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Lastedited:05.10.2017
October2017
EvaluationoftheEastMertonSocialPrescribingPilotMid-ProgrammeReport-JanuarytoOctober2017AshleeMulimba,RadhikaPuriandJoelMulimba
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TableofContentsKeyFindingstodate.........................................................................................................................................4
EastMertonModelofHealthandWellbeing..........................................................6
WhatisSocialPrescribing?.....................................................................................6
TheEastMertonSocialPrescribingPilot................................................................7Bi-MonthlyProgressReport.......................................................................................................................10
StakeholderSemi-StructuredInterviews..............................................................11HopesforSocialPrescribingPilot............................................................................................................11HopesforSPEvaluation...............................................................................................................................12Barrierstomobilisation/ConcernsaboutSPpilot............................................................................13Successes/Enablers.........................................................................................................................................15SuccessfulPlanning........................................................................................................................................15ChampionsofthePilot..................................................................................................................................16
Recommendationsforfutureprogrammes.........................................................................................17
GPPracticeFocusGroups.....................................................................................18ThePatientJourney........................................................................................................................................18IdentifyingPatients........................................................................................................................................19Makingthereferral.........................................................................................................................................19ThenumberofpatientsseenbytheSPC................................................................................................20Whomakesthereferrals..............................................................................................................................21Feedbackfollowingareferral....................................................................................................................22Impact...................................................................................................................................................................22
Recommendations..........................................................................................................................................23
EndServicesSemi-StructuredInterviews..............................................................24FirstContactwithSocialPrescribingPilot..........................................................................................24ReferralPathwayandCommunication..................................................................................................25Numbersanddemographicsofpatientssignposted........................................................................26CapacityofEndServices...............................................................................................................................27ScalabilityConsiderations...........................................................................................................................27LimitationsofSPPilot...................................................................................................................................29
Recommendations..........................................................................................................................................30
Mid-yearData......................................................................................................32PatientDemographics...................................................................................................................................32ReasonsforReferral......................................................................................................................................33Wellbeing............................................................................................................................................................34ImpactonGPAppointments......................................................................................................................37
SocialPrescribingObservations............................................................................40Observationmethodology............................................................................................................................40TheSocialPrescribingconsultation........................................................................................................40Whatwentwell.................................................................................................................................................41
Whatcanbeimprovedandrecommendations..................................................................................41FollowupdiscussionwiththeSocialPrescribingCoordinatorinAugust2017..................42
NextstepsforEvaluation.....................................................................................43
6.Appendices.......................................................................................................44
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AppendixA:SocialPrescribingPilotLogicModel............................................................................44AppendixB:SpecificationDeliverablesandMilestones................................................................45MilestonesandRAGrating..........................................................................................................................46AppendixC:SPObservationforms..........................................................................................................48
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ExecutiveSummaryHealthyDialoguesisconductingaformativeandsummativeevaluationoftheSocial
Prescribing Pilot Programme for East Merton. The evaluation looks at processes,
pathwaysandpatientandserviceoutcomes.
This is themid-year report andwill be followedbyBi-monthly updated reports in
December 2017 and February 2018. In this report, we explore views of the
stakeholders, practice staff and end services. We take a look at who is being
referred,theiroutcomesandanyimpactonGPappointmentsandwealsofeedback
onSocialPrescribingappointmentobservations.
KeyFindingstodate
Overallthepilothasbeensetupsuccessfullyandisrunningsmoothly.Stakeholders
attributethistogoodplanningintheinitialstages,thedriveandexpertiseoftheGP
leads and the skills and breadth of local knowledge of the Social Prescribing
Coordinator(SPC).
Therecommendationthemesinclude:
- Strongerengagementwiththepracticestaffandendservicestoensurethey
buy-intotheprogramme.
- Toco-designtheprocessesofmakingareferralfromthepracticetotheSPC
andfromtheSPCtoendservicessothattheyarefeasibleforallparties.
- Toco-designclearerdatacaptureandcommunicationmechanismswiththe
EndServicessothatthepatientoutcomescanbetracked.
The mid-year data shows that the biggest uptake for the Social Prescribing
programmeisfromfemalesofwhiteethnicity.Thebiggestreasonforreferraltothe
SPC remainsmild ormoderatemental health issues. Findings show a statistically
significantimprovementinpatient’soverallwellbeingbetweenfirstandmostrecent
Social Prescribing appointment. Additionally, there is a significant reduction in the
number of GP appointments for patients who have been through the Social
Prescribingprogramme.
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StrategicContextThecaseforcommunity-basedmodelsforhealthandwellbeingpromotionsuchas
Social Prescribing is strong. The Five Year Forward View emphasises that NHS
systems are increasingly under pressure as our population lives longerwithmore
complexhealthissues.1DemandsonGPservicesarealsoincreasingatatimewhen
fundingandworkforceresourcesarereducing.2
ThesustainabilityofNHSanditssystemsrelyonaradicalupgradeofpreventionand
publichealthwork.TheFiveYearForwardViewhighlightsseveralwaysinwhichthis
canbeachieved,including:
- Empoweringpatientsbyimprovingtheiraccesstotherightinformation
- Supportingpatientstomanagetheirownhealth
- Buildingstrongerpartnershipswiththecommunityandvoluntarysectors.1
Additionally,theCareActof2014putsdutiesandresponsibilitiesonlocalauthorities
topromotewellbeingandensurepeoplehaveaccesstotheinformationandadvice
theyneedtomakedecisionsabouttheircareandsupport.Existingresourcesfrom
withinthelocalcommunitycanensurethatpeoplewholiveintheirareahaveaccess
toarangeofhighquality,appropriateservicestochoosefrom.3
SouthwestLondonSustainabilityandTransformationplangoesonestepfurtherwith
ambitions to deliver more care in the community, implementing robust
multidisciplinarycommunityworkingsupportedbySocialPrescribing.4
1NHS(2014)FiveYearForwardView.Accessedat:https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf2Bairdetal.(2016)Understandingpressuresingeneralpractice.TheKing’sFund.3CareAct2014,Chapter23,accessedat:http://www.legislation.gov.uk/ukpga/2014/23/pdfs/ukpga_20140023_en.pdf4SouthwestLondonCollaborativeCommissioningGroup(2016)SouthwestLondonSustainabilityPlan.
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EastMertonModelofHealthandWellbeingIn2014apopulationhealthneedsassessmentfoundthatpeopledieyoungerinEast
MertonwhencomparedwithWestMerton,particularlyfromcardiovasculardisease
and cancer, with larger differences seen in younger people. This report looked at
existing community-basedmodels to transform care for long-term conditions and
highlighted the opportunity tomake imaginative and effective use of community-
basedapproaches.5
In responseto this,MertonCCGandtheLondonBoroughofMertonPublicHealth
teamhavedevelopedanewmodelofcaretomeetthehealthandsocialcareneeds
for the people of EastMerton, including thosewho arewell and thosewho have
serious health conditions and needs. This East Merton Health and Wellbeing
programmeisablueprintfortransformationacrosstheboroughthatworksbeyond
servicedeliveryandlookstobuildanddevelopasocialmodelofhealththatlooksat
the wellbeing of individuals. Additionally, it looks to address the gap between
shrinkingNHSresourcesandincreasingdemandonservices.
