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Reducing demand for health services

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Age UK
Age UK

Reducing demand for health services workshop presentation by Cynthia Dize at Age UKs "Living well with long term conditions" conference

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Primary Care Navigators Reducing demand for health services 14 November 2012
Why its well-regarded The Primary Care Navigator model meets a need Provides integration across health, social care and third sector Makes a real difference to the experience of patients and clinicians Flexible, adaptable, scaleable Is effective and efficient
Meeting the need 15 million people with LTCs 50% of GP appointments 70% of acute and primary care budgets DH predicts a rise of 25% in people over 65 with one + LTCs by 2050 Cuts to local government spending have led to raised eligibility for funded services Consequence is more pressure on secondary and primary care Kings Fund (Self-Management for LTCs, 2005) - people want to self manage but need improved provision of information about their condition and what is available locally Statistics are people with the tears washed off
Meeting the need London has rich and varied provision across statutory and non-statutory providers But patients and carers find that services are hard to locate and access Made worse by poor communication between health and social care Particular issues: Part of the solution is in social care, benefit support, housing advice unrecognised by people who have never associated themselves with this need, paid or unpaid Tendency to present in a crisis and needing unplanned care Very varied availability and quality of provision inequity ...All leading to isolation, loneliness, dependency on family members and call on unplanned services
Our response A Care Navigator role in primary care to work across health, social care and third sector. Three roles: Provide patient-focussed, integrated support to co-ordinate care around the patient and navigate the system Improve planned take up of services; reduce DNAs; reduce unplanned demand; improve communication primary/acute care Provide live feedback on service quality to GP commissioners - service improvement Role supported by mentoring and education package quality and consistency
Makes a real difference What the GPs say: Having a patient navigator at the surgery has been revolutionary for team working and patient care. Patients who were hard to reach, often missed appointments, and paradoxically were frequent users of non-elective care (e.g. OOH, A&E) have now had comprehensive holistic assessments by a team of healthcare professionals, all co-ordinated by the navigator. Dr Tahir, Barlby Surgery
Flexible, adaptable, scaleable: Piloted in primary care Pilot underway in a mental health team liaising with primary care Fits into Out of Hospital and Integration agenda Can sit in health, social care, third sector, community structured around local strengths Does not require a complex infrastructure with associated costs Economic for a very small team, and robust for a larger one
Effective and Efficient: Average healthcare use 6 months before and after intervention start GP contacts Outpatient Significant drop Out of hours Significant drop Inpatient A&E Significant drop Significant drop Significance test=Wilcoxan signed rank test
Potential cost savings per patient Indicative, based on 6 months pre and post Savings Average Average contacts Average contacts cost per 6 months pre 6 months post Saving: contact intervention intervention Difference 贈 Saving GP 贈25 8.6 4.6 -4.0 贈99 Inpatient 贈1,825 0.4 0.08 -0.3 贈584 Outpatient 贈160 2.9 2.3 -0.6 贈96 Out of hours 贈45 2.3 1.2 -1.2 贈52 A&E 贈152 1.4 0.6 -0.8 贈116 贈947 Costs Navigator unit cost (incl on-costs) 贈303 Net savings Potential net intervention saving per patient (over 6 months) 贈644 Assumes drop in activity post-intervention is all as a result of intervention. Effect of regression to the mean may reduce the calculated level of savings However, savings may be realised over a longer period than 6 months, as modelled here. Likely savings in other aspects of care e.g. prescribing
Abbotts Hearing Aid centre Campden Charities Floating Housing Support Occupational Therapy ACKC - friends & neighbours Carers Counselling Freedom pass Opthalomogy ACKC befriending referral Carers KC Osteopathy Optician ACKC benefits check Carers UK GP Orthopaedics Dept - St Mary's ACKC Dementia Team CARS HF Hammersmith Hospital Palliative nurse ACKC 'food & friends' Chelsea Theatre Health Trainers PALS ACKC outings Chemist home delivery Healthcall (home opticians) Parkinson's Society ACKC Practical Help CLCH Wheelchair Service Healthy Homes Peabody Tenant Support team ACKC Shopping Service Community Alarm Service Hepatology Pepperpot ACKC Support Broker Community Dementia Team Homeshare Scheme PhysIotherapy ACKC Toe nail Cutting Community Diabetes Team Housing Opportunitues Team Podiatrist NHS ACKC Toe Nail Cutting Service Community Mental HealthTeam Incontinence Service Practice Nurse ACKC-Info & Advice Community pharmacy K&C Cruse Psychiatric Services ACKC Escorting Cook & Taste sessions at Chelsea Theatre KCMS Quest ACKC - Respite care Cooperative Funeral Care Learning disability Occupational Therapy Red Cross ACKC Wayfinder Counselling Library Re-enablement Team H & F ACKC Ageing Well sessions Crossroads Care Library Home Delivery Service Retinal Clinic ACKC At Home Community Rehab Team Local colleges RNIB ACKC Memory Caf辿 Cruse KC local sports facilities Samaritans ACKC Volunteer CX Transport & Carer service Macmillan Centre at Chelwest Social Services ACKC Decluttering Day Services Meals on wheels Stroke Association ACKC Garden Guardians Depression Alliance Memory Service Substance Misuse Counsellor Admiral Nurses Dietician MIND Sudanese Women's Assoc Alcohol Resource Centre Disability Living Foundation Miranda Barry Day Centre Taxicard Attendance allowance District Nurses Mulberry Place Activity Centre Thames Water Finance assistance Binbrook House Support staff Dossett Box (chemists) New Horizons TMO Blue badge DVLA appeal process NHS Direct Transport for All British Heart Foundation Falls clinic Notting Hill Trust Vitalise Crossroads Care Burgess Fields Support staff Falls Service Nucleus Westway Community Transport Citizens Advice Bureau Fitness for Health Nutritionist Wiltshire farm foods Open Age World's End Neighbourhood Advice
Contact Cynthia Dize Chief Officer Age UK Kensington & Chelsea 1 Thorpe Close, London W10 5XL 020 8969 9105 cdize@aukc.org.uk www.aukc.org.uk

