The Rural and Farmers Health Service

As a result of the positive response to the Farmers' Health Project, The Rural and Farmers Health Service has evolved to replace the research project. In many ways the service will operate in a similar manner to the Project, but the inclusion of the word 'Rural' will mean that service will be extended to include all members of the rural community, within the boundaries of the service. Regular visits to auction marts will take place again when restrictions due to Foot and Mouth Disease are no longer a factor in the movement of livestock and vehicles.The repercussions of 'Foot and Mouth' are likely to felt for a considerable time after the disease has been eradicated and the Nurse Practitioner is well versed in dealing with the many problems affecting those who have are having difficult times. Though the 'Rural and Farmers Health Service' is primarily a clinical service, all aspects of health and well-being will be addressed by the Nurse Practitioner. The Nurse Practitioner will have the assistance of a support worker.

The original idea to develop the Farmers’ Health Project sprang from research by Dr. Cath Gerrard (1998), which found that farmers were a high risk group whose health needs were not being met. It was recognised that farmers had become isolated, marginalised and often felt misunderstood.Serious concerns had been identified about the lack of pathways for the appropriate health care of farmers and farming communities.

A multi-disciplinary Rural Mental Health Working Group was formed to explore ways of addressing these problems. This group strongly believed that the problems of physical and mental health among farmers are particularly, and perhaps uniquely, interrelated in the rural/farm context. Problems identified include:

A bid for funds to carry out an action research project to address these problems, taking a 'hands on' approach was successful early in 1999. In response, the new service was launched in July 1999, aiming to reach farmers, farmworkers and their families. Auction staff, agricultural merchants, haulage contractors and retired farmers are also able to access the scheme. The project covers a large geographical area across South Cumbria and North Lancashire and due to the way that auction marts serve a wide area, farmers sometimes access the project from beyond the boundaries of the Morecambe Bay Health Authority area.

This Nurse Practitioner-led initiative based at clinics in Carnforth Clinic takes health expertise and resources out to farms, supermarkets, church halls, agricultural shows and auction marts in North Lancashire and Cumbria. The nurses operate at the interface of primary and secondary care and are equipped to intervene in the field, work autonomously and offer practical clinical care.

They possess a good knowledge and understanding of the circumstances of farmers, and care is delivered in a non-judgemental way. Follow up research has confirmed the importance of the nurses themselves having a farming background and knowledge of the pressures and work patterns involved in farming.

The project has use of a specially adapted high roof Transit van, which acts as a mobile surgery and is equipped to carry out medical examinations and health screening. The project nurses staff the 'drop-in' vehicle and offer confidential consultations without an appointment and free of charge. If referral to GP or specialist services is indicated, necessary follow-up will be arranged. The drop in service generates farm visits, which can be made at a later date using a less recognisable vehicle, which patients generally prefer. The groundwork of the project involves informal conversations with people as part of the process of informing the target group about our aims and the potential value for them, as well as building trust and breaking down barriers.

The project has a support worker to assist with raising the profile of the work, including:

In addition to the outreach service offered through the van and home visits, the project team is also committed to rural health promotion and accident prevention. Information concerning relevant health issues is disseminated to the farming community, and this aspect of the work involves:

The project is coordinated from Lancaster University's Institute for Health Research and involves a multidisciplinary team.

The research collects both qualitative and quantitative data within an action research framework. As data is gathered and evaluated the project is modified accordingly, in a cycle of enquiry, intervention, and evaluation.

It is believed to be the first scheme of its kind in the UK, and one feature of this unique partnership is that the research team can call upon not just health professionals but social, economic and business support to help meet the complex needs of the farming community.

One of our aims is to enquire whether an occupationally sensitive approach can address the health needs of the farming community. We aim to make the service relevant to the needs of hard pressed farmers struggling with falling incomes, food scares, multiple hazards and mountainous bureaucracy. This is done by providing flexibility of access taking into account the geographical areas in which farmers operate, their time constraints and the pressures presented by their work.

The knowledge of farming issues among the nurses and support workers is greatly valued and respected by users, as is their capacity to appreciate the multiplicity of factors affecting farmers and their willingness to suggest practical cross-agency approaches to problems. The anxiety and economic effects of illness among farmers is well understood.

The health of farmers and their families is viewed holistically, the nurses look at the wider picture within the family and the farm as a whole. Indeed a key role of the project is to promote links with other organisations, which can offer different kinds of practical help to deal with situations that may be affecting the health and well-being of individuals and families.

In addition, therefore, to building relationships with Primary Care Teams, the project has also successfully established links with a variety of different agencies. These include

The response has been positive from these organisations, and they are actively involved with the Farmers Health Project in promoting links and making referrals, with the aim of increasing knowledge of available resources and uptake of a variety of services, which can benefit the rural community as a whole.

Uptake of the service has gradually grown following a slow start, indicative of the importance of building trust and forging relationships during the early stages. Since the project was launched in July 1999, 250 people have had formal treatment or assessment, and more than 600 follow-up consultations have taken place.

The frequency of presenting conditions shows that the highest initial presenting conditions among project users are:

The team is particularly pleased that the project appears to be reaching its target group. An analysis of the first 200 farmers who accessed the project formally, shows a high percentage of 30 to 60 year old men, which is the group least likely to visit their GP. In addition to registered clients receiving formal health care it is reckoned that over 2000 informal contacts have been made through the project.

All of these points contribute to generating lively discussion among the project group, and the resolution of problems is a constant and on-going process. Encountering and overcoming problems has, however, had the effect of broadening the discussion beyond the project group and focussed attention on how the project integrates with primary care more widely.

The project was based upon previously identified needs and has successfully developed knowledge and expertise in the use of outreach methods. This has resulted in new ways of addressing the inequalities which exist where communities are isolated from mainstream health care. Judging by the responses of its users it is succeeding in meeting the needs of farmers, farm workers and their families.

There may be important lessons here for the provision of services more generally in rural areas. The benefits of joint working between physical and mental health services, and between health and social and welfare services have become apparent. The FHP also performs an important and supportive role in forging cross-agency links within the agricultural community, which successfully promotes and strengthens community capacity building. It is also clear that scope exists for further development of collaborative working, and new avenues are being actively explored. Ideally the project group would wish this valuable element of the project to continue.

The project has the potential to act as a model for the development of other initiatives aimed at enabling health care for groups who may be marginalised. Much of the expertise developed by the Farmers' Health Project in delivery of outreach care and the knowledge of cross-agency links may be transferable to other geographical areas, and to social groups other than farmers.

The project is to move from its research phase into service development as from July 2001. Funding for another twelve months has been secured, and the service will be provided under the auspices of the Morecambe Bay Primary Care Trust. Evaluation of the project has pointed to the needs of rural communities more generally and so the Year 3 initiative is renamed 'Rural and Farmers Health Service'.

The Rural and Farmers Health Service

The Farmers' Health Project