One of the programmes within this strategy is to pilot a Social Prescribing
programme that utilises a collaborative pathway designed to free up General
Practitioners(GP)professionaltimewhileconnectingpeopletotheircommunityand
resources.
WhatisSocialPrescribing?SocialPrescribingisawayoflinkingpatientsinprimarycarewithsourcesofsupport
within thecommunity. ItprovidesGPswithanon-medical referraloption thatcan
operate alongside existing treatments to improve health and well-being, such as
leisure,socialactivities,education,welfare,housingandemployment.6
5Dent,T.(2014).TheHealthNeedsofMerton.PHAST.Accessedat:http://www2.merton.gov.uk/merton_the_health_needs_of_east_merton.pdf6CentreforReviewsandDissemination(2015).EvidencetoInformtheCommissioningofSocialPrescribing.UniversityofYork.
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A recent review of the evidence found that there is little in the way of robust
evaluative research into the effects of Social Prescribing,6 however these studies
indicate improvement in patient engagement and wellbeing following the
intervention. For example, wellbeing Social Prescribing programme based in
Rotherham found that patients showed significant improvement in wellbeing,
depressionandanxietyandapotentialreductioninGPappointmentsthreemonths
followingaSocialPrescribingintervention.7
ADundeeprogrammereportedthatpatients,includingthosewhocanbedifficultto
engage and support, found the scheme appropriate to their needs, helpful and
accessible with a range of activities and support. Additionally, pre- and post-
intervention data shows significant improvements in wellbeing and functional
ability.8
A Tower Hamlets six-month pilot scheme showed that patients got involved in a
range of activities as a result of the Social Prescribing intervention including
volunteering, taking a course, gaining a qualification, stopping smoking, starting a
hobbyandgainingcontrolovertheirfinancialsituation.35%ofpatientstookupone
or two referred services and 75% stated that their issue was partially or fully
resolvedandthattheyweresatisfiedfollowingtheintervention.9
TheEastMertonSocialPrescribingPilotThe EastMerton Social Prescribing pilot programme is funded for one year from
January to December 2017. The pilot was guided by an implementation group of
stakeholders from the community and voluntary sector, CCG, Local Authority and
General Practice. It is delivered by the Merton Voluntary Service Council’s Social
PrescribingCoordinator(SCP).
7Kimberlee,R.,Jones,M.andPowell,J.(2013)Measuringtheeconomicimpactofthewellspringhealthylivingcentre'ssocialprescribingwellbeingprogrammeforlowlevelmentalhealthissuesencounteredbyGPservices.ProjectReport.SouthWestForum,UK.8Frieldli,L.etal(2012).EvaluationofDundeeEquallyWellSourcesofSupport:SocialPrescribinginMaryfield.EvaluationReportFour.9Hogarth,S.etal(2013)SocialPrescriberPilotProjectEvaluation,January–June2013.TheBromleybyBowCentre
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The Pilot aims to promote self-help, social engagement and resilience to its
populationinEastMerton.Itwilldothisby:
- Providing a model of service delivery that connects medical care with local
resources
- Establishing a collaborative pathway between the voluntary, primary care and
statutoryandcommunityservices.
Theoverarchingaimsofthepilotareto:
1. Improvethehealthandwellbeingofpatientsbyprovidingaccesstonon-medical
support
2. Reduce general practice clinicalworkload and increase skill-mixwithin primary
care
3. Reduceavoidablecosts,includingA&Eattendancesandhospitaladmissions
TwoGPpractices inEastMerton;TamworthHouseMedicalCentreandWideWay
MedicalCentre,wereselectedtohostthepilotprogramme.Thesewerechosenas
pilotsitesastheyareideallylocatedandservethedemographicdeemedtobenefit
most from a Social Prescribing service. Return on investment estimates were
calculatedbasedon19evidence-basedhealthandwellbeinglocal-basedinitiatives.
They show that in 2016/17, 324 patients from Tamworth House Medical Centre
wouldhavebenefittedfromSocialPrescribingactivitieshadtheybeenavailable.This
wouldhave led toa savingof£140,374onplannedandunplannedcare.Similarly,
292 patients from Wide Way Medical Centre would have benefitted, with an
estimatedsavingof£84,935forplannedandunplannedcare.10
10Braun(2017)ImpactAnalysisofSocialPrescribingonlocalHealthEconomies:http://i5health.com/SPDashboard#
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MethodologyThisresearchaimstoassesshoweffectivetheSocialPrescribingpilotisinimproving
thehealthandwellbeingofpatientsandreducingtheGPpracticeclinicalworkload.
Using a mixed-methods approach, this evaluation seeks to review the referral
pathway andpotential scalability of themodel. Itwill also explore the facilitators,
barriersandkeyeffectiveingredients.
A logicmodel (Appendix A)maps out the outputs, inputs and intended outcomes
that we are evaluating. The logic model will serve as a theory of change for this
evaluation and will conclude in an overall summary of the outcomes and
embeddednessoftheSocialPrescribingpilot.
Theevaluationwillbeconducted intwophasesandwill trackthedevelopmentof
theSocialPrescribing(SP)Pilot,itsimpactandpotential.
Phase1(0-6months) Phase2(7-12months)• Establishingprocessoutcomes
• Collating and analysing baseline
quantitativedata
• Gathering information and feedback
fromstakeholdersonmobilisationof
SPPilot
• ObservationsofSPCconsultations
• Hopes and expectations within 12-
monthpilotandbeyond
• Capturing qualitative information
from all stakeholders including end
usersandservicesaround5keyareas
- Pathway
- Access
- Engagement
- Communicationanddatatransfer
- Scalability
• Longer-term outcomes such as
impact on local population and
embeddedness
• Collation and analysis of 3 and 6-
month post referral data to enable
comparison against baseline to
assessimpactonpatientoutcomes.
Appendix2outlinestheevaluationmilestonesandtimelines.
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Bi-MonthlyProgressReport
Healthy Dialogues will be producing bi-monthly progress reports to support the
businesscaseforfurtherSocialPrescribingprogrammesforacrossEastMerton.
This second report is themidyear reportwhich isanupdateon the first,baseline
report. It sets out findings from interviewswith stakeholders and leads from End
ServicesandfocusgroupswiththeClinicalStaffwithinthepractices.Inaddition,it
outlines findings from the patient data on who is being referred, health and
wellbeingoutcomesandGPappointmentchanges.
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Findings
StakeholderSemi-StructuredInterviewsThreestakeholdersidentifiedfromtheImplementationGroupwereinterviewedto
elicittheirviewsontheSPpilot,mobilisationprocessandexpectationsforthis
evaluation.Thestakeholderswere:
- RayHautot,SocialPrescribingCoordinator
- KhadiruMahdi,ChiefExecutiveoftheMCVS
- AmandaKilloran,FormerPublicHealthConsultantatLondonBoroughofMerton
- MohanSekeram,GPLeadforSocialPrescribingfromWideWayMedicalCentre.
- JohnDimmer,HeadofPolicy,StrategyandPartnershipsforLondonBoroughof
Merton.