More Related Content

Reducing demand for health services

  • 1. Primary Care Navigators Reducing demand for health services 14 November 2012
  • 2. Why its well-regarded The Primary Care Navigator model meets a need Provides integration across health, social care and third sector Makes a real difference to the experience of patients and clinicians Flexible, adaptable, scaleable Is effective and efficient
  • 3. Meeting the need 15 million people with LTCs 50% of GP appointments 70% of acute and primary care budgets DH predicts a rise of 25% in people over 65 with one + LTCs by 2050 Cuts to local government spending have led to raised eligibility for funded services Consequence is more pressure on secondary and primary care Kings Fund (Self-Management for LTCs, 2005) - people want to self manage but need improved provision of information about their condition and what is available locally Statistics are people with the tears washed off
  • 4. Meeting the need London has rich and varied provision across statutory and non-statutory providers But patients and carers find that services are hard to locate and access Made worse by poor communication between health and social care Particular issues: Part of the solution is in social care, benefit support, housing advice unrecognised by people who have never associated themselves with this need, paid or unpaid Tendency to present in a crisis and needing unplanned care Very varied availability and quality of provision inequity ...All leading to isolation, loneliness, dependency on family members and call on unplanned services
  • 5. Our response A Care Navigator role in primary care to work across health, social care and third sector. Three roles: Provide patient-focussed, integrated support to co-ordinate care around the patient and navigate the system Improve planned take up of services; reduce DNAs; reduce unplanned demand; improve communication primary/acute care Provide live feedback on service quality to GP commissioners - service improvement Role supported by mentoring and education package quality and consistency
  • 6. Makes a real difference What the GPs say: Having a patient navigator at the surgery has been revolutionary for team working and patient care. Patients who were hard to reach, often missed appointments, and paradoxically were frequent users of non-elective care (e.g. OOH, A&E) have now had comprehensive holistic assessments by a team of healthcare professionals, all co-ordinated by the navigator. Dr Tahir, Barlby Surgery
  • 7. Flexible, adaptable, scaleable: Piloted in primary care Pilot underway in a mental health team liaising with primary care Fits into Out of Hospital and Integration agenda Can sit in health, social care, third sector, community structured around local strengths Does not require a complex infrastructure with associated costs Economic for a very small team, and robust for a larger one
  • 8. Effective and Efficient: Average healthcare use 6 months before and after intervention start GP contacts Outpatient Significant drop Out of hours Significant drop Inpatient A&E Significant drop Significant drop Significance test=Wilcoxan signed rank test
