BUILDING THE KEEP WELL LEGACY

Policy origins of Keep Well

“…… preventive, anticipatory care rather than reactive

arrangements. The NHS should work with other public

services and with patients and carers to provide continuous,

anticipatory care to ensure that, as far as possible, health

crises are prevented from happening.”

“targeted action in deprived areas to reach out with

anticipatory care to prevent future ill-health and help

reduce health inequality.”

Delivering for Health, 2005

Policy evolution of Keep Well

2 systematic reviews of primary prevention trials

No surprises in what happened ….

What we learned

anne.scoular@ggc.scot.nhs.uk

Meanwhile….

• 1999: GRASP Programme (*Glasgow’s Responsive Angina 2y Prevention)

• 2004: New GMS Contract • ‘GRASP’ LES • Stroke/TIA & Diabetes models developed

• 2009: Incremental expansion to Clyde area

• 2010: COPD & LVSD models

• 2011: Presentational changes to templates

• 2012-13: ‘Intelligent templates’

• 2013-14: Major strategic review & workforce learning needs analysis/development programme

The Keep Well Legacy Year

The Keep Well Legacy Year: who participated?

The Keep Well Legacy Year: list size

Mean 5,008 95% ci 4,465 to 5,551

The Keep Well Legacy Year: deprivation characteristics

Mean 49% 95% ci 45 to 54%

How practices approached the legacy project

• ~50% draft d/w staff at full practice meeting • ~ 50% 1:1/single discipline discussions • Mainly PM with input from others • ‘Survey’ around practice; practice manager did thematic analysis • final draft action plan discussed at practice meeting in ~1/3 • FU with relevant teams • Minority:

• GP did first draft • initial discussion with KW coordinator • goals/targets defined • regular FU updates after plan agreed • training needs analysis for staff • will continue to use in future • decided no action required!

Innovations: Engagement

• Audit & evaluation methodology

• Brainstormed pt engagement

• Changed invite letters to make them compliant with Accessible Information Policy

• Changed invite letters – now include leaflets about CDM & lifestyle questionnaire

• Contact pts out of hours

• Created own translated posters

• Created DNA policy

• Elicited patient feedback on engagement

• EMIS Alerts to highlight communication needs

• Ensured mobile & other contact numbers up-to-date

• Home visits

• Interpreting services speakerphones

• Link up with community engagement team

• Developed more flexible appointments

• Practice cards/update forms

• Signs showing DNA rates in waiting room

• SMS messaging

• Staff training on engagement methodology

• Survey of non-attenders

• Targeting specific needs groups

• Whole team approach to CDM

• Wider range of contact methods

Innovations: Consultations

• Clinical quality initiative

• Create adequate time for CDM review

• Elicit patient feedback after CDM reviews

• Training: • Training needs analysis • Equalities & diversity training • Motivational interviewing • Unspecified

• Extend HCSWs role into CDM clinics • more PN time with pts • HCA foot checks

• Reviewed interpreting policy

• Learn from SEAs on consultation issues

• MDTs on CDM pts

• More customised appointments depending on disease category

• PN visits pts at home

• Strengthened goal setting

• Links worker support

Innovations: Consultations

• Complete loop on outcome following service referral

• Created own version of HImp Directory

• Got to know new services

• Getting closer to services

• Health promoting environment

• Become familiar with Health Improvement Directory

• Maintain Keep Well ethos

• Training on services & pathways

• Created or sourced written materials

• Used ALISS

• A small minority - no innovation!

Challenges & Barriers

• Access to training

• Time capacity

• Working as one team

• Doing things Health Board does

• Developing Keep Well ethos • wider group of staff • tensions with QOF

• Logistic challenges

• Loss of experienced staff

• Multiple daily issues in General Practice

• Moving to a new Health Board

• Obtaining and maintaining contact nos

• Part time staff

• Patient 'buy-in'

• Patient adaptation to changed system

• Seeking out external services

• Sustaining change

• NONE!

Questions for other practices

• Outcomes from these KW innovations

• SEAs

• Successes & challenges in CDM

• Why are you sure this (eg) would work?

• Did you really learn anything NEW?

• How did you get staff to use x?

• How best to involve HCAs in CDM

• How do you find support services?

• How hard was it to do xxx?

• How did you find time to do xxx?

• Links workers

• Pts attending practice meetings

• Can you share your feedback tools

• Can you share info ~ the services you found useful?

• Systems & processes eg FU after HI referral

• How to target specific service users

• Practice website for updating patient contact information

• NONE !

Conclusions

• Toolkit successfully identified ‘starters for ten’

• Webinars worked well

• Practices engaged well with approach to problem solving

• Appetite for joint solutions focused approach

• CDM programme should move forward as a collaborative

• Build on learning from KW legacy year • Specific • Programme level