- Anne-Marie Liew, former Community Development Coordinator for London
BoroughofMerton
- DrDouglasHing,GPandMertonCCGClinicalDirector
Semi-structured interviews using open-ended questions were conducted to allow
these stakeholders to express their ownperspective in detail. The questionswere
developedbasedon theprocessesoutlined in the logicmodel (AppendixA). Each
interview lasted between 20-60minutes. Theywere recorded and analysed using
theoretical thematic analysis. 11 The key themes around hopes, challenges and
successareoutlined.
HopesforSocialPrescribingPilot
“WewantGPsrecognisingthattheyareacommunityorganisation”-KhadiruMahdi
“Givingpeopleanotheroutletbyshowingthemotherwaysofsustainingtheirwellbeing.”
-KhadiruMahdi
11Braun,V.andClarke,V.(2006)Usingthematicanalysisinpsychology.QualitativeResearchinPsychology[online].3(2),pp.77-101.
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StakeholdersareverypositiveabouttheSPpilotandfeelthatitfitswellwithinthe
strategiccontextofEastMerton.Stakeholderexpectations/hopesinclude:
- Demonstrationofasuccessfulmodelofdeliverythatconnectsbio-medicalcare
tocommunityresourcesandfitswiththeEastMertoncontext
- Health and wellbeing improvement in residents by providing access to non-
medicalsupportthataddressestheirwiderneeds
- Demonstrationthatitisasustainablemodel
- Establish a collaborative pathway between primary care voluntary, community
andstatutoryservicesandutilisecommunityresourcesmoreeffectively
- Establish a practice learning network as part ofwider transformationwork for
EastMerton
HopesforSPEvaluation“WewanttounderstandwhatthemosteffectiveSocialPrescribingpathwayis,
particularlyasembeddedinGeneralPractice,ifrobustcanbeplannedtobetakenupinpracticesinEastMerton”
-AmandaKilloran
There are several key research questions the stakeholders hope to explore in the
SocialPrescribingpilot.Theseinclude:
1. Communityresources:Arewemakingbestuseofexistingcommunityresources
andoffering things like access to reading and gardening clubs?Whatdoes the
evaluationrecommendforthevolunteeringstrategy?
2. Patientoutcomes:Arewe seeing improvedwellbeingofpatients as a resultof
the Social Prescribing intervention? Are we demonstrating good outcomes for
patientswhoarenotbenefitingfrommedicalinterventions?
3. GP workload: Is the SP pilot resulting in fewer GP appointments for these
patients? Or if patients are engaging in their own healthmore, will it lead to
moreGPappointments?
4. A formative evaluation: There is a general consensus among the stakeholder
groupthattheywanttounderstandthe‘nutsandbolts’ofhowthepathwayis
working.
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5. Strengths and weaknesses: Overall the stakeholder group would like to know
whatisworkingwellandwhatcanbeimprovedtoensurecost-effectivenessand
embeddednessoftheSocialPrescribingprogramme.
6. SharingLearning:Providetheevidencethatthisisworking,notjustaboutthe
patients,toensurethatwehavesomelearningfortheGPs,sotheycanseethat
thisismakingadifferenceforthepatients.
Barrierstomobilisation/ConcernsaboutSPpilotWeaskedthestakeholdersquestionsaroundthechallengesandbarrierstosetting
upthisSocialPrescribingPilot.Thegeneralconsensusfromthegroupswasthatany
potentialchallengeswereanticipatedandaddressedearlyonduringmobilisation.
“Iamveryproudthattheprogrammeisupandrunningsosuccessfullyandthiscanbeseenhighnumberpatientsarealreadygoingthrough.”
-AmandaKilloran
The steering group was able to draw from learning from a previous Community
Navigator programme in Merton that some members had been leading on. Key
learning points from this programme showed that good visibility and engagement
withtheGPswaskeytoensuringtheprogrammeiswelcomeandconnectedtothe
systems within the practice. Setting up IT systems such as EMIS and establishing
wheretheSocialPrescriberCoordinatorwillbebasedwithinthepracticetakestime
toagreeandarrange.TheEastMertonPilotteamensuredthatthesesystemswere
set upprior to the SPC coming intopost and someof theengagementwithin the
practiceshadbegin.Thisenabledhimtostartseeingpatientsrightattheoutset.
One stakeholder reported that the set up did take some time and recommended
thatmoretimeandresourcesshouldbeallowedtopreparefortheimplementation
phaseaheadofthegolivedate.
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“Fleshingoutthefinerdetailsoflogisticsisjustasimportantastheoverallvisionto
puttingitintopractice”
- AnneMarieLeiw
She recommended providing a briefing to every staff member at the practices,
including reception staff, so that everyone knows what is going on, has an
opportunitytoaskquestionsandfeelsthattheirparttoplayisvalued.
“Everypracticememberisanimportantpartofthecogintheprocessandshould
feelpartofthewiderdialogue”
-AnneMarieLeiw
ShehighlightedtheimportanceofenablingtheSPCandpracticestafftofeedbackto
eachotheroncetheprogramme isupandrunning, onhow it isworkingandhow
the patients are responding to it. She also recommended that co-design of the
programmewithacross-sectionofthepracticestafffromtheonsetwillencourage
genuinebuyinatalllevelsratherthansimplyinname.
TheSPCalsohighlightedthatthereissubstantialtrainingthatisrequiredbeforean
SPCisreadytousethesystemswithinthepracticeandseepatientsandthisneeds
tobeaccountedforwithintheimplementationphase.
Allstakeholdersraisedconcernsaroundthecapacityofcommunityservices inEast
Mertonandtheirabilitytodealwiththeincreasedvolumeofreferralsgeneratedvia
theSPserviceonceitgainedmomentum.Therewasalsoaconcernwhetherexisting
services catered to the needs of ethnic minority populations. In some cases the
patientsdonotmeetthecriteriafortheendservicesastheyresideoutsideofthe
borough,inthesecasestheSPClookstoservicesbeyondEastMerton.
With regards to delivering Social Prescribing, the method for measuring patients’
wellbeing is throughuseoftheWellbeingStar.TheSPChighlightedthatthis isnot
alwaysappropriateforpatients,particularlyiftherearecommunicationissuessuch
15
as a language barrier or literacy issue, or if there the patient is distressed.
AdditionallythereferralformsarenotalwayscompletedinfullbytheGPswhichcan
leavetheSPCfeelingnotfullypreparedforhispatient,althoughtheinformationcan
befoundwithinthepatient’srecords.
Successes/Enablers
Overallthestakeholdergroupspokeverypositivelyaboutthepilotprogrammeand
attributeditssuccessfulsetuptoseveralfactorsincluding:
- CommitmentandsharedexpertiseoftheImplementationGroup
- Using learning from SP pilots across the country and carefully planning
mobilisationoftheprogramme
- FlexibilityandsimplicityoftheserviceandEndServicestomeetthediverseand
oftencomplexneedsofthepatients
SuccessfulPlanningThe stakeholders discussed a number of factors that they addressed in the
mobilisationphasetoensurethat it isembeddedwithintheGPpractices fromthe
outset.Thesewereanticipatedbybuildingonlearningfromotherprogrammesand
included:
- Strong engagement within the Implementation Group to ensure all key
stakeholdersagreedwhattheSocialPrescribingmodellookedlikeandwhat
thereferralcriteriawas.