  • 9. Potential cost savings per patient Indicative, based on 6 months pre and post Savings Average Average contacts Average contacts cost per 6 months pre 6 months post Saving: contact intervention intervention Difference 贈 Saving GP 贈25 8.6 4.6 -4.0 贈99 Inpatient 贈1,825 0.4 0.08 -0.3 贈584 Outpatient 贈160 2.9 2.3 -0.6 贈96 Out of hours 贈45 2.3 1.2 -1.2 贈52 A&E 贈152 1.4 0.6 -0.8 贈116 贈947 Costs Navigator unit cost (incl on-costs) 贈303 Net savings Potential net intervention saving per patient (over 6 months) 贈644 Assumes drop in activity post-intervention is all as a result of intervention. Effect of regression to the mean may reduce the calculated level of savings However, savings may be realised over a longer period than 6 months, as modelled here. Likely savings in other aspects of care e.g. prescribing
  • 10. Abbotts Hearing Aid centre Campden Charities Floating Housing Support Occupational Therapy ACKC - friends & neighbours Carers Counselling Freedom pass Opthalomogy ACKC befriending referral Carers KC Osteopathy Optician ACKC benefits check Carers UK GP Orthopaedics Dept - St Mary's ACKC Dementia Team CARS HF Hammersmith Hospital Palliative nurse ACKC 'food & friends' Chelsea Theatre Health Trainers PALS ACKC outings Chemist home delivery Healthcall (home opticians) Parkinson's Society ACKC Practical Help CLCH Wheelchair Service Healthy Homes Peabody Tenant Support team ACKC Shopping Service Community Alarm Service Hepatology Pepperpot ACKC Support Broker Community Dementia Team Homeshare Scheme PhysIotherapy ACKC Toe nail Cutting Community Diabetes Team Housing Opportunitues Team Podiatrist NHS ACKC Toe Nail Cutting Service Community Mental HealthTeam Incontinence Service Practice Nurse ACKC-Info & Advice Community pharmacy K&C Cruse Psychiatric Services ACKC Escorting Cook & Taste sessions at Chelsea Theatre KCMS Quest ACKC - Respite care Cooperative Funeral Care Learning disability Occupational Therapy Red Cross ACKC Wayfinder Counselling Library Re-enablement Team H & F ACKC Ageing Well sessions Crossroads Care Library Home Delivery Service Retinal Clinic ACKC At Home Community Rehab Team Local colleges RNIB ACKC Memory Caf辿 Cruse KC local sports facilities Samaritans ACKC Volunteer CX Transport & Carer service Macmillan Centre at Chelwest Social Services ACKC Decluttering Day Services Meals on wheels Stroke Association ACKC Garden Guardians Depression Alliance Memory Service Substance Misuse Counsellor Admiral Nurses Dietician MIND Sudanese Women's Assoc Alcohol Resource Centre Disability Living Foundation Miranda Barry Day Centre Taxicard Attendance allowance District Nurses Mulberry Place Activity Centre Thames Water Finance assistance Binbrook House Support staff Dossett Box (chemists) New Horizons TMO Blue badge DVLA appeal process NHS Direct Transport for All British Heart Foundation Falls clinic Notting Hill Trust Vitalise Crossroads Care Burgess Fields Support staff Falls Service Nucleus Westway Community Transport Citizens Advice Bureau Fitness for Health Nutritionist Wiltshire farm foods Open Age World's End Neighbourhood Advice
  • 11. Contact Cynthia Dize Chief Officer Age UK Kensington & Chelsea 1 Thorpe Close, London W10 5XL 020 8969 9105 cdize@aukc.org.uk www.aukc.org.uk

Editor's Notes

  • #5: And even within a small borough
  • #6: Patient numbers Total number of patients seen: 273 Total number of referrals: 323 The navigators see an average of 141 patients in a year, 167 referrals. (4 days per week). (12 patients a month, 14 referrals a month) Social Services Out of a random sample: 15/45 were receiving social services (33%) 22/45 are known to social services (49%)