[DAYS_LEFT] days left of your Medeconomics free trial

Subscribe now

Your free trial has expired

Subscribe now to access Medeconomics

'Barefoot doctors' come to Liverpool

Chinese-style health trainers in the community help GPs' patients to take better care of themselves.

Dr Faint and trainer Lee Lewis work with hard-to-reach patients (Photograph: ian simpson)
Dr Faint and trainer Lee Lewis work with hard-to-reach patients (Photograph: ian simpson)

Fifty years after the success of the so-called barefoot doctors in China, the idea of training local people in the basics of health care to help others in their community has resurfaced.

The NHS's new personal health trainers are recruited from the communities in which the people they try to help live, and have often faced similar lifestyle problems.

Successful pilot
The pilot project launched in Liverpool in April 2007 but is now mainstream in England. Initially health trainers visited people at home, offering one- to- one support on becoming more active, giving up smoking, losing weight or dealing with stress and anxiety.

But trainers are now being placed in GPs' surgeries to see patients who need more time to discuss these lifestyle problems than hard-pressed GPs and practice nurses can give them.

'We see this as a way of plugging a gap in the provision of health advice and support, says Dr Debbie Faint, a GP partner in the Brownlow group practice in central Liverpool where one of the 14 Liverpool health trainers is now based.

'A lot of our patients could make a major difference to their health by making some relatively small changes to their lifestyle.

'Doctors and nurses might not have the time to deal in depth with a person's need to lose weight, give up smoking or handle stress more effectively, but the trainers do,' Dr Faint says.

She cites patients with a raised BMI that is not high enough to go on the practice's obesity programme. As she explains, patients with a BMI over 28 have been invited to come in and have a chat with the health trainer about how they can address it.

China's 'barefoot doctors' were agricultural workers who worked barefoot in the rice paddies. The remote places they lived made seeing a doctor difficult. So the Communist regime trained some workers in basic medicine so they could bring healthcare to their community.

Community outreach
Dr Faint's practice deals with many of the city's homeless as well as the general population and a lot of students.

Many of the issues that people come to the surgery with have their roots in the way they live.

Lee Lewis is the health trainer at the Brownlow practice.

'We have a lot of students in who talk of being run down and feeling unwell. But the real problem is that they are struggling to manage life away from home,' he says.

'They are not eating well or are drinking too much and not looking after themselves,' he adds.

'I have protected 45-minute appointments so I am not up against the same pressures as the doctors and nurses. I can give people quality time to address their problems in a different way.'

Mr Lewis adds that he is up to date with the various outside organisations that can offer help and support. 'Things are always changing so it is hard for GPs and nurses to keep up.'

The Liverpool health trainers are part of a government initiative to reduce health inequalities and are funded by Liverpool PCT. Now that Mr Lewis is working from the Brownlow practice, the practice is paying part of his salary.

The service is managed and delivered in partnership with the social care charities PSS (Liverpool Personal Service Society) and Age Concern.

Dr Faint admits there are problems to be ironed out, such as whether patients should self-refer or be referred by a GP and says the practice will be monitoring outcomes.

'But this is about increasing patient choice and giving them time to talk about the problems affecting them so we can stop those problems developing in the future, ' she says.


  • A government initiative and originally a pilot spearheaded by Liverpool PCT, there are health trainers in PCTs across England.
  • Their earn about £15,000 to 17,000 on NHS salary scale 3 for a 37-hour week. In Liverpool salaries are paid by the PCT but the Brownlow practice contributes towards its on-site trainer's pay.
  • Training is a four-month course leading to NVQ level 3 (health trainer)
  • Liverpool has 14 trainers including three who operate a drop-in service at practices once or twice a week.
  • For more information contact Liverpool PCT (www.liverpoolpct.nhs.uk) or call the health trainer hotline, on 0151 226 3721.


Have you registered with us yet?

Register now to enjoy more articles
and free email bulletins.

Sign up now
Already registered?
Sign in

Database of GP Fees

Latest Jobs