I graduated from Medical School in Newcastle upon Tyne in 1994. I am not from a medical family. I grew up in a small working-class town in Lancashire. My dad left school at 14 and worked in manual occupations all his life. My mum was a secretary. They were loving and gave me and my two siblings great values. At eleven I won a scholarship to a grammar school three bus rides away. It no doubt changed the course of my life. I was the first person in my family to do A levels, go to university and get a degree.

I’m not sure having a doctor in the family was even a dream almost until it was real. I didn’t know what kind of doctor I wanted to be. My dad always said I had had a poor man’s upbringing and a rich man’s education which meant I could talk to anyone. Perhaps with this in mind I became a GP. In 2002 I became a partner in Central Surgery in South Tyneside. South Tyneside had suffered the loss of the shipyards and pits; the traditional employers. Lack of jobs, money and prospects meant poor health. And yet there was a strong sense of community and local identity. I loved it. One of the other GPs at Central Surgery was Morris Gallagher. We were different in many ways except in what really mattered to us. We both wanted to make a difference where it was needed most. We got on straight away and became great friends. Morris had worked with people struggling with addiction in the early 90s. I had had some experience in a previous practice. We both had a sense that this was an area of primary care that could be improved.  

In 2003 the system in South Shields was secondary care lead. There wasn’t much primary care input. Substance Misuse Management in General Practice was gathering momentum supported by the Royal College of General Practitioners. We agreed with their philosophy that people with addictions needed effective relationships with their GP to help manage both their addiction and their wider health needs. We started to have conversations with other interested people. We were introduced to Deb Forsythe and Tony Schofield. Deb was a counsellor who had been employed by the primary care trust. Tony was a local community pharmacist. The four of us became a team. The first thing we did was visit every GP Surgery in South Tyneside (there were over 30 back then) and ask our colleagues what it would take for them to get more involved. They told us they needed three things: firstly they wanted more education and training, secondly they wanted more hands on support and thirdly they wanted the increased work that we were asking them to do to be resourced appropriately. So that’s what we did. 

We negotiated a Locally Enhanced Service for the provision of Shared Care in South Tyneside with the Primary Care Trust.  

We developed a training package that taught GPs how to have an effective conversation when a person with substance misuse problems is brave enough to ask for help for the first time. To do this we had to find a way of getting and giving what could be literally lifesaving information in less than ten minutes, often in the middle of a busy day and most importantly done in a way that makes the person want to come back. We called this First Contact Training. We rolled it out to all GPs and their teams in South Tyneside over the next six months (you can still see some of the First Contact Folders on shelves).  

Morris and I trained as GPs with a Special Interest. Tony became the first pharmacist in the country to become an independent prescriber in Substance Misuse. And with Deb providing the counselling support we set up an intermediate care service supporting local GPs. This service was called First Contact.  

First Contact set up shop in the basement of the specialist treatment service and started seeing people in 2004.  

Over the next four years I started to appreciate the impact that people’s family, their education and whether they had a job had on someone’s health and wellbeing in a way that I don’t think I had before. Things that I had taken from granted growing up.  

By 2008 drug treatment in South Tyneside was changing. We were approached by the team who ran the service in Gateshead about collaborating on the upcoming tender. To be involved we needed to become a company and sat around Deb’s living room table. First Contact Clinical Community Interest Company came into being.  

Our collaboration was successful. It was time for a step change. During the previous couple of years, I had worked with Sue Gill at the Primary Care Trust. I approached Sue about joining First Contact Clinical CIC as our Business Development Manager. I was asking her to give up a successful NHS Career to join a newly formed CIC with one contract. Remarkably she said yes. I think that says more about her vision and bravery than it does about my pitch. I will always remember one of her first jobs was telling me via my Nokia (mobile phone) what IT equipment we would need as I walked around PC World (other retailers are available) with a cardboard box labelled “IT Department”. I’m pretty sure that box is still with us! Within a few years Sue became and remains our Director of Operations. The rest of this story is as much hers as it is mine.  

We successfully mobilised the service and implemented our model: a primary care based, personalised, community addiction service. We had a skilled worker “just next door” in every practice in South Tyneside. Almost all the practices were involved in the shared care scheme. They had all had First Contact Training and the people using our service and their families were benefitting.  

It was obvious from early on that the thing that was making the difference in our clinics wasn’t what me and the other prescribers were doing with our prescription pads. It played an important role particularly in the early stages of someone’s journey. And it was important that this was done quickly and safely. However, “evidence based treatment” wasn’t enough. The way we were relating with people made the difference.  

We were treating people as people not a collection of problems. We were having conversations that enabled healthy change.   

These conversations stopped being about the problem: drugs and alcohol. They started to be about what really mattered to people: managing worries, children, parents, friends, paying bills, finding meaningful work, having somewhere safe to call home. These weren’t issues that a doctor could diagnose and fix. And yet the people we were working with often didn’t know who else to turn to. They struggled to navigate a system that was designed to manage all of these things separately even though they were inextricably connected. The seemingly endless need to wait in line, fill in forms, repeat their story almost as if the system was designed to make it impossible for people who needed it most. The more you needed the harder it was to get. When people inevitably ran into trouble the coping strategies that had helped them survive their traumatic pasts didn’t work. They were labelled difficult or aggressive which just compounded the whole situation. They were de-personalised; they became the problem. 

These stories were not unique to people living with addiction. We realised that the kind of conversations we were having would be helpful to lots of different people struggling with what we now describe as the wider determinants of health. 

We were awarded a grant to test this out. We called this service One New Thing. The yearlong project was popular and successful; it was our springboard into what was becoming known as Social Prescribing. 

Over the last decade a lot has changed. Our focus has become less clinical and more relational. We gradually moved away from the provision of clinical substance misuse services completely. We grew our social prescribing teams and developed our education and training expertise. Some wonderful people moved on. But what really matters has stayed the same: our values, our belief in the power of relationships and the importance of a great first contact. 

Last year our services worked with over 7500 people. Three quarters of whom lived in IMD Deciles 1&2. First Contact workers are integrated into GP Practices, housing teams, hospital pathways, accident and emergency and the new integrated neighbourhood teams. We also delivered a range of behaviour change skills training to over 800 people. 

Our mission is to enable healthy change in the people and places that need it most. 

Our vision is to have a First Contact worker integrated into every team and pathway in the South Tyneside Health and Care system over the next five years.