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Socialprescribingforlongtermcondi3ons
ChrisDrinkwaterChair,WaystoWellness
Re-balancingthebio-medical&thesocial:Lookinginbothdirections
Hospital CCGsH&WB
Individuals&
Communities
GPsandPrimaryCare
LA&PH
Medicalmodel(QoF/healthchecks) Socialmodel
Evidence
Individualresponsibility&behaviourchangePatientcentredness
£££UnsustainableDemand
Physical CapitalSocial
ChoosingHealthWhitePaper2004
Pathwaysbetweenmedicalandsocialmodelsofhealth
h3ps://www.diabetes.org.uk/upload/Professionals/Year%20of%20Care/thanks-for-the-petunias.pdf
Challenges
• Socialprescribing–Whobenefits?Whatistheevidence?
• DevelopinganoperaIonalmodelwithinafinancialframework
• SIBOutcomesContracts,repaymentImescales• DedicatedMIS&be3eruseofdata• Culturechange
WhyPhysicalLTCsinpeople40-74?
• SignificanceofsocialdeterminantsondevelopmentandoutcomeofLTCs.
• CostofLTCstopublicpurseandspecificallytoCCGs.
• OpportunitytoaddresssecondaryprevenIon.• QOFregistersforLTCsanddemandonGPs
TheWaystoWellnessModel
h3ps://www.uk.ecorys.com/news/ecorys-uk-launches-report-uk%E2%80%99s-first-health-social-impact-bond.
GeBngThere• 2011VONNEinterestintesIngSIBsasavehiclefortheVCSE.
• StrongsteeringgroupwithVCSEandNHScredibilityhostedbyVONNE.
• 2012-14developmentfundingSEIFandBLF-evidencecase-financial&operaIonalmodelling-servicespecificaIonandprocurement-managementinformaIonsystem
• April2015Launch
Challenges1
• Tyingdownthetargetgroup–people40-74onLTCQOFRegisters
• OperaIonalcosts–acIviIesorlinkworkers?• Agreeingoutcomesandrepaymentmetrics• NegoIaIngasevenyearcontract• Doesthedeveloper(SPV)getthecontractorshoulditbeanopentender?
• Financialmodelling(Version18.2)
Outcomes
2. SecondarycarecostsSavingsinscheduled&unscheduledadmissions,out-paIentandA&Ecostscomparedagainstamatchedcohortresultsinanagreedpayment(70%)
1. Well-beingStarTM
Averageimprovementover1.5resultsinanoutcome-basedpayment(30%)
Challenges2
• Buildinglocalbuy-in–VCSE,GPs,paIentgroups.
• FindingandnegoIaIngwithinvestors.• SourcingaddiIonalfunding• Procurementofproviders• MeeIngNHSInformaIonGovernancerequirements(HSCICLevel2AQP)
• Retro-fiengtotheStandardNHSContract.
Investors
• Payforearlyservicecosts,drivedeliveryandcarryriskoffailure.
• One-offset-upfacilityfee.• Monitoringfee–investorsexperIseandengagement.
• Royaltypayments–dependentonsuccess,fixed%withacap.
• TodateWaystoWellnesshasonlydrawndown£1.1mofthe£1.65m.
Linkworkers22FTEacross4providers
ReferralCriteria• RegisteredwithaGPpracIceinNewcastleWest(18pracIces,112,000
populaIon,14,229onLTCQOFRegister)
• Long-termcondiIon(LTC):• COPD,Asthma,Diabetes(Type1or2),CoronaryHeartDisease,Heart
Failure,Epilepsy,Osteoporosis
• 40to74yearsofage
• FurtherprioriIsedreferralcriteria:• socialisolaIon• poorunderstandingofcondiIon,frequenta3enderatGPorhospital,
pooradherencetoprescripIon• anxietyordepression(inaddiIontooneoftheaboveLTCs)• poorhealthbutwithscopetoimprovewithlifestylechange• poorEnglishliteracy• obeseorinacIve
Service Metrics – Successful New Referrals Service to Date
14
Ø Successful New Referrals in Year 1: 1,127 = 103% of target (starts 924 = 84% of target) Ø Successful New Referrals in Year 2: 1,319 = 82% of target (starts 1,026 = 64% of target)
Ø To Date Successful New Referrals: 2,446 = 90% of target (starts 1,950 = 72% of target) Measuring Starts only - not those patients that are still open
4557 54
6674 74
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133142
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5665
74 74 74
108 108 108
130 130 130143 143 143 143 143 143 143 143 143
162 162
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Successful New Referrals Service to Date
7 April 2015 - 28 February 2017 Target vs Actual
SuccessfulNewReferrals TargetSuccessfulNewReferrals CompleIonof1stStar CompleIonof2ndStar
Service Metrics - Referrals by GP Practice
Service to Date
15
Above Target
Below Target
Target to 28 February 2017
0 50 100 150 200 250 300 350 400 450 500
NumberofReferralsbyGPPrac3ce7April2015-28February2017
ReferralsbyLongTermCondi3onArthriIs,Chronic
MSKPain,7
COPDandAsthma,147
Angina,2
Asthma,260
COPD,214
DiabetesType1,50
DiabetesType2,533
DiabetesType1and2,120
HeartFailure,61
CoronaryHeartDisease,223
Epilepsy,50Osteoporosis,
46
Highlightsfromfurtherdataanalysis:first1347pa3ents• Men46.6%(1stStar28.6)Women53.2%(27.4)• Age40-5945%(1stStar26.5)• Age60-7455%(1stStar30.4)• 40.6%with2ormoreLTCs,numbersincreasewithage.
• Linkworkersspendanaverageof8.4hourswitheachpaIent,whichrepresentsanaverageof23contactsperpaIent
Incaseyouwerewondering
• SecondarycaresavingscomeonlineinYear3.• DataforthefirstthreequartersofYear2-AveragespendperpaIent£19(2.5%)lessthancontrolgroup-Monthlyvariancebetween+5.4%to-10.8%
CultureChange
• Normalisingtheimportanceandvalidityofaddressingsocialdeterminants.
• Changingthewayservicesaredesignedandcommissioned.
• ChangingthebehaviourofGPs.• ChangingthebehaviourofVCSEproviders.• Theroleofspecialpurposevehiclesandsocialinvestors.
Opera3onalvresearchdesign
• NIHRPublicHealthrejecIon2015-toomanyworkpackages-notheoreIcalbasistounderpinintervenIon-tooambiIous-be3ercontrolsrequired
• BarrierstomoregranularanalysisofNHSHESandRAIDRdata.
Service Users …
“I feel really proud of myself that I’m getting out and about more.”
“I now have a totally different
outlook.”
“This service has resolved a lot of issues
that worried me.”
“It has helped to focus my mind and gave me belief that things can change.”
“I do believe that knowing the Ways to Wellness team is like
winning a lottery ticket in life.” “I feel like finally there is a light at
the end of the tunnel and I want to say thank you for calling me and listening, I really appreciate it.”
“I feel better already talking to
you. It helps motivate me.”
Thankyoutoallourprovidersandfunders
