workload to do and we can just join forces.
Teamwork
Andy Brooks
I think it’s really interesting the comment you made and I think I’m going to, hopefully this is the quote. He said, we did things that were on their to-do list. I think that’s really interesting. We often come, don’t we, saying, this is on our list, we need you to do this. But you seem to have really listened and helped find things that people in general agencies wanted to work together and create the programme together. Is that fair reflection?
Anna Darling
Yes, yeah, I think as well. When we started the priorities, we had a, you know, a general title and then actually you heard from everybody where their priorities were and we could shape the project based on everyone’s priorities rather than we had this set plan and this is what we’re going to achieve. I mean it’s evolved and changed you know 100 times over in each priority group about what we needed to do but it’s what’s been needed to do for a number of years and we can actually get on with it now which is really nice.
Leadership reflections
Andy Brooks
You’ve done co-design with agencies, co-design with staff and co-design with the public. And that’s really impressive to do all those 3 bits. It’s great to hear about your success and lovely to hear about your enthusiasm in talking about it, Anna. How have you felt personally doing all this change?
Anna Darling
I think it’s been the favourite part of my career, in all honesty, because you can actually make a difference and you can action something really, really quickly. I’m quite used to sort of starting lots of projects because they will take a long time and there’s all delays. I think the negative from this, if it is a negative, is that everything’s been a goer. So everything has got going. So it’s a lot of work all happening at once, but that’s because there’s enthusiasm between all the different teams and the public to get this moving.
We’ve had lots of support from our family hubs. And so I would recommend making contact with your family hubs because they have venues, they have volunteers, they already have a huge amount of engagement with the community and know what’s needed. So that’s been really helpful and made projects run a lot quicker because we can work alongside them and do it as a joint approach. I’ve got the most satisfaction out of this role because you can make a difference and you can make it quickly. And you can look at prevention. I think that’s something in healthcare that is always on our wish list and we’d like to get there. And you’re so focused on trying to manage the day-to-day, but this gives you the opportunity to sort of really focus on the future and improving health for children, young people and young adults.
Prevention
Andy Brooks
And that’s really encouraging to hear. Often people say, prevention takes time. and neighbourhood working, it’s going to take time to deliver. But you’ve actually demonstrated that even working with lots of different agencies, you can do stuff if you get the energy and enthusiasm and harness that and you can focus on prevention, which is really encouraging to hear about neighbourhood health. And it’s also great to hear about it being really enjoyable for you in your career. And I think you said that it’s one of the best things that you’ve done. I was wondering about what have you got planned next, Anna, given all the stuff that you’ve done? What’s coming up next on your agenda?
Anna Darling
One of the priorities, well, one of the priorities we’ve now got is a community approach to cancer care. And the link from that was the production company who made our film worked with the Wessex Cancer Alliance and the Wessex Cancer Alliance said they wanted to work with an integrated neighbourhood team. So they linked us up. And then we work together and we’ve seen huge opportunities that we could take forward in Purbeck. So that’s a new priority for Purbeck. So we are working to reinstate our chemo and SACT clinic in Wareham, which was stopped a couple of years ago.
We’re looking to have, it’s called Right By You, it’s a community cancer nurse specialist who would be linked with the acute, but working in the community, so sort of bridging those gaps. between the acute and secondary care and sort of looking at the left shift of moving some work out of the hospitals, looking at increasing our diagnostic availability locally and sort of linking in with the palliative work that we already do that’s going really well, but sort of making sure we’ve got that sort of whole approach to cancer care and making it sort of easier for patients to access and having a sort of more local approach. So the Wessex Council Alliance have been absolutely brilliant in that, but that’s a really big part of our current INT work.
Advice
Andy Brooks
Excellent. I think given your kind of experience, what advice would you give to people who are perhaps starting off there thinking about developing neighbourhood health or integrating neighbourhood teams or working with PCNs? What advice would you have for others?
Anna Darling
I think it’s not getting overwhelmed from the start because it seems absolutely, it is enormous, but you have to choose the areas to focus. It’s having those conversations. It can just be a conversation over a coffee about what someone’s thoughts are and that can be the start. I really sort of believe in there’s clarity and action that sometimes you need to take one step to then see where you need to go. So sometimes you can’t spend your whole time planning everything. You might have to try something, see which way it takes you. And you don’t normally get that opportunity in healthcare to be able to do that where you seem to be able to do that with the INTs.
You can try something and see where it goes and then it opens up so many more opportunities from there. So it sometimes then feels a bit overwhelming with the workload, but then There’s loads of opportunities and it doesn’t have to just be you that does the work. You’ve then built all these relationships with other organisations that could then lead. You don’t have to know everything and every approach and have an answer for everything because you’ve now got this huge team with all this experience and with the voluntary organisation and all their experience about sort of how you’re going to shape services, what’s been learned from the past and it can all be done together.
