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Primary Care NavigatorsReducing demand for health services        14 November 2012
Why it’s well-regarded The Primary Care Navigator model meets a need Provides integration across health, social care and...
Meeting the need 15 million people with LTCs 50% of GP appointments 70% of acute and primary care budgets DH predicts ...
Meeting the need▪ London has rich and varied provision across statutory and non-statutory providers▪ But patients and care...
Our responseA ‘Care Navigator’ role in primary care to work across health, social care and third sector.▪ Three roles:    ...
Makes a real differenceWhat the GPs say: “Having a patient navigator at the surgery has been revolutionary  for team work...
Flexible, adaptable, scaleable: Piloted in primary care Pilot underway in a mental health team liaising with primary  ca...
Effective and Efficient: Average healthcare use6 months before and after intervention start     GP contacts               ...
Potential cost savings per patientIndicative, based on 6 months pre and post    Savings                                   ...
Abbotts Hearing Aid centre     Campden Charities                      Floating Housing Support                   Occupatio...
Contact                    Cynthia Dize                    Chief Officer            Age UK Kensington & Chelsea          1...
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Reducing demand for health services

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Reducing demand for health services workshop presentation by Cynthia Dize at Age UKs "Living well with long term conditions" conference

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Reducing demand for health services

  1. 1. Primary Care NavigatorsReducing demand for health services 14 November 2012
  2. 2. Why it’s well-regarded The Primary Care Navigator model meets a need Provides integration across health, social care and third sector Makes a real difference to the experience of patients and clinicians Flexible, adaptable, scaleable Is effective and efficient
  3. 3. Meeting the need 15 million people with LTCs 50% of GP appointments 70% of acute and primary care budgets DH predicts a rise of 25% in people over 65 with one + LTCs by 2050 Cuts to local government spending have led to raised eligibility for funded services Consequence is more pressure on secondary and primary care King’s Fund (Self-Management for LTCs, 2005) - people want to self manage but need improved provision of information about their condition and what is available locally Statistics are people with the tears washed off
  4. 4. Meeting the need▪ London has rich and varied provision across statutory and non-statutory providers▪ But patients and carers find that services are hard to locate and access▪ Made worse by poor communication between health and social care▪ Particular issues: ▪ Part of the solution is in social care, benefit support, housing advice – unrecognised by people who have never associated themselves with this need, paid or unpaid ▪ Tendency to present in a crisis and needing unplanned care ▪ Very varied availability and quality of provision – inequity...All leading to isolation, loneliness, dependency on family members and call on unplanned services
  5. 5. Our responseA ‘Care Navigator’ role in primary care to work across health, social care and third sector.▪ Three roles: ▪ Provide patient-focussed, integrated support to co-ordinate care around the patient and navigate the system ▪ Improve planned take up of services; reduce DNAs; reduce unplanned demand; improve communication primary/acute care ▪ Provide ‘live’ feedback on service quality to GP commissioners - service improvement• Role supported by mentoring and education package – quality and consistency
  6. 6. Makes a real differenceWhat the GPs say: “Having a patient navigator at the surgery has been revolutionary for team working and patient care. Patients who were hard to reach, often missed appointments, and paradoxically were frequent users of non-elective care (e.g. OOH, A&E) have now had comprehensive holistic assessments by a team of healthcare professionals, all co-ordinated by the navigator.” Dr Tahir, Barlby Surgery
  7. 7. Flexible, adaptable, scaleable: Piloted in primary care Pilot underway in a mental health team liaising with primary care Fits into Out of Hospital and Integration agenda Can sit in health, social care, third sector, community – structured around local strengths Does not require a complex infrastructure with associated costs Economic for a very small team, and robust for a larger one
  8. 8. Effective and Efficient: Average healthcare use6 months before and after intervention start GP contacts Outpatient Significant drop Out of hours Significant drop Inpatient A&E Significant drop Significant drop Significance test=Wilcoxan signed rank test
  9. 9. Potential cost savings per patientIndicative, based on 6 months pre and post Savings Average Average contacts Average contacts cost per 6 months pre 6 months post Saving: contact intervention intervention Difference £ Saving GP £25 8.6 4.6 -4.0 £99 Inpatient £1,825 0.4 0.08 -0.3 £584 Outpatient £160 2.9 2.3 -0.6 £96 Out of hours £45 2.3 1.2 -1.2 £52 A&E £152 1.4 0.6 -0.8 £116 £947 Costs Navigator unit cost (incl on-costs) £303 Net savings Potential net intervention saving per patient (over 6 months) £644 Assumes drop in activity post-intervention is all as a result of intervention. Effect of regression to the mean may reduce the calculated level of savings However, savings may be realised over a longer period than 6 months, as modelled here. Likely savings in other aspects of care e.g. prescribing
  10. 10. Abbotts Hearing Aid centre Campden Charities Floating Housing Support Occupational TherapyACKC - friends & neighbours Carers Counselling Freedom pass OpthalomogyACKC befriending referral Carers KC Osteopathy OpticianACKC benefits check Carers UK GP Orthopaedics Dept - St MarysACKC Dementia Team CARS HF Hammersmith Hospital Palliative nurseACKC food & friends Chelsea Theatre Health Trainers PALSACKC outings Chemist home delivery Healthcall (home opticians) Parkinsons SocietyACKC Practical Help CLCH Wheelchair Service Healthy Homes Peabody Tenant Support teamACKC Shopping Service Community Alarm Service Hepatology PepperpotACKC Support Broker Community Dementia Team Homeshare Scheme PhysIotherapyACKC Toe nail Cutting Community Diabetes Team Housing Opportunitues Team Podiatrist NHSACKC Toe Nail Cutting Service Community Mental HealthTeam Incontinence Service Practice NurseACKC-Info & Advice Community pharmacy K&C Cruse Psychiatric ServicesACKC Escorting Cook & Taste sessions at Chelsea Theatre KCMS QuestACKC - Respite care Cooperative Funeral Care Learning disability Occupational Therapy Red CrossACKC Wayfinder Counselling Library Re-enablement Team H & FACKC Ageing Well sessions Crossroads Care Library Home Delivery Service Retinal ClinicACKC At Home Community Rehab Team Local colleges RNIBACKC Memory Café Cruse KC local sports facilities SamaritansACKC Volunteer CX Transport & Carer service Macmillan Centre at Chelwest Social ServicesACKC Decluttering Day Services Meals on wheels Stroke AssociationACKC Garden Guardians Depression Alliance Memory Service Substance Misuse CounsellorAdmiral Nurses Dietician MIND Sudanese Womens AssocAlcohol Resource Centre Disability Living Foundation Miranda Barry Day Centre TaxicardAttendance allowance District Nurses Mulberry Place Activity Centre Thames Water Finance assistanceBinbrook House Support staff Dossett Box (chemists) New Horizons TMOBlue badge DVLA appeal process NHS Direct Transport for AllBritish Heart Foundation Falls clinic Notting Hill Trust Vitalise Crossroads CareBurgess Fields Support staff Falls Service Nucleus Westway Community TransportCitizens Advice Bureau Fitness for Health Nutritionist Wiltshire farm foods Open Age Worlds End Neighbourhood Advice
  11. 11. Contact Cynthia Dize Chief Officer Age UK Kensington & Chelsea 1 Thorpe Close, London W10 5XL 020 8969 9105 cdize@aukc.org.uk www.aukc.org.uk

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