Bringing the Community into General Practice:

Helping people help each other and themselves

(Towards Social Prescribing, Self Management and Community Navigation)

Tim Anfilogoff, Integration Lead

What have we learnt from the Healthier Communities Projects?

1. The Thinking2. The Fund3. Some examples4. Learning5. Where do we go

from here?

1. The Thinking: Determinants of Health

• Health behaviours 30% (smoking 10%, diet/exercise 10%, alcohol 5%, poor sexual health 5%)

• Socio-Economic factors 40% (education 10%, employment 10%, income 10%, family/social support 5%, community safety 5%)

• Built Environment10% (environmental quality 5%, built environment 5%)

• Clinical interventions 20% (access to care 10%, quality of care 10%)

1. The Thinking:The world is not linked up enough

There is help out there(12,000 voluntary groups in Hertfordshire?)

It is complicated to find the right one

What does a busy GP do?

Signposting and Referral

‘It is clear from the preliminary work that we have done that GPs are not as efficient at signposting patients to the other support agencies, services and charities that exist in their local area as they could be. It may be that although the GP surgery should be the local hub signposting outwards to other services, the GPs themselves may need help in fulfilling this role effectively.’ A healthier communities fund provider

2. The Fund (2013-14)

• To create partnerships between local groups/voluntary organisations and GP practices

• £5k per practice/group partnership• Money for groups not surgeries• New partnerships• Showing outcomes• Minimal bureaucracy• Joint funding agreed by Chair of CCG and Executive

Member Adult Social Care

3. Some examples

• 12 projects• Totalling £90k

– Carers– Weight loss/exercise– Addiction– Bereavement– Cognitive impairment

3.1 Healthy Lifestyles ProgrammeHerts Sports Partnership – The Project

• For patients (identified as obese) from three GP practices (New Road, Coach House and Baldwin’s Lane surgeries) to help them make changes to their eating habits and lifestyle to reduce body weight and increase physical activity

• One to one consultation sessions over 12 weeks• Weekly exercise session (over 45 weeks) at a local church

hall (same instructor as this helps motivation)• Patients have entered the 12 week one to one support

programme on a rolling basis throughout the year.

3.1 Co-Production? Adaptation from original model?

• Additional instructor needed for exercise classes (high attendances at beginning). Many people new to exercise -additional instructor to ensure everyone had the attention they needed to ensure correct exercise technique. A small fee of £2 per class was introduced to cover the cost of the additional instructor

• The service users regularly asked for feedback and the type of activity was set in accordance with their feedback

• The one to one consultations were fixed to a set timetable to enable the project to accommodate the required number of service users.

3.1 Outcomes demonstrated

71 patients enrolled

Many did not attend last consultation to enable us to capture their end measurements

Following these patients up to re-book the appointments to give us end point measurements

A full report of the programme will then be produced and submitted

3.1 Case Study

• D is a male aged 65 years. At the start of the programme he had chronic back pain, type II diabetes, hypertension, high cholesterol and was taking eight types of medication

• Starting BMI was 40.5 (morbidly obese). He only reduced his body weight by 2% to a BMI of 39.6 but reduced blood pressure considerably from 141/94 (hypertension) to 123/73 (normal range)

• D did very little physical activity at start of programme (finds movements like walking very difficult). Now attends physical activity class twice a week. He has said he is getting much fitter.

3.1 GP’s View of Healthy Lifestyles Programme

Herts Sports PartnershipDid project meet needs? I believe that the project more than fulfilled the needs of our patients/carers and would support a continuation. The classes were successful as they also engaged the participants with diet and included regular exercise with a highly engaging and motivated instructor.

Learning There is a need to engage with a wider skill set outside of primary care set to help with the challenges of rising obesity. With trained instructors to assist with life style changes.

Lasting legacy? Clear and concise information, with easy referral pathways and good communication, this was aided by running the project on site.

Value for money? Yes ,(I think that the timing of the availability of this resource needs to be carefully looked at as the response was slower in the summer months.

3.1 Other Benefits from GP Point of View

We have noticed that generally the patients enrolled on the scheme seem to consult us less often, at least one has had a reduction in their blood pressure medication, and they on the whole seem more confident to manage their health. The scheme has been very popular with the patients and it has been a bonus having the instructor in the surgery – the lifestyle tips he has given us have helped us and our staff to become healthier. We have been able to pass the tips onto many more of our patients.

