At work in GP surgeries and health centres

“The Right Prescription”

“Susan”

David’s Story – West Kent

“I cannot believe where I am now. If you had told me a year ago, I wouldn’t have believed you. My life has literally been turned around”

• From being ..a skilled plumber for 35 years• To….three years out of work• Now ….working as an Inspection Officer for a housing

association

“Troll’s” Story - Bristol

“After living on the streets, Tomorrow’s People has given me the confidence to get up and get on with life - and do what I really want to do”

• From being …15 years a Lance Corporal in the Army• To…living under a railway bridge• With a criminal record• Now …looking forward to going to university and becoming a

counsellor

Robert’s Story - Hastings

“I really enjoy my job and I love working with people. It’s what I really wanted. I am so grateful to Tomorrow’s People and the

time they took to help me. They helped me turn a very big corner”

• Bright, sociable, educated, trained engineer – but visually impaired

• 100 job interviews• Now a Sainsbury’s Customer Service Operative

Some Questions

• So what is it about Tomorrow’s People that has helped these clients?

• Why is the GP Surgery model so effective?• What are the health outcomes?• What are the benefits?• How could Locality, LIFT and practice-based commissioning

help?

Who are Tomorrow’s People?

• A specialist employment charity that helps break the cycle of unemployment and deprivation

• For 21 years has worked directly within communities to help the hardest-to-reach groups

• Develops sustainable outcomes:• - 90% of the people we help find a job are

still in employment 3 months later• - 76% still in employment 12 months later

Source: Oxford Economic Forecasting Evaluation

Why is this important? Counting the Cost

• 2.7 million people claim Incapacity Benefit, costing £6.8 bn pa

• Dept of Work & Pensions research shows that the longer someone is off work, the less likely they are to return

• 75% of new IB claimants have more manageable conditions, eg back pain, mild depression, etc

• 50% of IB claimants say they would like to work, if they were given the help and support to do so

• Medical evidence suggests that for such conditions, a return to work can aid long-term recovery

• Source: Five-Year Strategy, DWP, February 2005

Number of people out of work and in benefit‘000

Direct cost of people out of work and on benefit (not including lost tax or indirect benefits – eg Housing Benefit)£m

Long term sickness is a worse problem than ‘pure’ unemployment

1,124

2,420

855

5,466

6,942

2,849

JobseekersAllowance & New Deal

Long term sick

JSA & New Deal

Long term sick

Incapacity Benefit

Income Support*

* Income Support (Disabled) for working age people only

** Cost of directly lost benefits. Not including lost tax or indirect benefits (e.g. Housing Benefit)Source: Department of Work and Pensions, Inland Revenue,

Unemployed people are more frequent users of health services

Unemployment has more impact on happiness than any other life-changing event . . .

. . .and local hospital visits and levels of unemployment are positively correlated

• Being Unemployed

• Being separated

• Being divorced

• Having second quartile income

• Having third quartile income

• Having top quartile income

• Being married

• Being widowed

Correlation with happiness

Source: Eurobarometer Surveys, 1975 – 98, Well-being over time in Britain and the USA, University of Warwick, 2002, University of Hull Business School, Memorandum 43

Correlation with high unemployment

• Hospital Visits

• Low levels of education

• Crime rate

• Poor housing

National Strategy

“Health professionals, wherever they work, need to start from the point of view that getting people back

to work is likely to benefit their long-term health. Return to work must be seen as the norm and .. should be included in treatment plans from the

outset”.• (“Choosing Health: Section 7: para 9).

Tomorrow’s People- GP Surgery Model

What is the model and how does it work?

The model is based upon a pilot based in the James Wigg Practice, Camden, London. One adviser - one day a week.

In 2005, Tomorrow’s People commissioned an independent and in-depth evaluation of the outcomes achieved over three years (Sept 2001-Dec 2004). Evaluation carried out by regeneration consultant Elizabeth Rawson and Nick Boys-Smith of NBS Consulting.

To date, TP Advisers have been co-sited in 80 GP practices across UK, as well as in Pain Management Units

As at August 2006, there was a waiting list of over 500 GPs (representing 831,000+ patients)

Advisers are:• Carefully selected, well trained and supervised• Expert in closely supporting clients as they learn to find a pathway back into work• Expert in helping clients overcome multiple/ complex personal, social and health barriers• Fully integrated into the primary (or secondary) healthcare team• Doctors working particularly in areas of unemployment/ deprivation recognise the value of

the services

Self-referral for one-to-one private sessions in the GP surgery

• Stage One: Working with TP Specialist Employment Adviser:- Problem-solving – and working with other agencies- Re-building confidence and self-esteem- Enabling patient to overcome personal barriers

• Stage Two: Expert training and advice:- Supporting patient’s aspirations in Job search, CV writing,

interview skills; acting as broker with employer

• Stage Three: Sustained outcome- Once a patient gets a job - continuing involvement

to make sure success is permanent

Outcomes for patients who registered in the James Wigg scheme

Outcomes for patients who registered in the James Wigg scheme

20% reduction in GP consultations;

74% reduction in referrals to practice counsellors;

19% reduction in anti-depressant prescriptions (after 18 months being registered with their GP);

15% reduction in anti-depressant prescriptions (after 12 months being registered with their GP)

82% of those patients who gained employment were still working twelve months later

Qualitative benefits

“A peak in consultation and prescribing rates over the 6 months prior to registration suggests that beneficiaries are often in a state of increasing distress, which is to some extent alleviated by meeting with the Employment Adviser….”

