More than 3.5 million people aged 65 and over in the UK currently live alone¹, with 2.9million claiming to have no-one to turn to for help and support². This has an enormous impact on an individual’s health, with links to detrimental effects on blood pressure, mental health, increased emergency hospital admissions, and mortality rates. This subsequently presents a number of major challenges for primary care providers and the wider health and social care system, and, with spending on social care in England having fallen by £770million since 2010³, this is greatly exacerbated by ever-increasing financial constraints.
Tackling loneliness and social isolation amongst the elderly population, and fundamentally changing the way health and social care is delivered, is therefore vital. It can not only improve the quality of life for older people but it can limit dependence on healthcare services and ease the pressures on already over-burdened GP practices across the UK.
What’s the Solution?
Developed and delivered by the team at Prime GP, a comprehensive healthcare organisation, the Prime 75+ initiative places a primary focus on prevention; with coordinated, convenient, safe, and reliable care delivered within general practice in partnership with the local community. Moving away from a traditional model of care focused purely on health issues, the scheme instead looks at the overall physical, mental, and social needs of those aged 75+. Initially commissioned by NHS South Warwickshire CCG in January 2015 and trialled across four of its GP practices, the initiative has now seen further roll-outs and has to-date reached over 6,800 75+ patients across the UK.
How does it work?
Dedicated over 75s Coordinators work alongside clinical and reception staff across participating practices and use risk stratification tools and intelligence to identify patients (who are in some cases frail) at risk of being lonely, and socially isolated. The Coordinators seek the views of the patients themselves to add value and support, and work with them to identify shared interests and activities within the local community that they can participate in and be a part of. Where there are gaps, the coordinators work with the patient and community to organise activities appropriate to the individual’s needs – anything from first aid courses and gardening projects, to mosaic classes and tea parties (including a 20,000 Year Tea Party which saw the collaboration of the biggest over 75 patient group in the history of the NHS).
What impact has it had?
Through communication and engagement with the over 75s, and the use of the developed Prime Monitoring and Impact Tool (MIT), the number of GP appointments made by those identified as potentially lonely and/or social isolated and subsequently seen by the Coordinators has reduced significantly by 20-30%, which can be easily interpreted in terms of hours saved to the GP for non-medical appointments.
A key element of the success of this project has been collaboration between practice staff, patients, and the local community. As well as the acknowledgement that change isn’t something that happens with just one appointment – but when a genuine, trusting relationship is built which replicates that which the patient has with their doctor.
Across the industry, the initiative has received national recognition and was awarded the esteemed Person-Centred Care Innovation title at the West Midlands Academic Health Science Network’s Celebration of Innovation Awards in 2016, in addition to a shortlisting in this year’s HSJ Value in Healthcare Awards (Care of Frail Older Patients).
What does the future hold?
If rolled out nationally, taking into account an average cost of £35 per ten minute appointment, a CCG with a population of 200,000 could potentially save 88,800 GP surgery appointments and £3.1million per year. For the NHS as a whole, this would mean a saving of over 24 million appointments and £236million in avoidable admissions.
Ultimately, Prime75+ is a simple yet hugely effective social prescribing model which is having a significant impact on patient satisfaction, access to GPs, and occurrences of avoidable hospital admissions. With vast improvements to health, wellbeing and morale, this initiative has the very real potential to bring about major change across the NHS and to successfully tackle the loneliness and isolation agenda.
¹ Later Life in the United Kingdom Age UK, Jan 2017, ² TNS Survey for Age UK, Dec 2014, ³Personal Social Services: Expenditure and Unit Costs, England 2012-13
Article written by Tim Coker, Chief Executive of Prime GP PLC