- Using the existing systemswithin the practices to ensure that SPC is easily
embeddedwithinGPPractices
- StrongengagementandvisibilitywithallPracticestaffandpatients
- EnsuringearlysetupofITsystemsensuringSPChadaccesstopatient’scase
managementsystemsandcouldbookpatientappointmentsstraightaway
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ChampionsofthePilotOneofthestakeholdersdiscussedthestrongsenseofcommitmenttothepilotand
theadvantageof havingupfront funding from theCCGand the LocalAuthority to
strengthenstrategiccommitment.
TheleadGPswerekeyintranslatingthe‘blue-sky’ideaswithinthepilotstrategyinto
practicalsolutions,draftingtheprojectplan,andvisualisingthepathway.Theyalso
leadandchampionedtheprogrammewithintheirPractices.
The SPC is also seen as a key contributor to the success of the pilot so far. His
experience andbackground gives him skills and competence to deliver effectively.
Hislocalknowledgeandnetworksenablesanunderstandingofwhatwidersupport
isavailableforpatientsinthecommunity.Hisgoodlisteningskillsenableseffective
consultations.
“Fortunately,wehadsomebodywhounderstandstheboroughverywellandunderstandsthe
communitysectorverywell,healsoengagedwiththestaffinthepracticesverywell.”
-KhadiruMahdi
Additionally,thecommunityorganisationshavebeenwillinglytakingonthereferrals
fromthepatientsandthepatientshavebeenutilisingthisresource.
“Wehave10minutesappointmentsandwearecurrentlygeareduptowardsamedical
modelwherewegivesomethingtothepatientstotakeawaywiththem…whenpatients
raisesocialissues…wecannowcapturethatandreallymakeadifferenceandsayIknow
someonewhocanhelpwiththat.”
-MohanSekeram
“The[SPC]isabletodealwithconcernsthatwerebeyondremitofthe[SPC]…andtheGPcan
seestraightawaytheinterventionandwhathashappenedinthefollowup.”
-KhadiruMahdi
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Recommendationsforfutureprogrammes
Recommendation1:Futureprogrammesshouldoutlinetherolesandresponsibilities
oftheSPCandeachmemberofthepracticeteamfromtheverystart.
Recommendation 2: Clear communication channels should be outlined to include
opportunities to reflecton theprocessesof theprogrammeand theoutcomes for
patients.
Recommendation3:Allowsufficienttimefortheplanningforthelogisticsofsetup
fortheSPCwithinthepracticeandit’sprocesses.
Recommendation 4: Co-design the programmewith the practice team so that the
SocialPrescribingpathwayfitsneatlywithinthepracticesprocessesandthepractice
staffhaveboughtintoit.
Recommendation5:TimefortrainingandengagementwithinthePracticeandEnd
ServicesneedstobetakenintoaccountwhenrecruitingnewSPCsandplanningtheir
mobilisation.
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GPPracticeFocusGroups
ToexploretheSocialPrescribingprogrammefromaclinician’spointofviewweheld
afocusgroupateachpilotpractice.ParticipantsincludedGPs,GPRegistrars,
PracticeNursesandaCCGPrescribingPharmacist.
WeaskedtheClinicalTeamateachpracticetomapoutapatient’sSocialPrescribing
pathwayfromtheGPsviewpoint.
Theydescribedtheprocessestowhichpatientsareidentifiedandreferredtothe
SocialPrescribingappointmentandwhathappensnext.Ateachstagetheywere
askedtodescribewhatworkedwellandwhatcouldbeimproved.Keythemesand
recommendationsareoutlinebelow.
ThePatientJourneyEachpatientjourneycanvarydependingonhowtheyareidentified,whattheir
needsareandhowtheyrespondtotheservice.Figure1outlineswhatatypical
patientjourneycanlooklikefromtheeyesofaclinician.
Figure1:Patientjourneyfromclinicianperspective
1 PatientisidentifiedbyapracticestaffmemberandisgivenaSocialPrescribing
booklet.
2 TheGPwillseethepatientandifthepatientiswillingtheGPwillmakeareferral
totheSPC 3 ThepracticeadministratorreceivesthereferralformandforwardsittotheSPC
4 TheSPCreviewsthepatient’snotes,makesaTriagecallandbooksan
appointment
5
TheSPCseesthepatientandupdatesthepatientnotesonEMIS
19
IdentifyingPatientsPatientsareidentifiedthroughanumberofmeansforexample,throughGP
appointments,lunchtimediscussionsbetweencliniciansandduringpatient
dressings.AdditionallyWidewayMedicalCentrediscusshowthereceptionteam
havebeengreatatidentifyingpatientswhentheycomeinforfrequent
appointments,orwhenapatientsexpressesaneedthatcannotbeaddressedbythe
medicalteam.TamworthHouseMedicalCentrehavenotyetinvolvedtheir
receptionteaminidentifyingpatients.
Therearevastdifferencesbetweenthepracticesinthenumbersofpatientsbeing
referred.WidewayMedicalCentrearereferringsomanythattheSPChasbuilta
waitinglist,whereasTamworthHouseMedicalCentredonotfillalltheSPC
appointments.TamworthHouseMedicalCentrediscussedhowtheywouldlikemore
informationfromWidewayMedicalCentreonwhotheyarereferringthroughand
howtheyareidentifyingthem.
MakingthereferralTheteamatTamworthHouseMedicalCentredescribea“three-step”approachto
makingthereferral(seefigure2):
- Codingthereferraltype
- FillinginthereferralformforadministrationteamtoemailtotheSPC
- Givingthepatienttheleaflet
Theyfeltthatthiscouldbesimplifiedbychangingthereferraltoa1-2lineemailsent
directlytotheSPC.TheSPCcanlookupadditionalinformationthroughthepatient
notesheldontheEMIS.
Conversely,WidewayMedicalCentrefeltthereferralprocesswasrelativelysimple
astheirreferralformsareautomaticallypopulatedbytheEMISsystem.Theydidnot
feelanyvaluablechangescouldbemade.
20
Figure2:TamworthHouseMedicalCentre’sFocusGroupFeedback
ThenumberofpatientsseenbytheSPCTherewassomediscussioninbothmeetingsregardinghowmanypatientstheSPC
booksforeachday.CurrentlytheSPCreserves45minutesforeachpatient.Healso
allowsfor15minutesbeforeandaftereachappointmenttoreviewandupdate
patientnotes,makereferralsandplanning.Althoughbothpracticeswouldlikemore
patientsseeninaday,theybothrecognisedthevalueofallowingthepatientto
havethattimewiththeSPC.
Bothpracticesidentifiedtheopportunitytointroducesomeflexibilitytothe
appointments,forexample,sometimecouldbeallocatedfordrop-insessions.
Internet,telephoneandvideoappointmentswerealsodiscussedasanoptionto
explorefurtherwiththeideathatitcanfreeupsomeappointmenttimeandbe
flexibletothepatientsneeds(seefigure3asexample).
