Home Truths: How well do you understand GPs?

Home Truths: How well do you understand GPs? 18th April 2013

The basics of Home Truths • A group of councils (10), CCGs (2), INLOGOV, HSMC and iMPOWER working together • Aiming to demonstrate that understanding and improving relationships with GPs can improve social care outcomes and save money, in particular by reducing unnecessary admissions to residential care • Wave 1 commenced in December and going into implementation in April/May. Initial evaluation in October • Further councils are commencing wave 2 and a Scotland group in April-June

A theory of change is emerging The future of sustainable social care, and local public services generally, depends on the ability to transform the relationship between citizens and the state To deliver this kind of change we need a much deeper level of insight and evidence on individual values and motivations, influences and relationships right across the system We can build evidence for this by focusing in on one relationship first. GPs/social care is an under-exploited relationship

Building a new evidence base • A key principle of the programme has been the value of building a different kind of evidence base • It is valuable to know and track knowledge, trust and motivations of stakeholders • So, before we tell you what we have found, a few questions (show of hands) • Q1 – How many meetings have you had with your CCG(s) in last month? • Q2 – How many meetings have you had with GPs (other than those in CCG lead positions) in the last month? • Q3 – Would you describe relationship with GPs as very good, good, bad or very bad?

Do you understand GPs? Can you play your cards right? • Have spoken to more than 250 older people, 150 GPs, over 100 GP surgery staff, social care CCG acute and community staff, hospital discharge teams • Surveyed 150 GPs. 10% across 6 sites

Question 1 – Higher or lower than 50%? My relationship with social care is poor 56%

Question 2 – Higher or lower? I trust hospital discharge teams to make decisions in the best interests of my patients? 56% 41%

Question 3 – Higher or lower? I can make a better assessment of need for residential care than social care? 41% 41%

Insight 1 ”I don't feel confident that care packages & support services can be relied on to provide services at short notice (especially on Friday afternoons!)” Lack of trust exists, and matters “Social care is (perceived as) inaccessible (and) remote”

Question 4 – Higher or lower? I trust Social Care to make decisions in the best interests of my patients? 41% 73%

Question 5 – Higher or lower? I would value closer links with Social Care? 73% 92%

Insight 2 “I can make a referral but often there is no feed back until there is a crisis” The desire to improve relationships can be tapped in to with positive feedback “GPs aren't told about when Homecare services start … better communications may make GPs/ District nurse feel more confident that an elderly patient remains safe at home”

Question 6 – Higher or lower? I would rate reablement as unsatisfactory or very poor 46% 56%

Question 7 – Higher or lower? I don’t believe any telecare services exist 46% 59%

Insight 3 There is value in understanding the perception gap as well as service gaps “I am not aware and up to date with what is available”

Question 8 – Higher or lower? A reduction in home visits would motivate my advice to patients regarding residential care? 59% 68%

Insight 4 Incentives and tensions in the system have not been explored thoroughly enough “ … ‘urgent' seems to mean a different thing to us and Social Services” “The big concern for me is that cuts ... will lead to . ..cost shunting”

Question 8 – Higher or lower? Financial incentives would motivate my advice to patients regarding residential care? 46% 68%

Insight 5 GPs are different. Those you see are generally not the ones you want to influence “Clearly they could have been managed at home with the right support” “Of course money wouldn’t incentivise us”

How are we using the insight? • Developing a new set of tools for a different kind of change • Perception gap reduction • Influence realignment • Motivation pathway reconfiguration • GP personalisation • Tension management • Growing business case for savings and improved outcomes • Building momentum for a new starting point for “health and social care integration”`

Discussion questions • Do any of the GP responses surprise you? • How do you think your area compares with these findings? • 56% Rate the quality of relationship with social care poor or very poor • 41% trust hospital discharge team to make decisions in best interests of their patients • 57% believe social care can make a better assessment of need for residential care than GPs (41% said GPs make better assessment) • 73% trust adult social care to make decisions in best interests of their patients • 92% would value closer links with social care, 56% strongly value • 46% of those who knew about the service thought reablement was unsatisfactory or very poor • 59% said they are aware of no telecare service available • 68% said a reduction in home visits would motivate their advice to patients on residential care • 46% said financial incentive would motivate their advice to patients on residential care

For more information • For more information: • On the findings, analysis, solutions from Wave 1 • Or on Wave 2 commencing in April to June • Contact: • jcooper@impower.co.uk • wreynolds@impower.co.uk • 0202 7017 8030 • www.impower.co.uk

Home Truths: How well do you understand GPs?