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Ways to Wellness

Ways to Wellness. A Newcastle Social Prescribing Model Dr Guy Pilkington Clinical Chair of Newcastle West CCG. Chair - Professor Chris Drinkwater CEO – Tara Case. A short history. Year of Care Having better conversations Shared decision making How to respond to peoples wishes?

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Ways to Wellness

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  1. Ways to Wellness A Newcastle Social Prescribing Model Dr Guy Pilkington Clinical Chair of Newcastle West CCG

  2. Chair - Professor Chris Drinkwater CEO – Tara Case

  3. A short history • Year of Care • Having better conversations • Shared decision making • How to respond to peoples wishes? • Social aspects • What matters to you • NESTA grant 2011 - 2013

  4. Ways to Wellness: structure, operations and governance Big Lottery Commissioning Better Outcomes Fund – £2m Cabinet Office Social Outcomes Fund - £1m Social Outcomes Contract Social investors Referral of people with long-term conditions Bridges brings at-risk support, and also project finance 16 GP practices providing referrals WtW is 100% owned by the WtW Foundation Performance Management is provided by Ways to Wellness (WtW) funded by central costs. WtW has budget in place to fund: Full time CEO and FD Robust Management Information System Marketing activities General admin support Chair, Treasurer and an experienced board Service Delivery Contracts Service Providers deliver Link Workers to provide the social prescribing intervention

  5. Referral Criteria • Registered with a GP practice in Newcastle West (18 practices, 140,000 population, 14,229 on LTC QOF Register) • Long-term condition (LTC): • COPD, Asthma, Diabetes (Type 1 or 2), Coronary Heart Disease, Heart Failure, Epilepsy, Osteoporosis • 40 to 74 years of age • Further prioritised referral criteria: • social isolation • poor understanding of condition, frequent attender at GP or hospital, poor adherence to prescription • anxiety or depression (in addition to one of the above LTCs) • poor health but with scope to improve with lifestyle change • poor English literacy • obese or inactive

  6. How it works Link workers 26 FTE across 2 Providers (NHS Band 2-3-4) 26 FTE Link workers across 2 providers (NHS Band 2-3-4)

  7. Ways to Wellness service characteristics • 18-19 months average length of time on service • 4 - 5 goals average per patient • 60% of patients are signposted, averaging of 2.3 sign-postings each • Average Link Worker case load around 100 • Quantitative and qualitative data shows patients referred have a high level of complexity*: • high historical use of hospital services • higher levels of co-morbidity • problems with stress, anxiety and depression • multiple social and economic issues including: debt, housing problems, low income and unemployment • https://bmjopen.bmj.com/content/7/7/e015203

  8. Service metrics: patient numbers • Referrals to date (to 31 March 2019): 6,025 • Engaged patients to date (to 31 March 2019): 4,463 • Currently engaged patients (at 31 March 2019): 2,919 • Practice Referral Rate (per 1000 of Eligible Population): 727 - 90

  9. Outcome metrics Well-being StarTM(30%) Average improvement over 1.5 results in an agreed outcome payment Secondary care costs (70%) Savings in scheduled & unscheduled admissions, out-patient and A&E costs compared against a matched cohort results in an agreed outcome payment

  10. Outcome 1: Impact on Well-being • 2,639 patients have completed two or more Well-being StarsTM assessments as of early 2019 (typically 6 months apart), allowing for measurement of change • The average patient improved 3.1 points, more than double the target of 1.5 points • Clients who previously described themselves as "finding out how they can improve things in their life to feel more in control“ are moving to "making changes”, or even "managing their lives pretty well"

  11. Outcome 2: Secondary Care CostsChanges in non-elective activity

  12. Outcome 2: Secondary Care CostsChanges in elective admissions

  13. Impact on Secondary Care Costs • Ways to Wellness’ impact on secondary care costs is measured by comparing the full eligible Ways to Wellness cohort with a similarly matched cohort in the north and east of Newcastle • The average annual hospital cost per patient across the full Ways to Wellness cohort was 7.5% (£86 per head) lower than the comparison cohort last year (2017/18). • Across the full eligible Ways to Wellness cohort (14,300 patients), this difference equates to annual savings of over £1.2 million in 2017/18. The annual net savings for the CCG was approximately £440,000.

  14. Quotes from Patient & GP Satisfaction Surveys Patient: “I began to see there were ways to move forward regardless of my ongoing medical problems ” Patient: “I was grateful for any help to get well. Manageable targets and other useful suggestions helped me.” Patient: “The Link Worker had knowledge of activities and their benefits in my area. I wouldn't have known where to look for these. “ GP Practice: “Excellent service – it has helped our patients in ways that other services have been unable to.” GP Practice: “The team are really friendly, approachable and adaptable; it has become an important service to many of our patients.” Patient: “I felt at ease with my Link Worker and she listened and offered advice to help my situation “

  15. Summary • Unusual funding model (SIB) • Attempt to change the routine offer • Large scale • Long term • Targeted – pros and cons • Embedding deeply in primary care • Generating the evidence we need to change the way we engage in supporting people

  16. Evaluating ‘Ways to Wellness’ Link Worker Social Prescribing Social Prescribing in Southwark 16th May 2019 Suzanne Moffatt Josephine Wildman Newcastle University