21
Figure3:WidewayMedicalCentre’sFocusGroupFeedback
WhomakesthereferralsAtpresent,referralstotheSPCarebythepracticeGPsonly.Bothpracticesdiscussed
howthiscouldbeopenedupsomewhattobroadenthereachoftheSPCandto
lessentheworkloadoftheGP.Currentlyifthepracticenurseorreceptionist
identifiesapatientwhomaybenefittheSPC,theyhavetoinformtheGPwhothen
makesthereferral.
Practicenurses,pharmacistsandperhapsevenreceptionswerediscussedas
options.
22
FeedbackfollowingareferralTheTamworthHouseMedicalCentreteamexpressedthattheywouldlikemore
updatesfromtheSPContheirpatients’progress.Thiscouldbeintheformof
regularverbalfeedbackat,forexample,teammeetings,orviaanemailedsummary.
Theyfeltthatthiswouldhelpthemseemoreofthevalueoftheserviceforthe
patient.Thesummaryshouldinclude:
1. Howmanypatientsarereferred
2. Howmanypatientsareseen
3. Whatfurtherfollow-upsorplanshavebeenmade
The teamwelcomedtheSPC toattend their teammeetingsand join them in their
discussionsregardingeligiblepatientsandtheprogressoftheirpatients.
ImpactWidewayMedical Centre have begun to see the impact of the Social Prescribing
programmeontheirpatients.Theyhavefoundthatoneortwofrequentattenders
havebeenattendinglessfrequently.
“Patientswhocomeinfordepressionandareprescribedanti-depressantsoftencomeback
lessdepressedandnolongerneedingtheirmedicationbecausetheyhavebeenreferredto
thesocialprescriberforarelatedissuelikehousingorloneliness”
BothpracticesfeltthatthepresenceoftheSPCinthepracticewasverypositiveas
thereisaneedfortheserviceandtheSPChasmoretimetobeabletospendwith
patients.
“Weoftenseepatientsthatwecan’tdoanythingforbecausetheirissuesareabouttheir
housing,financesorisolation,itisreallyvaluabletohavethatoptionwithinthesurgeryfor
thepatient.”
- WidewayMedicalCentre
23
Recommendations
Recommendation1:TheSocialPrescribingCoordinatorattendsteammeetingsat
bothpracticestoraisetheprofileoftheprogrammeandtoupdatecliniciansontheir
patient’sprogress.
Recommendation2:Futurereferralprocessesshouldbeco-designedwitheach
practicesothatitissufficientenoughtomeetstheneedsoftheSPCyetfitswithin
theproceduresofthepractice.
Recommendation3:Reviewthedifferencesbetweenpracticeswithregardstowhich
patientsarebeingreferredtotheSPCandwhereimprovementscanbemade.This
canhelpthepracticestoknowwhatpatientswouldbenefitmostfromthe
programmeandwillsupportTamworthHouseMedicalCentretoidentifymore
patientsfortheprogramme.
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EndServicesSemi-StructuredInterviews
To understand how the Social Prescribing programme works alongside the end
services,wespoketofourservicesthattheSocialPrescribingCoordinatorhasbeen
referringpatientsinto,theseare:
- CommonsideCommunityDevelopmentTrust
- AgeUKMerton
- MertonIAPTservice
- MertonCouncilofVoluntarySector’svolunteeringservice.
Themain aimwas to understand referral pathways, communication between the
SPCandendservices,whattheythoughtabouttheinterventioningeneralandany
thoughtstheyhadaboutscalabilityandfactorswewouldneedtoconsider.
“Ithinkit’sgoodtohavethatkindofholisticviewofpeople'swellbeing,thatisnotjust
medical;itcanbemuchwiderthanthat-socialandcommunityconnections.Ithinkit’sa
positivesignthatthathasbeenrecognised”
Overalltheserviceswerequitepositiveabouttheeffectivenessoftheintervention
andfeltthatitwasneededinEastMerton.Theconversationshighlightedtheneed
todeveloprobustreferralpathwaysandsystemstocapturenumbersandfeedback.
Thekeythemesareoutlined.
FirstContactwithSocialPrescribingPilotServices we spoke to knew about the SP pilot before it started or in the initial
months. Some knew the pilot was coming to Merton as they had been working
closelywithWidewayMedicalCentreandtheleadGP.Othersestablishedlinkswith
theSPCandthepilotatmeetingssuchastheMentalHealthForum.TheSPChimself
wasa familiar figure tomost servicesashehasworked in theBoroughpreviously
andisawareofalotoflocalorganisations.
25
“He(SPC)hadafairlygoodgraspoftheworkwedohereandIhadamemoryofhimand
howheworks.Sofairlyeasytoestablishaworkingrelationship”
ReferralPathwayandCommunication“SPChasgivenalotofhisclientsourdetails,whetherthat’sactuallyresultedinthemcoming
toaccessourservicesIdon'tknow.Itdoesn'tmeantheyhaven'tbutit’scertainlynotbeen
somethingthathasbeenobviousfromoursideofthings”
A clear distinction between ‘Referral’ and ‘Signposting’ was made by one of the
servicesandtheconsensuswasthattheprocessbywhichindividualsmaketheirway
fromtheSPCtotheirserviceswassignposting.
There is no referral form and no uniform way in which the SPC communicates
information about patients who are signposted to end services. Two out of four
servicessaidthattheyknewtheSPCwasgivingoutinformationabouttheirservices,
butaswithotherself-referralstheyweren’tabletosayhowmanypeopleaccessed
theirserviceasaresultoftheintervention.
OneservicereceivesthecontactdetailsofpatientssignpostedtothembytheSPC
via anemail and then,basedon thedetails theyare given, theyeitherpostout a
letter,telephoneoremailtheseindividuals.TheSPCvisitsoneoftheservicesona
regular basis gets information from staff about which patients have accessed
services.Due to thesedifferences inapproach, feedback fromservicesonpatients
thepatientsreferredtothemiseithernotavailableoriscollectedandgiventothe
SPCindifferentways.
“Welethimleadonthis.Ifheisn’tgettingtheinformationhewouldletusknow.He
rings/popsinwithalistofpeople.Welethismonitoringneedsleadusratherthaninvent
somemonitoringforourselves”
The frequency of interactionwith the SPC varies; in some cases, the SPCdrops in
weekly, is inregularcommunicationoveremails,orjustmeetsservicesatcommon
26
eventsandmeetings.TheSPCisbasedinthesameofficeastheMVSCvolunteering
servicewhichmakescommunicationeasier.
ServicesrecognisedtheimportanceoflettingtheSPCknowaboutanychangesthat
weretakingplaceintheirservicesandmakingsuretheinformationhehadforthem
wasn’toutofdate.
ThepathwaydescribedbystakeholdersissummarisedinFigure1.
Figure4:SignpostingandfeedbackPathway
1 SPCspeakstopatientsandassessestheirneeds.
2
Patient is given leaflets/ information about service and encouraged to make
contactbySPC.Inthecaseof01service,theSPCemailedcontactdetailsforthe
servicetofollow-up
3
Patientcomestoserviceandmay/maynotidentifyasbeingsentbytheSPC
4 Patient may/may not access service based on suitability and in some cases
patientmaybesignpostedtootherrelevantservices
5
FeedbacktoSPC isvaried;there isnoformalmechanismand is ledbytheSPC.
