Gloucestershire CCG Social Prescribing 17092015
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Transcript of Gloucestershire CCG Social Prescribing 17092015
28/09/2015
1
Social Prescribing in Practice
Matt Pearce
Senior Commissioning Manager
Gloucestershire CCG
Helen Edwards
Local Implementation Manager
Gloucestershire CCG
28/09/2015
2
Demographic context
• Population of approximate 629,000
• GCCG, local authorities, community provider, acute provider and
mental health provider co-terminus
• One upper tier council and six lower tier councils
• Around 2% of the county’s population live in areas considered to be
amongst the most deprived 10% in the
country
• Gloucestershire has an ageing population
• As the age profile of the population increases, so does the number of people living with long-term conditions
“Health is a state of complete physical, mental and social
well-being and not merely the absence of disease or
infirmity.”
World Health Organisation 1948
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Social circumstances, 15%
Environmental exposure, 5%
Health care, 10%
Behavioural Patterns, 40%
Genetic prediposition, 30%
Health care provision plays a small role in preventing premature death
The environment around us, our genetic inheritance, how we live our lives and the opportunities we have together
largely determine our health. International studies suggest healthcare contributes only about 10% to preventing
premature death, although this varies in different settings.
McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion.
Health Aff (Millwood) 2002;21(2):78-93
The wider determinants of health, including behaviour, have a greater influence
on health outcomes than genetics and healthcare combined
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Why social prescribing
• GP’s conscious that they were not always meeting the
wellbeing needs of their patients.
• Some VCSE organisations under utilised
• Increasing recognition in the role of the wider
determinants of health by the health community
• The CCG had a strong focus on prevention and self care
• A need to shift from a reactive, disease-focused
fragmented model of care towards one that is more
proactive, holistic and preventative
The Social Prescribing is a
key enabling project within
the CCG’s Prevention & Self
Care programme of work
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What is Social Prescribing
“A clear, coherent and collaborative process in
which healthcare practitioners work with patients
and service users to select and make referrals to
community based services.”
(Langford et al, 2013)
Pilot sites in Gloucestershire
Forest of Dean
South Cotswolds
Cheltenham
Stroud and Berkeley Vale
Gloucester City and South Tewkesbury
Tewkesbury – 3 town centre Practices
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Partners
The issues spectrum
Social isolation
Carers and caring
Respite
Mobility / Transport
Debt / rent & council tax arrears
Employment
Literacy
Food banks, gas & electricity
Poor mental health & wellbeing
Sensory disabilities
Benefits related
Lifestyle
Substance misuse
Lack of social skills
Domestic violence
Managing homes
Supporting / handholding
Learning disabilities
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Services, organisations and community
Support Grant for
carer's travel Age UK
Active and Able
Classes Social Groups
Citizens Advice
Bureau Memory Café RNIB Active Lifestyles
Information on
pension credit Memory Club
Information on Green
Gym Environmental Health
Information on Blue
Badge application Alzheimer's Society Singing Groups
Mears Safe at Home
service
Counselling Carers
Gloucestershire Crossroads Fairshares Timebank
Chiropodist Information on local
solicitors Information on local
hairdressers Hospital Transport
Respiratory Exercise
classes Befriender service Village Agents Netball Club
South Cotswolds
• 100% of respondents have seen
an increase in their WEMWBS.
• On average, scores increased by
21.9%.
0
5
10
15
20
25
30
35
40
45
Forest of Dean (n=11) South Cotswold (n=10)
Average Initial and Follow-up WEMWBS
InitialWEMWBS
Follow-upWEMWBS
Mental Health & Wellbeing
Warwick-Edinburgh Mental Wellbeing Score (WEMWBS) tests undertaken at referral and after 12 weeks.
The evaluation of social
prescribing in Rotherham
found a comparable figure of
83% of referrals (n =283)
seeing a positive increase.
Forest of Dean
• 72% of respondents have seen an
increase in their WEMWBS.
• On average, scores increased by
13.5%.
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Use of Primary Care
Data collected by participating practices on frequency of appointments 6 months before and after referral.
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
Forest (n=34) S Cots (n=63)
Avg TotalAppnts. 6monthsbefore
Avg TotalAppnts. 6monthsafter
Average total appointments 6 months before referral and 6 months after.
Forest of Dean (n=34)
• 67.7% of patients have seen a reduction in their use of primary care.
• On average, in the 6 months after referral patients saw a 24% reduction in appointments
South Cotswold (n=63)
• 44 % of patients have seen a reduction in their use of primary care.
• On average, in the 6 months after referral patients saw a 9% reduction in appointments
An evaluation of a social prescribing project
in Bristol found that 60% of patients saw a
reduction in their use of primary care.
The evaluation of social prescribing in
Rotherham also found significant reductions
in use of hospital-based services.
“This has changed my life - because from having reduced confidence and not knowing who
to turn to, now I have this background support. It has made a huge difference to my life”
“It made my depression a little better”
“ I have people around me and by joining a walking group I have made new friends”
“You coming to see me gave me the best day in ages”
“It helps me to live a healthy active life”
“It was very easy to get in touch with the co-ordinator, who co-ordinated contact with the next person at the Independence Trust”
• 75% of patients spoken with felt that their social prescription had a positive impact on their emotional wellbeing
•50% of patients spoken with felt that their social prescription had a positive impact on their physical wellbeing
Interviews, questionnaires and collected case studies.
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She takes Cocodamol regularly, NSAID prn; PPI, docusate; low dose amitriptyline
eGFR drops her into CKD3, Ramipril added, then CCB.
