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In this episode of the Unprescribed podcast, hosted by Jacob Haddad, we're joined by Professor Sir Sam Everington, GP at the Bromley by Bow Health Partnership in Tower Hamlets and Non-Executive Director of NHS England.
Sam qualified as a barrister before training as a doctor, and has been a GP in Tower Hamlets since 1989, where the Bromley by Bow practices pioneered social prescribing. Over nearly four decades he has campaigned on race discrimination, tobacco advertising and junior doctors' hours, served as Deputy Chair of the BMA and chaired NHS Tower Hamlets CCG. He is now Co-Chair of the College of Medicine. He was knighted for services to primary care in 2015 and received the RSA's Albert Medal in 2022.
"At my heart, I'm a campaigner. I'm about making change," Sam says. Early in his career, he and a colleague sent fake job applications to hospitals that were identical apart from the surname. Applicants with Asian names were half as likely to be shortlisted. The research got them arrested, then published in the BMJ, and it was one of the first pieces of work to highlight race discrimination in the NHS. He went on to campaign against tobacco advertising. In 1989, he slept outside the London Hospital to highlight junior doctors working an average of 84 hours a week. That campaign won a New Deal from Virginia Bottomley without a strike. Today, Sam sees being in the room where decisions are made as just as important as campaigning on the street.
At Bromley by Bow, the starting point is that biomedicine isn't enough. Sam asks every audience he speaks to what makes them well, and says no one ever mentions doctors, medicines, surgery or hospitals. With a 20-year gap in healthy life expectancy between rich and poor, he argues more medicine alone won't close it. Social prescribers act as motivational coaches, working with people where they are. England is now the first country to put a social prescriber in every GP practice, and health systems around the world are taking up the model. For Sam, it comes down to focusing on "what matters to you as a patient, not what the matter is."
Sam points to general practice as the NHS's best value: around 33 million consultations a month, with rising productivity and patient experience despite no significant increase in funding. For him, the secret is the partnership model. "You own it. You think about it 24 hours a day," he says. If something needs changing, you change it today or tomorrow. That ownership, he argues, is also why primary care has seen the greatest advances in technology. Jacob points to total triage as one of the biggest drivers of GP productivity. Sam explains that triage is a skill learned on the job: experienced GPs know the right pathway for most requests straight away, and it works best when the most experienced doctor is "at the front gate".
Sam wants clinicians re-engaged in solving the NHS's problems, as they were during Covid, when managers and clinicians worked together in real time. He would put more clinicians on trust boards and cut back statutory training. He argues that resident doctors' unhappiness isn't all about pay. It's rotas, lost continuity, and no longer feeling part of a team. His advice to leaders is to take risks rather than wait for consensus, and to break rules when patients need it: "It's not anarchy, but it's breaking the rule because that's the right thing to do for patients." Or, as he puts it: "Life is not a rehearsal. Don't be defined by your past. Define your future and break the rules."