SPCmightapproachservicesthemselvestocheckifpatientshavesignposted,or
checkwithpatientswhentheycomebackforsecondappointment
NumbersanddemographicsofpatientssignpostedOne service recorded a surge in the number of people coming through between
March andMay andhad40 extra people accessing their services.Another service
had10peoplesignpostedand8ofwhomtheycouldcontact.Therestcouldn’ttrack
theirSocialPrescribingreferralsandweren’tabletocomment.
27
WhereindividualscanbetrackedasSocialPrescribingpatientstherewasagreater
representationofolder,whiteworking-classindividuals.
OneservicementionedthattheywouldideallyliketohavemorereferralsfromBME
populations,men,olderadultsandthosewith long-termconditionsandworkwith
theSPCaroundthis.
CapacityofEndServicesThe services that could commenton the volumeof referrals they receive felt that
they could cope with the demand in the short term. Should the programme be
expandedor extended thiswould need to be discussedwith commissioners. They
felt that needs of the people being referred is also an important part of the
consideration.
The end services also talked about the option of accepting signposts into services
theychargedfororforservicesthatareunderutilised.
One service is trying to increaseuptake rates and said theywouldwelcomemore
numberofreferralscomingintotheservice(targetgroupsmentionedabove).
ScalabilityConsiderationsServicestalkedaboutseveralfactorsthatneedtobeconsiderediftheintervention
weretobeupscaled:
1. Robustreferralandfeedbackpathways-Servicesareopentoworkingwith
SPC to lookathow referralpathwaysand systemscanbe setup toenable
better data capture and feedback between services. For example, data
sharingagreementsorsimplyaskingthosewhoself-referwheretheyheard
abouttheservice.
2. Understandingpatientneed-Toascertainwhetherpatientsneedareferral
serviceorasignpostingservice.
28
“IfIgavealeaflettoaclient,didtheclientreallygototheagency?Wasthereany
hesitationinthere,wasthereanythingthatwasmissed.Ifthat'snotworking,thendoI
fillthereferralformordoIcalltheGPpractice”
3. Data Protection - If the Pilot is upscaled, data protection and sharing
agreements will have to be revisited. It is important to not become too
encumbered and maintain a balance. Organisations taking part will need
trainingaroundsharinginformationwithpeopleandthiscouldbesomething
thattheMVSCcouldsupportwith.
“IfitdoesgoBoroughwide,theproblemisthatitbecomesencumberedwithlotsofcontrol
andprotectionsystems-whicharegoodinthemselvesbutcanstymiesomeoftheenergy
thatwehavehadintheearlystages”
4. GP commitment - There was recognition that the lead GP in Wideway is
massivelycommittedtothisandhasbeenchampioningthepilot.Ifthepilot
were toexpand,otherGPpracticesneed toembrace thisapproachandbe
fullycommittedtoitsdevelopment.
“Idon’tknowifotherGPsareasenthusiasticasthem.Theyhavetodoitiftheyhavetodoit,
notbecausetheylovetheirjob.SoifsomeGPsorotherprofessionalsinthepracticewere
thinkingthatohgoshthisisanotherthingthatIneedtofitinourdailyjobs,thatwouldthen
killsomeofitseffectiveness.So,wehavetosellitassomethingthathelpstheireffectiveness
andnotsomethingthataddstotheirtodolist”
5. Building Capacitywithin the Voluntary Sector - Serviceswere clear that if
theprojectweretobeupscaled,therewouldneedtobefundingputintothe
voluntary sector. There were some suggestions including paying the
organisation per person per visit. If this was not possible, then towork in
partnershiptolookforfundingopportunitiesorreallocatefundingfromdead
projects.
29
“Asthevoluntarysectorisreliedonmoreandmoretofillingapsandpickupservices,onthe
onehanditisgettinglessandlessfundingandontheotherhandmoreandmore
referrals.Atsomepoint,thatisnotgoingtowork.Youcanonlyscaleitupifyoucanfund
thevoluntarysectortoabsorbtheincreaseddemand”
6. Staff Capacity - Thinking aboutwhethermore salaried SPCs are neededor
couldvolunteerssupporttheservice.
7. Geographical Considerations - Expanding to other areas in EastMerton as
well aspossiblyhavinga service inWestMerton so that there isabalance
acrosstheborough.
8. Consider other similar models - Stakeholders talked about other similar
interventionssuchastheLivingWellprojectwithinAgeUK,carenavigators,
community navigators based out of the Nelson Health Centre and
Commonside Trust and the Fire Safe and Well coordinators. It would be
worth looking at synergies and how these different projects could work
together.
9. Linking in with Funding opportunities-Housing and regeneration partners
like Merton Housing and United Living are willing to work with local
stakeholders around designing services that meet the needs of the local
population. They have expressed an interest in working with the SPC and
don’twanttoduplicateeffortsorsetupsomethingthatdoesn’thavesynergy
withtheSPPilot.Thiscouldbeexploredwithothers likeClarionHousingas
well.
LimitationsofSPPilot
“Itishardtomanageboththecapacityofthatandknowwhatdifferencethesignpostinghas
made…Iknowtherearesomeamazingcasestudies,whereSPChasbeenabletorefer
someoneandthatpersonhasgonefromstrengthtostrength,butIlikesaid,ifyoujust
30
signpostsomeone,it’squitehardtoreallytrackthatagainstanyimprovementthathave
beenmadeinthatperson'slife”
ServicesspokeaboutsomeofthelimitationsoftheSPPilot:
1. Signposting system that makes it difficult to track uptake and provide
feedbackorprepareforanyupscaling.
2. End services not knowingwhat the actual intervention is, howmany times
doesthepatientgetseenetc.whichmakesitdifficultforthemtothinkabout
impacts.
3. There were concerns that for certain vulnerable groups for example older
people,signpostingwouldn’tbeaseffectiveasareferral.
4. The SP intervention is based on the premise that there arewider services
that can meet patient needs. There is a concern that there might not be
enoughservicesorcapacitywithinthoseservicestoaddressneedsoraccept
signposts.
“Whereitfallsdownis,it’safantasticideareferringpeople/signpostingpeopletoservices,
butthereareincreasinglyfewerservices.Ifyoudon'thaveanywheretosignpostpeopleto,
thenthemodelfallsdown”
Recommendations
Recommendation 1: Standardisation of Signposting/Referralmechanism-We need
toconsiderifsignpostingissufficientoraproperreferralsystemneedstobesetup.
Eitherway theSPpilotneeds toworkwithend services toagreeandput inplace
properdatasharingagreementsandsystemstoenablequantitativeandqualitative
datatobecapturedandshared.
Recommendation2:Feedbackmechanisms including frequencyandmethodsneed
tobestandardisedandagreedwithallendservices.
31
Recommendation3:Conversationsneedtotakeplacewithallrelevantstakeholders
andendservicestounderstandtheircapacitytoacceptreferralsbasedonthedata
wehavebothintermsofvolumeandneeds.Thisisanimportantstepbeforerolling
outthemodel/up-scaling.