• Source: NBS Consulting 2005

Figure 1. AVERAGE MONTHLY CONSULTATION RATES OVER 6, 12 AND 18 MONTHS BEFORE AND AFTER REGISTRATION WITH TOMORROW'S PEOPLE

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

All beneficiaries registered with GPs Beneficiaries registered with GPs for 18months before and after registration with

TP

Beneficiaries registered with GPs for 12months before and after registration with

TP

Rat

e

18 months

12 months

6 months

6 months

12 months

18 months

Before After Before After Before After

Qualitative benefits

• Programme tends to attract patients with complex needs who are likely to have difficulty returning to labour market:

• “The proportion of those suffering from depression is, at almost half, far higher than national figures.”*

• Beneficiaries from BME groups are 44% compared with 27% in the borough as a whole*

• *Source: NBS Consulting 2005

Who benefits?

• Patients and their families: Financial, emotional and health improvements

• GPs and health professionals in Primary/Secondary Care: Reductions in consultations and effective treatment in the surgery Additional resource and alternative to clinical interventions (eg

drug therapies) Time and cost savings

• Government - the NHS and Department of Work and Pensions Meets Government agenda Opportunity to innovate/improve services and gain quality outcomes

• Taxpayer: £720 funded each registered patient on this programme, compared

to £1,101 pp for New Deal for Disabled People (2003)

What GPs are saying

• “GPs at the health centre are excited about the scheme and its achievements so far. They say that it has … helped save about 5 GP consultations per patient involved, … Patients prefer to visit an independent expert here without any fear of the stigma that can sometimes be attached to visiting a job centre or a more formal service that they might find threatening.”

• Dr Roy Macgregor, clinical tutor and senior partner at James Wigg as quoted in General Practitioner, August 2004.

Alignment with government agenda

The patient populations reached by the programme meet government criteria for helping key groups return to work:

The lowest qualified Disabled Lone parents Minority ethnic groups Aged 50+ 30 worst performing local authority districts

How can commissioning help?

“Silos” currently complex and fragmented funding arrangements

Benefits to patients, NHS and the Exchequer but funding generally via Dept of Work and Pension bids (eg

Pathway pilots) from time to time

Demonstrable benefits to local economies through Locality, LIFT and Practice-based commissioning

Black & Minority (%)

* Sustained work defined as % still in work after 6 months. ** Not including cost of ongoing benefits *** Assumes that c.12.5% annual churn of IB claimants. Studies show only 30% of IB leavers go directly into work Source:Tomorrow's People, Hansard, Department of Work and Pensions Statistic, OEF analysis, NBS Consulting analysis

Pilot implies Tomorrow’s People scheme is better at reaching vulnerable groups, more effective, cheaper than comparative schemes

NVQ1 or lower (%)

• Tomorrow’s People GP Pilot

• New Deal

25+

• New Deal Disabled People

• Incapacity

Benefit

Better at reaching the very hardest to help . . .

n/a

Finding work (%)

Sustained work (%)*

. . .more effective at finding sustained work . . .

Gross Cost per job (£)**

. . .and cheaper !

*** **

Scheme offers an unparalleled ROI due its efficiency and success rates

-2,385

10,274

9,150

-720 3,1022,762

Key Drivers

Benefits: Demographic of Income Benefit recipients means average success saves 1 to 5 years benefit savings

Efficiency: Cost to serve each registrant is only £720 – compared to £1,101 (2003) for the New Deal for Disabled People

GPs: Savings to GPs have 4 components (GPs, prescriptions, counselling and fixed costs)

Financial Case

Source: Tomorrow’s People ROI Model, Tomorrow’s People Evaluation Study, DWP, NBS Consulting analysis

• Cost per Job, £

• Cost per Participant, £

• Cost to serve

• GP saving

s

• Benefit Saving

s

• Tax and indirect Savings

• Benefits per job

• In-work benefit costs

423

-3,000

• Cost to serve

• GP savings

• Benefit Saving

s

• Tax and indirect Savings

• Benefits per

participant

• In-work benefit costs

1,837

-906

128

Total Financial Benefits

6,086

• These projects have been quoted as an example of effective good practice by the Prime Minister’s Strategy Unit. The government has described Tomorrow’s People’s projects as an inspiration for a new pilot it hopes to introduce ….

• Source: Health Management, December 2005But one of the most important

things to clients is that this initiative is completely

independent of the system, which so many feel has let

them down.

Summary - Keys to success:

• One-to-one, tailored programmes delivered in heart of local communities

• High quality, well supported, dedicated staff

• Environments of trust and independence

• Sustained, holistic support for hardest to reach populations

• Strong relationships with local employers

• Focus on aftercare

Tomorrow’s People Offer A Unique Combination

Independent Intensive Sustainable

Tomorrow’s People has right experience and organisation to ‘bed-in’ success

Provides ongoing support Organisational experience of

planning and rolling-out intensive job schemes

Unmatched experience from pilot and parallel projects

Experience with mixed funding models and incentives

Wealth of links to private sector

Clients prefer to use a Tomorrow’s People advisor

Independence from government agencies

Service complementary, not judgemental

No risk of losing benefit due to looking for a job

GPs also prefer non-Government non-judgemental advisor

Source: Tomorrow’s People, NBS Consulting interviews with GPs and advisors

Tomorrow’s People has right culture of intensive support

Intensive and attentive service Flexible and entrepreneurial Passion and energy (“not like a

usual Jobcentre”)

Only Tomorrow’s People has right experience to offer;Independence from government;Experience of running intensive job searches;Capability to provide long term support; with

The only organisation with experience of working in GPs’ surgeries