A walk-in fishermen's clinic saved Tom from sepsis

Tom Parker was alone three miles (4. He was 8 kilometers (off the coast of Devon) when his fishing boat encountered a wave and lurched to one side.

I was pulling one of the ropes and I collapsed and collapsed,

he says.

I had this really bad pain in my ankle. I couldn't get up off the ground, but so many others.

He didn't know it at the time,

says Tom, 37, who had broken his fibula and severely injured his ankle ligaments. He somehow pulled out his fishing gear and carried it to the hospital to be patched up, but his wound didn't heal properly months after the crash. It was only after he turned up at an innovative clinic in Brixham that he was put on antibiotic therapy and told him he needed a second operation.

I'm sure I'd have ended up with my leg turning septic, but I'm not sure what would have happened after that," he says. According to health officials, the NHS in England needs to shift from hospitals to community health, and away from treating illness to preventing it in the first place under a 10-year plan, which was announced last month. Small-scale examples of this strategy are already present in various parts of the world. So what can we learn from the Brixham model, and how can the concept of targeted, local care be expanded to millions of NHS patients?

On a hot summer morning, a spare room in the trawler agent's Brixham harbour's offices is quickly converted into a temporary health clinic. Blue screens are used to divide the room: a homemade reception at the front and then ample space to cram in two GPs, a pharmacist, physiotherapist, two nurses, and someone coordinating prostate cancer tests. A steady stream of port employees are arriving, from fish market employees to crews from the trawlers in the harbour.

The skippers of the boats and the entire fishing community now know exactly where to find us,

Dr. James Gunning, the local NHS GP in charge of the clinic that day, says.

They're a group that fits into health inequalities, in which a majority of the population is either unable to access or has trouble finding normal NHS services.

With promises of free health checks and physiotherapy, clinic workers get up early in the morning, walking around the docks, and coercing workers out of the boats.

Fishermen don't have nine-to-five jobs, they don''t get lunchtime where they can just pop off their fishing boat and to the GP's office, so it's really important that we provide those services to them,

Sandra Welch, founder of the Seafarers Hospital Society, which also supports another charity, the Fishermen's Mission. Every three months in Brixham and at other ports around the UK, including Folkestone, Peterhead, and Kilkeel in Northern Ireland, a pop-up Seafit clinic. Any services have started to grow, and now include skin cancer screening, mobile dental services, and mental health advice.

The NHS acknowledges that people who live in coastal and rural areas are more likely to experience poor health conditions and mortality as a result of their 10-year plan. Seaside and coastal towns often have older populations with more complicated health problems, while local NHS services can suffer from recruitment issues, leaving staffing gaps where they are most needed. According to an analysis of hospital results, NHS trusts in England treating coastal areas tend to have longer wait times for both emergency care and appointments scheduled in advance, such as surgery.

According to NHS bosses and Westminster, the answer is to get as much care as possible out of those expensive hospitals. 300 community health centers will be opened throughout England under the 10-year plan, starting in areas with the lowest health care needs. A combination of GPs, nurses, social care professionals, pharmacist, mental health specialists, and other medics will be on the sites, which are set to open 12 hours a day, six days a week. The main aim, as with the Brixham fishermen's clinic, is to better tailor health services to local populations and to encourage people to avoid becoming sick in the first place. Much of this might feel very familiar. Ministers in 2019, 2015, and even by the Blair government in the early 2000s, shared similar aspirations.

Despite being the right target, none of those were truly fulfilled,

Luisa Pettigrew, a GP and senior policy fellow at the Health Foundation, says.

It's impossible to move funds from hospitals to community services. You need upfront investment, and the results may not be visible for five or ten years, in some cases longer.

Medical unions have also asked how the new centers would be staffed,a doctor said,should not be moved around like pieces on a chess board or made to work even harder.

The medics in Brixham are also convinced that their local, preventative approach would benefit not only the fishing community but also the wider health care system.

We've been able to find new diabetic patients who may have gone on to have more severe disease,

says Dr. Gunning.

We've picked out people with cardiovascular disease and those with elevated blood pressure. We certainly want to prevent more costly illnesses from causing.

Rob Caunter, who recently resigned from the fish market this year, is just finishing his radiotherapy for prostate cancer. After staff at the hospital advised him to perform a blood test, the 66-year-old, who has a family history of the disease, was diagnosed.