Recommendation 4: A regular SP Forum to be set up to refine and standardise
processesaswellasforsharingofinformationincludingwhattheSPinterventionis,
howotherservicesoperateetc.
Recommendation5:Iftheprogrammeisexpandedtootherareas,itisimportantto
getGPpracticesonboardfairlyearlyintheprocessandensurethatthereisbuyin
intothevisionandclinicalteamsunderstandthevalueoftheprogramme
32
Mid-yearDataWe undertook an analysis of the patients that have been referred to the SP
programmeup to themid-yearpointof thepilot.Theanalysishighlights trendsof
referrals,eligibilitycriteria,patientwellbeingandchanges inclinicalworkload.The
collectionandanalysisof thedata is anon-goingprocesswith subsequent reports
incorporatingnewerdata.
PatientDemographics
AsofSeptember2017,183patientsand49patientsfromWideWayMedicalCentre
andTamworthHouseMedicalCentrerespectively,werereferredtotheSPservice.
Whatfollowsisabreakdownofthesereferralsbyage,genderandethnicity.
Age&GenderDatacollectedsofar indicatesthattheSPChasseensubstantiallymorepatientsat
WideWayMedical Centre. There is engagementwith all age groups at both sites
withfemalepatientsarebeingreferredtotheSPCmorethanmales(seefigure2).
Figure2.NumberofSocialPrescribingpatientsbyage-group,genderandpractice–
JanuarytoSeptember2017
33
Ethnicity
AbreakdownoftheethnicityoftheSocialPrescribingpatients(inFigure3)shows
thatoverhalfofpatientsarewhite(57%).ThenextlargestethnicgroupisBlack
(22%)followedbyAsian(11%).
Figure3.NumberofSocialPrescribingpatientsbyethnicity,genderandpractice–
JanuarytoSeptember2017
ReasonsforReferral
TheanalysisofreasonforreferraltotheSPprogrammewasbasedontheWellbeing
Star data rather than GP practice data. The reason we adapted this approach is
because theWellbeing Star datawasmore complete. The Star data capturesdata
frompatientswhohavebeenseenbytheSPC,butnotpatientswhodidnotattend
theirSPCappointment.
The majority of the patients referred to the Social Prescribing programme were
referred for more than one reason. The most common reason cited was
mild/moderatementalhealthissues(seefigure4).Thenextmostcommonreasons
cited was for long term physical condition(s) although this was not within the
establishedreferralcriteria.
34
This analysis also highlights somediscrepancy between the reasons for referral as
pertheStardatacomparedtothereasonsaspertheGP(EMIS)notes.Subsequent
reportswilladdresswaysofreconcilingthesetwodatasources.
Figure4.Referralcriteria–JanuarytoSeptember2017
Wellbeing
At each Social Prescribing appointment, the SPC asks the patients to fill in the
WellbeingStarquestionnaire.13Thisisareliableandvalidtool14,15thatlooksateight
health andwell-being sub-categories that patients rate on a scale ranging from 1
(Notthinkingaboutit)to5(Asgoodasitcanbe).Theresultsaredisplayedinastar
13MacKeith,J.andBurns,S.(2010)TheWellbeingStar:UserGuide,Brighton:TriangleConsultingSocialEnterprise14MacKeith,J.(2011).ThedevelopmentoftheOutcomesStar:aparticipatoryapproachtoassessmentandoutcomemeasurement.Housing,CareandSupport,14(3),98-106.15Mackeith,J.(2014).AssessingthereliabilityoftheOutcomesStarinresearchandpractice.Housing,CareandSupport,17(4),188-197.
35
diagram that the patients can see and compare with previous results at each
appointment.TheStaranditssub-categoriesareshowninFigure5.
Figure5:TheWellbeingStar
Between January and September2017, 55patientshad twoormore SPC sessions
with wellbeing scoring. Initial analysis shows that most of these patients have
experiencedan improvement intheiroverallwellbeingscore(seefigure6)withan
average increase of 0.74. T-test analysis of the data shows a highly significant
improvementinoverallwellbeing(p-valueof0.00).
36
Figure6.ChangeinAverageWellbeingscore–JanuarytoSeptember2017
37
Of the147patients thathavehadaStarassessment,56have returnedandhada
second or third Star reading. A breakdown of the sub-categories of the measure
showsthatonaverageparticipantsimproveinallcategoriesbetweentheirfirstand
latest Social Prescribing appointments. As seen in figure 7, overall patients
experiencethegreatestimprovementin‘Lifestyle’and‘SymptomManagement’.
Figure7.WellbeingscoresduringfirstandlatestSPCsession–JanuarytoJune
2017
ImpactonGPAppointments
ThenumberofGPappointmentsapatientrequiresbeforeandaftertheirfirstSocial
Prescribing consultation can indicate whether there is any impact on clinical
outcomes.
38
Toimprovetheaccuracyoftheassessment,thedaythepatientwasfirstseenbythe
SPCandaStarassessmentcarriedoutwasusedasthebaselinedate.Atthepointof
data collection, there were 77 patients seen by the SPC for whomwe had three
monthspre-andpostGPappointmentfigures.
The average number of appointments per patient reduced from 3.3 to 2.3. This
equatestoatotalof78fewerGPappointments.At-testanalysisshowsthatthisisa
highlysignificantreductioninthenumberofappointments(p-valueof0.004).
Figure 8 illustrates that the reduction in the number of GP appointments is
improvingover time.Patientswhowere seen laterduring thepilot, i.e. frommid-
April onwards showed a substantially improved reduction in the number of GP
appointmentswhencomparedwiththepatientsseenearlierinthepilot.
39
Figure8.ChangeinGPappointmentnumbers3monthsbeforeand3monthsafter
firstSocialPrescribingappointment,JanuarytoSeptember2017
40
SocialPrescribingObservations
ObservationmethodologyHealthyDialoguesobservedfiveSocialPrescribingconsultations, includingtwofirst
appointmentsandthreefollow-upappointments. Thepurposeoftheobservations
was to get an understanding of the structure of the consultations, the
communicationbetweentheSPCandpatientandreferralprocess.
Observationswereratedon theBehaviourChangeCounsellingChecklist that looks
at person-centred methods for behaviour change counselling. Each item of the
checklist is ratedon a Likert scale of 0-4whereby a higher score reflects stronger
behaviourchangecounsellingskills.Notallitemsonthechecklistarerelevantforall
consultations so an average score for the relevant items are recorded for each
consultation. The observer also recorded what went well and what could be
improved.TheobservationformusedcanbefoundinAppendixC.
TheSocialPrescribingconsultationPatientsareseenbytheSPCbetweenonetofourtimes,dependingontheirneeds
and expectations. The time for the consultation varies between 15 minutes to 1
hour.Priortomeetingthepatient,theSPCgathersasmuchinformationastheycan
aboutthepatient’sbackgroundandreasonforreferralusingEMISandthereferral
form.
The SPC begins the consultation by welcoming the patient and ensuring they are
comfortable.Heexplainsthereasonforreferral,describeswhatSocialPrescribingis
andasksthepatienttofillintheSTARquestionnairewhereappropriate.Duringthis
time,thepatientisabletodiscussin-depththeirpersonalcircumstancesandreason
for referral. The SPC offers referral options and signposting throughout the
discussionwhentheopportunityarises.Theconsultationendswithanagreementto
meetatalaterdatetoreviewthecontactwiththeendservices.
