Between 20% and 60% patients attending their GP have underlying social problems that primary care is ill-equipped to respond to. Resulting in a revolving door of increasing medicalization of social problems creating high cost and (failure) demand at the NHS front door. Through ICE (a strategic alliance of public and VC&SE organisations working together to design and test better ways of providing public services), over 2 years we have worked together with local GPs to design and test social prescribing schemes to offer alternatives to traditional services to see if helping people to do more to help themselves reduces demand.
Feedback about the Wellbeing Exeter (WE) is overwhelmingly positive and reflected in the health, wellbeing and activation outcome scores recorded by clients. People typically enter with a low mental wellbeing score (7 points lower than national average) with :-
•85% showing improvement in at least 1 of measures, 54% in at least 2 and 15% in all 4
•54% showed improved mental wellbeing, decreased loneliness and increased levels of social inclusion
•46% showed increased levels of motivation. Service utilisation analysis indicates that WE approach has the potential to reduce future demand on primary care, unplanned hospital care, planned outpatients and social care. As we move to the mainstreaming phase we are predicting a rate of return of £2.3 for every £1 spent.
Our evaluation methodology, now firmly embedded, will enable us to pinpoint, real time where reductions in demand actually manifest. The ability to track cause and effect is the “Holy Grail” of complex social interventions and there is widespread support to extend our experiment given the positive outcomes reported by clients, GPs and delivery partners and the growing confidence in the evaluation framework.
Co-production is at the heart of all ICE programmes and the Wellbeing Exeter part of the collaboration consists of:
•11 GP practices
•6 VC&SE organisations (including patient participation groups)
•Devon County Council
•Exeter City Council
•New Devon CCG
•Royal Devon & Exeter NHS FT
Co- designed from the outset with all delivery partners;
WE started with 3 GP practices in 2015 and by 2017 expanded to 11. WE is now a resilient collaboration with all partners successfully advocating for its mainstreaming and expansion with GPs across Devon wanting to get involved.
This was achieved by:
•Being part of the wider ecosystem of change through ICE architecture creating a test and learn environment
•Strategic VC&SE sector leadership
•Investment in strong clinical leadership
•Iterative design process based on Human Services Design methodologies
•Changing clinical practice from “what is the matter with you” to “What matters to you”
•Qualitative patient feedback loops built into the design process
•Regular network and delivery partner meetings and workshops
•Integrated workforce training and development
•Qualitative process and outcome evaluation built in
•Real time feedback loops tracking activity, experience and outcomes
•Quantitative evaluation framework enabled by ICE information sharing agreements and risk stratification and pathway costing tool enabling the tracking of WE clients across the system over time.
•Wellbeing Exeter branding
•Wellbeing Exeter is successfully delivering the type of support that is highly needed, yet unavailable for patients within primary care.
•The approach is identifying people who are most likely to benefit from social prescribing, reaching people who are the least likely to self-refer.
•Through connecting and one-on-work, WE is helping people to improve their mental wellbeing, reduce loneliness, engage with their community and manage their own health.
•85% of clients showing measurable improvements in mental health and wellbeing.
•Wellbeing Exeter has the potential to reduce demand on statutory services (generating a rate of return @ £2.3 for every £1 spent).
Wellbeing Exeter is at the forefront of thinking in terms health and “interdependence” through community connection. Therefore we have weathered some storms but ultimately the programme is delivering and represents a radical and transformative approach to system-wide thinking and collaboration between the public and VC&SE sectors. Expansion is being planned, funded by local authorities, NHS and social investors, to cover a population of @396,000 across 49 GP practices by 2020. The confidence to continue the journey and invest further is an indictment of the quality of collaboration with demonstrable changes in culture and practice at senior leadership levels.