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Social Prescribing in Wandsworth

Learn about the impact of social prescribing on patient wellbeing in East Merton. Discover the process, benefits, challenges, and future steps in integrating social prescribing into primary care networks.

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Social Prescribing in Wandsworth

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  1. Social Prescribing in Wandsworth Dr Mohan Sekeram, Clinical Lead for Social prescribing Tanya Stacey, Senior Primary Care Commissioning Manager 3rd June 2019

  2. Workforce • DES provides workforce reimbursement to build expanded Primary care team • Year 1 (per PCN, approx. 30-50k population) • 1 Clinical pharmacist (70/30 split) • 1 Social Prescriber (100% funded) • Year 2 • PA, Paramedics, MSK..

  3. Introduction to Social Prescribing • Links patients to ‘non-medical’, community based sources of support (20 %) • Housing, Debts/ benefits, social isolation , employment.. • Determinants of health (deprivation) • Provides GPs with ‘non-medical’ referral option • Medical modelPsychological – Social • Depression -> bereavement • Infections -> housing

  4. Current Model (East Merton) • ‘Link worker’ – aka SocialPrescribing Coordinatorembedded in primary care • Computer systems • Supervising clinician to help support • SNOWMED codes (*) • GP refers patient to Coordinator with referral reason, i.e: • Socially isolated • Frequent GP attender • Mild/moderate mental health issues • Social needs • Coordinator Advises and signposts

  5. Link Worker at practice Social Prescribing Process 1. 2. • GP: • Completes referral form • Gives SP booklet to patient 3. Link worker reviews patient and documents on Emis Completes wellbeing star (PAM to be included soon) 4. Advises and signposts

  6. Social Prescribing Key Themes The Social Prescribing Coordinators helppatients access local organisations across sectors who offer support with: • Social aspects of healthy living - diet and exercise and non-medical support to manage a long term health condition. • Anxiety and depression • Housing and finance • Employment and volunteering • Practical support at home and keeping safe • Loneliness and social isolation • Carers support • Bereavement

  7. Potential Support for Networks • Create Personalised care plans • Diabetic input- healthcoaching • Dementia awareness • Home visiting ? • Social determinants • Embed into MDT team

  8. Collaboration with Stakeholders is Key • Practices • Voluntary sector (employers / linking other) • Public health • CCG • Federation

  9. Patient stories Wellbeing Star (used at baseline and follow up) 75 patients had completed two stars, with an average increase in overall wellbeing score of 0.7; Increase from 2.8 to 3.5. Statistically significant (t = 1.99; p = 0.00 ) EVALUATION( ref appendix) (QUALITATIVE) Not thinking about it Finding out Making changes Getting there As good as it can be

  10. GP APPOINTMENTS AT 3 MONTHS This box chart shows the number of GP appointments patients attended three before and after their first Social Prescribing appointment. • 138 visited the GP within 3 months of SP. • They took up 1,641 appointments before SP and 1,098 afterwards (reduction of 543). • The average number of appointments per patient reduced from 11.9 to 8. • T-test analysis shows that this is a highly significant reduction in the number of appointments (p value = 0.00). APPOINTMENTS 3 MONTHS BEFORE SP APPOINTMENTS 3 MONTHS AFTER SP Average apps: 12 Average apps: 8

  11. Social Prescribing in Action • Patient B seen before Christmas for Depression and medical certificates. Seen monthly for 4 months • Saw Ray- Identified he work as chef and other benefits. • Job at community center (July 2017) • Bottom photo – Nov 2018 • Currently working and off medication and no more medical certificates. • Self esteem • Resilience • Supporting community • Reduced use primary care

  12. The Current Model (Merton) • Funding required for current model: c£50,000 per Navigator, including overheads and development costs. This includes: • Training needs assessment and delivery • Funding of voluntary sector • Peer and individual supervision delivery • Support for the Coordinators • Provider engagement with local voluntary sector • Monitoring of referrals and activity, input into evaluation • Monitoring of impact on voluntary sector • Stakeholder engagement • Role and responsibility development • Estates cost for the base location

  13. Benefits to Primary Care • Health and wellbeing of practitioners • Utilisation of resources • Collaborative working / identify resources • Mindful of effect on Voluntary sector.. (evaluation) Challenges • Funding and support/evaluation of voluntary sector • Support and supervision for Social Prescribers

  14. Primary Care Networks (PCNs) Impact of New GP Contract • Movement towards integrated care systems • New Directed Enhanced Service (DES) contract – PCN development • In 2019/20 (from July) each PCN can receive c£35k to employ or sub-contract the employment of a Social Prescribing Link Worker (covers staff salary costs only) • Applies to new staff and not payment of existing staff. • Consider quality assurance / support

  15. Moving Forward.. • How do we support Social prescribing and continue momentum ..? Proposal: • If PCNs agree with the proposed model, it is suggested that; • CCG supplement 35k to 50k to ensure an effective model and not simply salary costs – result is 1 Coordinator per PCN in each borough (assuming PCN interest) • CCG would manage the contract with the Providers – reduces strain on PCNs • Successive years: as per NHSE guidance we will develop the model to allow for additional further social prescribers, in collaboration with views of the PCNs and area need

  16. Procurement Timelines • July – Go out to tender for 2 weeks • Use the remaining weeks in July to evaluate applications and conduct bidder interviews • August – Award contract and allow 6 weeks for mobilisation • Mid-September/October – Commencement of Service and deployment of Social Prescribers to Wandsworth PCNs

  17. THANK YOU ANYQUESTIONS?

  18. Possible KPIs ( Personalised CP) • ( ?to report from 2020) • Monitored via a primary care network dashboard

  19. Proposed Measures of Impact • Office of National Statistic Wellbeing scale (ONS4) • Patient Activation Measure (PAM) • Highly motivated good control • Poorly motivated good control • Poorly motivated bad control • Highly motivated bad control

  20. A&E APPOINTMENTS AT 6 MONTHS This box chart shows the number of A&E appointments patents attended six months before and after their first Social Prescribing appointment. • 36 patients visited their GP within 6 months of SP. • They visited A&E 60 times before SP and 31 times afterwards (reduction of 29 visits). • The average number of appointments per patient reduced from 1.4 to 0.7. • T-test analysis shows that this is a significant reduction in the number of appointments (p value = 0.04). A&E APPOINTMENTS 6 MONTHS BEFORE FIRST SP A&E APPOINTMENTS 6 MONTHS AFTER FIRST SP Average visits: 1.4 Average visits: 0.7

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