Does commissioning advice provide value

to the NHS?Julie Hirst

Public Health Principal Derbyshire County Council

14th October 2015

Some definitions of health‘Health is not merely the absence of disease,

but a state of complete physical, mental and social well-being’ (WHO 1948)

‘Health is…... behavioural immunity, i.e. successfully coping with adverse conditions in life’(Antonovsky, 1993)

WHY?

WHY COMMISSION ADVICE IN

GENERAL PRACTICE?

Determinants of health(Dalgren and Whitehead, 1991)

BENEFITS

FOR PATIENTS

FOR EFFICIENCY OF HEALTH SERVICES

Outcomes 2009/10 to 2014/152009/10 2010/11 2011/12 2012/13 2013/14 2014/15

Clients seen 3,490 5,587 5,857 6,226 6,785 7778 Contacts 11,641 16,697 17,138 16,906 21,811 23,433 Problems dealt with 18,589 26,141 29,673 30,528 28,622 30,779 Financial gains £4.5million £7m £7.7m £9m £10.5m £12.2m Debt advised £7.6million £8m £8m £6m £4.5m £5.7m Cost per client £187 £141 £131 £123 £124 £109 Cost per contact £56 £47 £45 £45 £39 £36 Cost per problem £35 £30 £26 £25 £29 £28 Cost to commissioners £790,000 £753,966 £767,377 £767,377 £843,597 £850,800

BENEFITS

BENEFITS

Patients who received additional income as a result of advice in GP surgeries had measurable improvements in mental health and vitality six and 12 months later

(Liverpool University study - Abbott and Hobby 2002)

BENEFITS

BENEFITS

Potential links between advice interventions and health outcomes

SCALING UPInitiation depends on local circumstances, e.g:Start small and roll out incrementally e.g.

Derbyshire or Visionary leadership, e.g. Liverpool CCGsEither way needs local champions to make the caseAnd continue to make the case (over 20 years!)Evidence helpsNeeds economic evaluation/evidence of saving GP

timeSupport from the top (DH) would be

transformational

Thank you

Julie HirstPublic Health PrincipalPublic Health DepartmentDerbyshire County CouncilSmedley Street MatlockDerbyshireDE4 3AG01629-536174julie.hirst@derbyshire.gov.uk