Community support that’s more than a sticking plaster

General practice at the front line

“Sadly, I don’t think we could manage without the help of organisations like Granville,” says Kilburn Park GP Tamara Joffe. “So much of general practice here is sitting with patients, holding uncertainty with them. Having access to services that are able to provide genuinely practical help makes a big difference.”

Practices in deprived areas are the “NHS front line,” she says, in managing the effects of food insecurity among people who suffer poverty alongside learning and physical disability, mental ill health, alcohol and drug dependency, traumatised backgrounds, and age related frailty.

That situation is mirrored throughout the country. IFAN, which represents more than 400 independent food banks, saw an 88% increase in the need for emergency food in the nine months to October 2020 when compared with the same period in 2019.2 Figures show that the number of adults in food insecurity on a regular basis has quadrupled since the March 2020 lockdown.3

The level of desperation behind these statistics shows in the Granville Community Kitchen’s experience. Cooked meals and food parcels are served twice a week from 3 pm, and people start queuing from 2 pm “People turn up here in tears; they feel embarrassed, and we’ll try to spend time reassuring them,” says Woods.

Structural change

Yet both Joffe and Woods recognise that handouts from food banks should be seen never as a permanent solution but as temporary emergency responses while “lifting voices to advocate for structural change to end the need for food banks,” as IFAN defines its mission.

“Yes, we as doctors should be ready to work with charities,” says Joffe, “but practices like ours could do a better job with an equitable distribution of resources, similar to schools, where extra funding to meet higher need is proportionate to the number of children getting free school meals.”

Granville Community Kitchen is a “community response to entrenched deprivation,” Wood says. “That should mean empowering people, rather than normalising the idea that large numbers of people are too poor to buy their own food.”

She says that shortly before she spoke to The BMJ a man came to deliver half a dozen bulky carrier bags overflowing with baguettes and rolls. “It’s a local person who took it on themselves to go round sandwich shops and bakers in surrounding affluent neighbourhoods and bring in unsold food from yesterday,’ explains Woods. “Yes, it’s good to see this happen,” she says. “And, of course, donations to IFAN will make a huge difference to people today. But we must also say clearly that we cannot depend on goodwill to feed people, nor should people have to rely on charity to get by.”

Already, the kitchen sells culturally appropriate “veg bags” at affordable prices, bought directly from local farmers, with a plan to extend the scheme to buy food directly from farms in West Africa. Wood says her job is a community food educator and urban agriculturalist rather than a food bank manager.

IFAN coordinator Sabine Goodwin takes the same view. “However valuable community hubs might become within a locality and to the NHS, they should not be responsible for addressing food insecurity. If people are unable to afford food, it’s income that needs to increase, not the provision of food aid.”