41
Whatwentwell
The SPC rates very well on the Behaviour Change Counselling Checklist with an
average score of 3.2 out of a possible 4; his strengths include: encouraging the
patienttotalkabouttheirbehaviourandstatusquo,acknowledgingchallengesand
beingsensitiveandunderstandingtothepatientsconcerns.
Overall it is clear that the SPC is friendly, approachable and skilled atmaking the
patientsfeelatease.Heisalsoflexibleinofferingappointmentsofvaryinglengthsto
meetindividualneeds.Patientsareabletodiscusstheirpersonalcircumstancesin-
depthandcantalkaboutarangeofissueswithoutstricttimeconstraints.
The SPC recalls the patient’s information from prior meetings and from medical
records.Heregularlyrecognises,acknowledgesandpraisesthepatient’sstrengths,
intentionsandbehavioursthatleadinthedirectionofpositivebehaviourchanges.
TheSPCalsohasawealthofknowledgeofthelocalservicesavailabletothepatients
andprovidessupportandguidancetothepatientsastohowtheycanaccessthese
services.
Whatcanbeimprovedandrecommendations
-Theconsultationscanoftenbenefitfromhavingaclearerstructure.Attheoutset,
whentalkingaboutwhatwillbecoveredduringtheappointment,itwillbebeneficial
toaskthepatientwhattheywouldliketodiscussandsettingajointagenda.
-Restrict thenumberof referralopportunitiesofferedtothepatientas thiscanbe
overwhelming. To narrow the focus, the patient can be askedwhat they hope to
achieve/ what solution would work best for them. Alternatively, when there are
severaloptions,theycanbeshowna‘menuofoptions’andaskedwhich1-2services
wouldtheyliketobeginwith.Thiswouldalsoensurethatadviceandsignpostingis
tailoredtotheneedsexpressedbythepatientsandthattheyhavemoreownership
onnextsteps.
-Insteadofaverbalagreement,itwouldbemorebeneficialtohaveawrittenplanof
actionwhichhasbeendiscussedandagreedwiththepatient’sactiveparticipation.
42
Evidenceshowsthatawrittenagreementofbehaviourchangeisastrongindicator
ofpositivebehaviourchange.15
FollowupdiscussionwiththeSocialPrescribingCoordinatorinAugust2017
These recommendationswere discussedwith the SPCwhoput them into practice
fromAugust2017.FeedbackfromtheSPConthechangeshasbeenpositive.Hefelt
thatthechangeshaveallowedthepatienttohavemorecontroloverhissignposting
andthathehasbecomemoreflexibleinhisapproachtoallowingthepatienttoset
theirownprioritieswiththeirconsultationwithhim.
FurtherObservations:
HealthyDialogueswillreturntoobservemoreconsultationsinDecember2017.
15Burd,H.&Hallsworth,M.(2016).Makingthechange:Behaviouralfactorsinperson-andcommunitycentredapproachesforhealthandwellbeing.Accessedat:https://www.nesta.org.uk/sites/default/files/making_the_change.rtv_.pdf
43
NextstepsforEvaluation
Our January report will continue to look at end-services’ views and capacity to
continue to receive referrals. Additionally we will have made contact with the
patientsof theservice.Weseekpatient’sviewsonhowtheservicehasbenefitted
themandhowitcanbeimproved.Wealsoseekvolunteerstobecomecasestudies
fortheprogramme.Figure9outlinestheplanforthenextphaseoftheevaluation.
Figure9:OctobertoJanuaryresearch
Patientinterviews/focusgroups
Patientviewsandoutcomes
RecommendationsandNextSteps
CapacityandOpportunities
EndServicesInterviews
44
6.Appendices
AppendixA:SocialPrescribingPilotLogicModel
45
AppendixB:SpecificationDeliverablesandMilestones
KeyDeliverable Tasks Timeframe
Literaturereview DeskresearchonSPinterventions,
supportgroupsandprevious
evaluations.
15thJune2017
Stakeholderengagement ConsultationwithSPleads,GPs,
datamanagers,commissioners,key
expertsandImplementationGroup
15thJune2017
Baselinedataanalysis
report
. 15thJune2017
StakeholderInterviews ConductPhase1interviewsand
analysis
Feedbackfindingsto
commissioners
July-August2017
ProgressionReports Agree,deliverandreportagainst
projectplanandRAGriskrating.
Updatesummariesanddiscussions
withImplementationGroupon
progress,strategyandemerging
themesandissues.
Bi-monthly
Interviews ConductPhase2interviewsand
focusgroups.
Transcribeinterviewdata.
Januaryand
February2018
Analysisandwrite-up Collatequestionnairedataand
conductmultivariateanalysis.
Reviewinterviewdataandconduct
athematicanalysis.
Writeupfindingsintofinalreport.
March2018
Recommendations Presentationoffindingsand
recommendationsforpilot
developmentandimprovements
April2018
46
MilestonesandRAGrating
Milestone Activities Keyenablers CompletionDate
RAG Comments
LiteratureReview
June2017 - Complete
BaselineReporting
- DataCollection
- Analysis
- Practice
Manager
June2017 - Complete
SPCInterview
- Face-2-face
interviewand
analysis
- SPC
July2017 - Complete
SPObservations
- Observesocial
prescribing
consultations
andscoreBCCI
- SPC
July2017 - Complete
PrimaryCareFeedbackonProcesses
- Focusgroups
- Interviews
- PracticeManagers
August2017
- Complete
Stakeholderinterviews
- Makecontact
withend-
servicesand
implementatio
ngroupto
arrange
interviews
- Telephone/face
-to-face
interviews.
- Implementat
iongroup
membership
- Keyend
services
August2017
- Complete
Mid-programmereport
- Summaryof
analysisand
recommendati
onstodate
- EMISandSTAR
datacollection
andanalysis
- Presentationto
implementatio
ngroup
- PracticeManagers
October2017
Patientinterviews/focusgroups
- Contact
patientsto
request
- SPC
November2017
47
Milestone Activities Keyenablers CompletionDate
RAG Comments
participation
- Focusgroups
andface-to-
faceinterviews
Implementationgroupfocusgroup
- Focusgroupon
outcomes,
feedbackand
nextsteps
- Implementat
iongroup
January2018
-Tobearranged
PrimaryCareinterviewsandfocusgroups
- Feedbackon
outcomesand
nextsteps
- Practice
Manager
February2018
SPCinterview
- SPCinterview
onoutcomes
and
recommendati
ons
- SPC
February2018
3SPCobservations
- Consultation
observations
andfeedback
ondistance
travelled
- SPC February2018
Patientdatacollection
- EMISandSTAR
datacollection
andanalysis
- Practice
Manager
February2018
AppendixC
48
AppendixC:SPObservationforms
SocialPrescribingObservationForm
Observer
Date
Practitioner
Appointmentdescription
Whatworkedwell?
Whatcouldbeimproved?
AppendixC
49
BehaviourChangeCounsellingIndex