  17. Impact of social prescribingQualitative research: 14 women, 16 men • Health related behaviours • physical activity • diet • Mental health • loneliness and social isolation • depression • anxiety • Long-term condition management • taking account of multi-morbidity and condition fluctuations

  18. Physical activity/long term condition management 'The instructor here has given me a programme that I'm working on to help build up the muscles for the legs and for my back … I'm managing [my arthritis] with the help of the gym … [also] my sugar levels … [have] come down to 4.9 … [and] my cholesterol was 3.1, which is good … all that had to do with Ways to Wellness and the exercise I've been doing.' (P6, male, 65–69 years) Depression/multimorbidity/physical activity 'I was really down, so I couldn't go on Friday. It's been like that since I first joined. I've been missing [sessions] because of my COPD … bad turns … chest infections … [but] they [Ways to Wellness] restarted me again, so they've looked after me … they've been really, really good … they've stuck with me.‘(P1, male, 71-74 years)

  19. Long term condition mangement “I am on the road [to better health] but it is slow … if it was easy I would have done it years ago … I have been well impressed [with Ways to Wellness] … because they have a very practical approach and know it has got to be incremental … you can’t do everything at once … you can’t do everything at once so you have got to start small and build up … they have got the big picture in mind.” (woman aged 55-59 years)

  20. Outcome measures (for pilot before/after study conducted Aug-Dec 2016) • quality of life (EQ5-D) • long term condition management (LT6) • depression (PHQ-9) • anxiety (GAD7), • loneliness and social isolation) • demographic variables (age, gender, ethnicity, long term condition(s) Baseline response rate 30.1% (N=101) 3 month follow-up response rate 16.4% (N=54) We concluded self completion questionnaire was not a feasible method for evaluation

  21. Public Health Research Programme: 16/122 Community groups and health promotion Impact of a community based social prescribing intervention on people with type 2 diabetes in an ethnically diverse area of high socio-economic deprivation. Exploiting a natural experiment to evaluate effects on health and health care utilisation with economic assessment and ethnographic observation. Aims to evaluate the impact and costs of a community-based link worker social prescribing intervention on the health and health care utilisation of adults aged 40-74 with type 2 diabetes, living in a multi-ethnic area of high socio-economic deprivation. This work is funded by the NIHR, Public Health Research Programme, Community Groups and Health Promotion, grant no. 16/122/33. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

  22. Statistical data – routinely collected • Quality and Outcomes Framework (QOF) data • The QOF is a GP performance management and payment system. • It rewards GP practices in England for the quality of care they provide to their patients. e.g. QOF indicator: % of patients with diabetes and history of CVD who are prescribed a statin • Data on type 2 diabetes management, smoking, weight, blood pressure etc.

  23. Statistical data – routinely collected • Secondary Uses Service (SUS) data • Used for healthcare planning, hospital payments and commissioning etc. • Information collected whenever a patient or service user is treated or cared for e.g. hospital visit, admission (routine or emergency), length of stay etc.

  24. Treatment and control groups Group 1 Treatment: Eligible patients in WtW referring GP practices who have been with WtW for a year or more Control:patients who have just started with WtW Group 2 Treatment:Patients in WtW Control:eligible patients in WtW referring practices who are NOT in the WtW service. Group 3 Treatment: Patients in WtW Control:Eligible patients NOT in WtW referring practices Group 4 Treatment: All eligible patients in WtW referring practices (regardless of whether they take part) Control:Eligible patients NOT in WtW referring practices

  25. Using Ethnography (observational methods) • Combination of participant observation, interviews, focus groups, ‘shadowing’ • Participants are service users, link workers and onward referral agencies (for PhD study, GPs, practice nurses, health care assistants, practice managers) • Yielding detailed accounts to build an understanding of how and whyWtW works and for whom, as well who it doesn’t work for and why

  26. Overview of WtW evaluation – July 2018-Spring 2021

  27. Conclusions • Social prescribing is highly complex; selecting outcome measures is difficult • Collecting data • Implications for service providers • Implications for service users • Consider routinely collected data (but may not be easily available) • Mixed methods have advantages

  28. Research Team Newcastle University Suzanne Moffatt - Reader in Social Gerontology John Wildman – Professor of Health Economics Mark Pearce – Professor of Applied Epidemiology Jo Wildman - Research Associate Kate Gibson – Research Associate Jayne Jefferies - Research Associate Linda Penn – Research Associate Bethan Griffiths – PhD Student Allison Lawson – Research Administrator Durham University Tessa Pollard – Associate Professor of Social Anthropology Northumbria University Chris Drinkwater - Emeritus Professor of Primary Care Development Nicki O’Brien – Senior Lecturer in Health Psychology

  29. Publications Moffatt, S. Steer, M. Lawson, S. Penn, L. O’Brien, N. (2017) "Link Worker social prescribing to improve health and well-being for people with long-term conditions: qualitative study of service user perceptions" Moffatt S, Wildman J, Pollard TM, et al (2019) “Evaluating the impact of a community-based social prescribing intervention on people with type 2 diabetes in North East England: mixed-methods study protocol” Wildman, J. Moffatt, S. Steer, M. Laing, K. Penn, L. O’Brien, N (2019) "Service-users’ perspectives of link worker social prescribing: a qualitative follow-up study" BMC Public Health Drinkwater, C. Wildman, J. Moffatt, S. (2019) "Social Prescribing" British Medical Journal Practice

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