3.2 COGs Club Berkhamsted

• Cognitive Stimulation Therapy (an evidence based group programme of activity and stimulation grounded in person centred care - recommended in the NICE Guidelines as a non-drug related treatment for memory problems

• The COGS Club is a 14 week programme supporting up to 10 people on the programme at a time. The day is from 10am to 3pm, once a week, for as long as a member can benefit from the stimulation

• It provides the opportunity for them to recall or develop new skills in activities and to facilitate the transfer of these skills to activities at home. It also provides the unpaid family carer with a day’s respite.

3.2 GP’s view of COGs

Did Project Meet Needs? Yes. Definitely would benefit from more clubs for people with early memory problems. This COGS club was too successful – carers benefitted from social contact and people did not want to stop attending. It revealed a gap for people with early cognitive decline, still functioning relatively independently, with MMSE 26-28

Learning for primary care? This was a very successful collaboration and working with AGEUK a delight

Lasting Legacy? Networks and awareness of cultures

Value for money? Yes

Anything else you want to tell us? Hertshelp but with referral – so practice could pass patient details and navigator get in touch to assess…

3.3 Living Room St Albans

• Partnership with 3 local GP surgeries to develop awareness of The Living Room and the service we offer (group therapy to addicted people and their families and friends)

• We started the project in January, with the creation of information packs, and the work is still ongoing

3.3 Living Room:Challenges and Successes

• Harder to engage busy GP practices than anticipated and to get feedback

• Schedule for worker of visiting GP surgeries, pharmacies and service providers

• We are receiving far more referrals from GPs now, as well as CRI Spectrum, Adash and other drug and alcohol services

• We have also had referrals to our family and friends group from children’s services.

3.3 Impact

• Of 9 clients filling in a survey, 5 reported that they were now seeing their GP less

• Very positive about the service• EG: ‘I have learnt more about addiction and

myself than I have after 15 years of going to other services. The Living Room has changed my life for the better. I can’t believe it!’

3.4 Groundwork

• Groundwork Hertfordshire developed and delivered "Get Outdoors, Get Active"

• Project to improve people’s health and fitness through outdoor conservation activities in the Grovehill area of Hemel Hempstead

• After a slow start in March/April the project ran through to June

• 12 sessions with a total of 9 different people attending including 3 carers assisting the person they care for

3.4 Challenges and Successes

• GP surgery, the number of referrals from the GPs was low with only 1 individual attending as a result

• A much improved referral response was received from carers’ networks, MIND, CVS and local press

• In the future we would look to engage with more surgeries from the outset rather than just the one

3.4 Challenges and Successes (contd)

• 100% engaging in moderate exercise – The activities ranged from moderate to strenuous with most sessions achieving 12.5 METS.

• 80% report increased likelihood of continuing to undertake outdoor exercise – 100% interested in continuing with second stage (i.e. further sessions in Oct/Nov) and at the conclusion will be provided with leaflets and information on how they can continue to engage in similar programmes within the local community.

• 40% report improved mental well-being over the duration of the programme, using the Short Edinburgh-Warwick Mental Wellbeing Scale (SEWMWS).

• SEWMWS was dropped - some embarrassed to fill out the form – alternative form developed and used

User views

Participant A: “I'm currently unemployed as due to clinical depression I had to give up working back in January this year. I can honestly say that every time I have attended [Get Outdoors Get Active], when it has been such a struggle to just even get out of bed because of depression I've always felt much better during and after. And it has always lifted my mood and made me more positive. I loved physical exercise and used to get a real buzz out of it and it's helped me to remember this. As for my mental health the exercise is great for reducing my anxiety levels and depression and talking to everyone and listening to their help and advice has made me think about things in a different and more positive way. It has also given me more self esteem and confidence”.

User views (2)

Participant B: “I really enjoyed it! The fact that I was outside, learning how to look after the park and picking up new skills, was really good. Also, I felt like I was getting the exercise I needed. Working outside made me feel much better inside. I would definitely recommend it to other people – it really helps!” Participant C: “It gave opportunity to do local conservation work, get physical activity and meet other locals. It should have improved my physical health.”

4. Learning

• GP Engagement critical – role for navigation in improving referrals?

• Role of voluntary sector in improving health is significant

• Scope for more ‘self-management’ peer support (and issues around sustainability)

• New type of local commissioning linked to locality health profiles is needed? With Public Health role in design and evaluation?

5. Next Steps

• ‘Social prescribing’ event next year• Develop the work of HertsHelp and the navigators –

how much more value can we get out of what is there already?

• Develop the evidence base for investing in more of this sort of activity – preventing disease, social isolation, admission to hospital and creating healthier communities

• Understanding role of peer support/community activists in developing healthier communities