A fall resulted in a Colles fracture; adcal and alendronate added
Loss of confidence with walking, can’t get out to walk her dog…SSRI
82 year old lady, widowed, family live 10
miles away, but with very busy lives
• Main problem: loneliness
• Main presenting complaint: low back and
leg pain
10 Medications…for loneliness
What does this mean for GPs?
• Surgery-based knowledgeable resource who can signpost to social
support
• Allows GPs to think and practise more holistically
• Takes pressure of GPs
• More healthy alliances formed
• Produces a system that is safer, more caring, more responsive,
more effective
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Social prescribing and
Prime Minister’s Challenge Fund
Scale up to cover all (82) GP Practices in the county –
629,000people.
Referrals from community hospital staff and staff in 21 Integrated
Community Teams.
Use of Prime Minister’s Challenge Fund to recruit social prescribing
hub coordinators.
Further evaluation.
Aligning social prescribing with Arts and Culture
Acknowledgements Create Gloucestershire and Joe Magee
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Background
• A 3-year programme supporting arts and cultural organisations to engage
in public sector commissioning and to create awareness amongst public
service commissioners of the potential for arts and culture to jointly deliver
their outcomes.
• Funded by Arts Council England and delivered by the National Council for
Voluntary Organisations (NCVO), in partnership with New Philanthropy
Capital (NPC), New Economics Foundation (NEF)
• Gloucestershire CCG is one of two national pilots with Kent County
Council being the other
• A local partnership between Gloucestershire CCG, CREATE
Gloucestershire, Forest of Dean District Council, Gloucester, City Council
and Tewkesbury Borough Council and supported by GCC, VCS Alliance
and the University of Gloucestershire
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National objectives
• Enable arts and cultural organisations to diversify and increase
their income streams by responding to public service strategic
commissioning opportunities.
• Create a greater understanding amongst public service
commissioners of the potential for arts and culture to deliver their
outcomes.
• Support policy development relating to strategic commissioning
so that it takes more account of arts and culture.
• Support an increase in audience or participant numbers for arts
and culture.
Cultural Commissioning Grant Programme
• Field of arts and culture for health and wellbeing in the UK is a
newly emerging specialism, and as such requires investment and
testing of approaches and models.
• £150,000 identified in the CCG’s 14/15 operational plan
• Seeking to understand how commissioning arts and culture may
have a positive impact on health & wellbeing outcomes
• Themes for the projects
a) raise awareness of certain health conditions
b) help people to develop strategies to manage specific aspects
of their health conditions
• Aligned with the needs of our local population
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Building on our clinical programmes approach
Grant projects
• Promoting healthy lifestyles in families
• Raising awareness of eye health through arts and culture
• Raising awareness of the early signs of dementia
• in the black, minority ethnic (BME) community
• Raising awareness of the importance of taking prescribed medication for diabetes with
teenagers
• Exploring how singing can benefit adults with long-term respiratory (breathing)
conditions
• Supporting young people to develop awareness & self-management strategies for good
mental health
• Exploring how arts and culture can support men who live with long term pain from
musculoskeletal conditions
• Exploring practical opportunities though arts & culture, to promote confidence and the
benefits of peer support for people with colorectal and prostate cancer
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SOCIAL PRESCRIBING IN GLOUCESTERSHIRE A mechanism for linking patients with non-medical sources of support in the community
REFERRAL BY HEALTH CARE PROFESSIONAL
(including GPs, PNs, ICTs, Community Hospital teams)
• Vulnerable and at risk groups e.g. low income, single mothers, recently bereaved older people
• People with chronic but stable physical illness; emotional stress
• Frequent attenders in primary care presenting with social isolation and other psychosocial and emotional
needs
HUB CO-ORDINATOR
• Personalised assessment/ care planning, co-production, behaviour change strategies
• Signposting/ information prescription or supported referral into appropriate group/ service
Welfare &
employment Arts & Culture
Environment &
horticulture Social groups
& support
Physical activity
& lifestyle
Employment,
benefits, housing,
debt, legal advice,
parenting support,
community
transport
Community choirs,
arts groups, drama
classes
Harp playing in NICU
Songwriting in
CAMHS units, singing
for stroke rehab
Universal/
low health
need
Singing for COPD and
mild/mod depression.
Arts on prescription
Gardening,
horticulture,
forestry,
bushcraft,
willowcraft,
woodcraft, green
gyms
Befriending
schemes, lunch
clubs, self
management/self
help groups,
memory café,
volunteering, time
banks, peer
advocacy
Health walks,
exercise classes,
healthy cooking,
Exercise on
prescription, weight
management
Respiratory exercise
classes, cardiac
exercise classes
Targeted
/moderate
health need
Specialist/
high health
need
Patient referred by hub co-ordinator Patient referred by health professional
A Stepped Model
Universal health & wellbeing needs
Mild to moderate needs and/or stable health conditions
Multiple & complex needs and/or potentially unstable health conditions
A continuum of
intervention to meet
a continuum of need
Small group singing co-
facilitated by vocal leader and
respiratory physio for unstable
COPD or asthma
Ballroom dance for frail
elderly in care homes for falls
prevention
Live harp music in a special
care baby unit to soothe
stressed babies and parents
Singing to increase lung
capacity in stable COPD or
asthma
Street dance for diabetic
teenagers to manage blood
glucose & salsa for adults
Yoga for low back pain
Creative writing to alleviate
mild depression
Walking for health; community
choirs for social isolation;
Zumba for weight management;
painting for relaxation; luncheon
clubs for friendship; debt advice
for stress
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Questions
Matt Pearce
Senior Commissioning Manager
Gloucestershire CCG
Helen Edwards
Local Implementation Manager
Gloucestershire CCG