Digital health
Andy Brooks
Excellent. I was just wondering about you’ve given some really great examples about speed and about taking that first step as you’re saying get on and do stuff and learn and adapt. Are there things perhaps on the flip side that actually you can’t rush that do take a bit more time to develop?
Anna Darling
I think the bigger issues such as IT, it’s incredibly complicated. If you ask a health professional how to fix it, would be really straightforward that all the systems would talk to each other and you’d be able to do a prescription that can be seen on system one and the GP record. They’re the frustrations that obviously need a lot of support, a lot of sort of investment. So that’s where we haven’t been able to sort of make a difference yet in our local INT. And it’s it’s raising these concerns and sort of opportunities, but also not letting it stop you in what you can achieve so that there’ll be 100 other things that you can be getting on with while that’s being looked at.
Challenges
Andy Brooks
That’s interesting, isn’t it? So seeing the barrier, it may be a barrier, but that isn’t going to be a halt, you know, we’ll find ways of dealing with it, we’ll work around, we’ll use the enthusiasm. That’s come across really strongly with some of the stuff you’ve been saying, Anna. I was wondering, given your role in the kind of this programme, you’ve been working well locally, is the stuff that isn’t being talked about, neighbourhood care that needs to be talked about a bit more.
Anna Darling
I would, I think the biggest challenge I personally have is time. The integrated neighbourhood team was added on to my day job and my day job is busy. So it’s, you know, they might give a pocket of funding but it doesn’t create more hours of my time. Like so it’s having that balance or looking at opportunities of what can you hand over because there seems to be a lot of work that’s moving into primary care which has its benefits but also there doesn’t seem to be the investment that’s followed to be able to staff it.
So that’s one of the biggest challenges and I think that’s the same for every other sort of lead within the integrated neighbourhood team that nothing got taken off our job descriptions. to be able to absorb this and we are doing it because it’s the right thing to do and it’s satisfying to see the improvements but really if there could be something to sort of if this is going to be happening for the next 10, 20 years everybody’s working over and above at the moment and I think it needs to be put into the day jobs.
Andy Brooks
Yeah so that’s a really interesting point that people like yourself have got lots of enthusiasm but that needs to be perhaps more formalised and recognised if we’re really going to make the most of neighbourhood team. I think that’s a really, really good point. Looking back on what you’ve done, is there anything that if you were starting now you’d do differently?
Anna Darling
Not at the moment. It’s been, I mean, we’ve learned lots and there’s, but I think anything that hasn’t gone quite to plan, we’ve learned and it’s adapted into something that has worked. I think that’s sort of the biggest learning is to not be afraid of failures because they say it’s learning, but it is because you tried that it may be developed into this. So not every plan A was successful, but a lot of our plan B’s, plan C’s have been.
I think it’s no, it’s worked. It’s worked well. And I think it’s because we had the enthusiasm from our partners to do it all together. I think it’d be really difficult if you were trying to sell this idea to lots of other organisations, but we had that from the start that everybody was keen and we had good support from the volunteer organisations and the links.
National advice
Andy Brooks
You’ve described your population in Purbeck. People may say, well, that’s okay in Purbeck, but surely that’s not transferable to where I am somewhere else, somewhere very potentially. What would you say to that challenge or question?
Anna Darling
I think it’s just seeing what other areas are doing and learning and adapting. So I had a really good meeting with the Saints Foundation in Southampton who are doing a lot of integrated work and we’ve got completely different populations and demographics but the way they’re running their service would work really well in Purbeck so we can take the learning from them and adapt it. We’re not going to do it exactly the same but the basics actually will work really well for us and we’ve got completely different populations.
So I think it’s just sharing information with others, which everybody’s really good at. I think that’s one of the really nice learning points is that people are really happy to share their risk assessment or share their plan because they want this to work sort of nationally in your county. It’s not sort of competing with each other. So I think you can take learning from any area and you will need to adapt it, but that’s the joy of an integrated neighbourhood team that you adapt it for your population. So therefore it works.
Conclusion
Andy Brooks
So thank you very much Anna for joining us on this podcast. It has been fascinating and really enjoyable to chat to you, particularly around your enthusiasm, your kind of get go and do attitude. And it’s been fascinating to hear about all the variety of work that you’ve got going in such a short period of time, covering all the three shifts and particularly around the prevention and young people. Thank you for sharing your expertise and knowledge and I’m sure people listening to this podcast will be able to use the ideas and the how you’ve done things in their local area. And I wish you all the best with some of the future plans that you’ve described. Thank you for listening to this NAPC podcast.
