Commissioners in Warwickshire managed to reduce appointments in general practice by a third by helping elderly people at risk of social isolation
As a nation, we are experiencing a growing ageing population, with the numbers of 65-84-year-olds, and over-85s, expected to increase by 39% and 106% respectively by 2032.1
More than half of all 75-year-olds in the UK live alone, and one in 10 is suffering from intense loneliness.2 This has a huge impact on both physical and mental health, and is linked to detrimental effects on blood pressure, emergency hospital admissions and mortality rates. Frailty among this age group is also a strong predictor of several negative outcomes including disabilities, institutionalisation and mortality – and is also linked to acute illness, falls and increased vulnerability.
Isolation presents a number of major challenges for primary care providers and the wider health and social care system – with more than two million unplanned hospital admissions per year of those over 65, accounting for nearly 70% of emergency bed days.3
These challenges are, of course exacerbated by increasing financial constraints, and it is estimated that a continuation of the existing model of care will result in the NHS facing a funding gap of around £30 billion between 2013/14 and 2020/214.
It is therefore vital to tackle frailty, social isolation and loneliness among the elderly population, and fundamentally change the way health and social care are delivered. Not only will this improve the quality of life for older people, it will limit dependence on healthcare services, reduce avoidable emergency and non-elective admissions, and help ensure the future of our NHS.
For 18 months, we have been working on a pioneering project, Prime 75+, which aims to improve socialisation of ageing patients and reduce dependency on the healthcare system. Although it’s early days, the impact is already profound.
“It’s not just something that happens in one appointment,” says Amanda Cogley, manager of Prime 75+. “The most powerful impact follows on from the relationship being built, similar to the trust that’s built with the doctor. Now patients are coming back and we’re seeing the difference the service is making.”
Developed and delivered by Prime GP, a healthcare organisation that combines clinical and commercial expertise, Prime 75+ was initially commissioned by NHS South Warwickshire CCG in January 2015 and trialled across four practices. The scheme moves away from a traditional model of care that focuses purely on health issues, and instead looks at the overall physical and mental needs of patients aged 75 and over.
This model harnesses the power of collaboration and strongly supports the evidence that self-management, personalised care planning and shared decision-making are highly effective means of giving individuals greater control of their own health. Patients who are actively involved in their own care experience more positive outcomes, and are less likely to be hospitalised.5
The project had the following aims and objectives:
Identifying the lonely
A dedicated over-75s co-ordinator works alongside clinical and reception staff in the participating practices to identify patients who are lonely, socially isolated and in some cases frail.
The co-ordinator then seeks the views of the patients about the support and level of engagement they would welcome, and works with them to identify activities in the local community that they can be part of.
Where there are gaps, they work together to organise and co-ordinate activities that are appropriate to patients’ needs and desires – anything from first-aid courses and gardening projects to mosaic classes and tea parties (including a 20,000-year tea party, which gathered the biggest over-75 patient group in the history of the NHS).
This not only promotes the development of friendships and self-confidence, it also reduces the individual’s reliance on the person they saw as their sole trusted confidante – their GP.
The positive impact of this patient engagement has been showcased in a number of ways. One example is the production of an information guide designed to help individuals remain happy and healthy in their senior years.
Prime75+ brought more than 50 elderly patients together through bespoke sessions where ideas, thoughts and feedback were obtained on ways to live independently and with dignity. The result was the Stay in the Prime of Life booklet, which the patients were involved in from initial conception through to final design and production.
Since launching, the scheme has facilitated contact with over 690 patients from across the four practices and has conducted more than 280 initial assessments. The co-ordinator has liaised with more than 43% of the total population of over-75s, has completed full assessments with 18% of those individuals, and has identified approximately 21% who are lonely.
Through communication and engagement with the over-75s, the number of GP appointments by participating patients has reduced by over a third.
If rolled out on a national basis, taking into account an average cost of £35 per 10-minute appointment, a CCG with a population of 200,000 could potentially save 88,800 GP surgery appointments and £3.1 million per year.
For the NHS as a whole, this would mean a saving of over 24 million appointments and £236 million in avoidable hospital admissions.
The key to the initial success has been patient engagement, as well as the acknowledgement that change will not happen with just one appointment.
Indeed, the most powerful impact begins to happen when a genuine, trusting relationship is built that replicates the patient’s relationship with their doctor. The Prime75+ model thus demonstrates the importance of a single point of contact within the GP practice, who is an expert in supporting older patients, and who understands the community and the support available.
Early intervention and awareness of the patient’s holistic needs is clearly preventing crises.
Patient involvement is resulting in an increase in community support, engagement and high levels of patient satisfaction. Individuals themselves are sometimes becoming the problem solvers, and are proactive in tackling social isolation and loneliness across their communities. All four practices involved have recognised the value of building relationships with the community, and the impact that Prime75+ can have on the health and wellbeing of patients. Ultimately, Prime 75+ is a simple yet hugely effective model that is having a significant impact on patient satisfaction, access to GPs, and avoidable hospital admissions. This initiative has the very real potential to bring about major change across the whole NHS and to successfully tackle loneliness.
Not only is the model impacting significantly on the socialisation, morale and overall health of patients, the project is also seeing huge annual savings being achieved – providing CCGs and the public the reassurance of a high-quality service that is proven to improve health and wellbeing while ensuring that the investment brings value for money. Following the initial successes of the initiative across South Warwickshire, it has now been commissioned by NHS Eastbourne, Hailsham and Seaford CCG and is currently being implemented across four practices across East Sussex, with further roll-outs planned for 2017/18.
1. The King’s Fund analysis of Office for National Statistics 2010-based National Population Projections
2. The Silver Line thesilverline.org.uk/what-we-do/ and itv.com/news/2013-03-07/more-than-half-of-elderly-over-75-now-live-alone/
3. Imison C et al. Older People and Emergency Bed Use: Exploring Variation. King’s Fund 2011
4. NHS England analysis england.nhs.uk/wp-content/uploads/2013/12/cta-tech-Annex.pdf
5. Hibbard JH, Green J. ‘What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs’ Health Affairs, 2013