More than 3.5 million people aged 65 and over in the UK currently live alone, with 2.9 million claiming to have no-one to turn to for help and support. This has a huge impact on an individual’s health and has links to detrimental effects on blood pressure, mental health, increased emergency hospital admissions and mortality rates. In fact, an estimated four million older people in the UK have a limiting longstanding illness – equating to 40% of all those aged 65+.
No man is an island
This presents a number of major challenges for primary care providers and the wider health and social care system and, with spending on social care in England having fallen by £770m since 2010, this is greatly exacerbated by ever-increasing financial constraints.
Tackling loneliness and social isolation amongst the elderly population, and fundamentally changing the way health and social care is delivered, is, therefore, vital. It can not only improve the quality of life for older people but can also limit dependence on healthcare services and ease the pressures on already over-burdened GP practices across the UK.
Every question has an answer
So, what’s the solution? Developed and delivered by Prime GP, Prime75+ was initially commissioned by NHS South Warwickshire CCG in January 2015 and was trialled across four of its GP practices, with further roll outs now reaching over 6,800 75+ patients in different parts of the country. With a greater focus on prevention, and with co-ordinated, convenient, safe, and reliable care delivered within general practice in partnership with the local community, the scheme moves away from a traditional model of care which focuses purely on health issues and instead looks at the overall social, physical, and mental, needs of those aged 75 and over.
A practical approach
How does it work? Dedicated over-75s co-ordinators use risk stratification tools and intelligence from practice staff to identify those patients who are at risk of being lonely, socially isolated and, in some cases, frail and offer health, social and voluntary care interventions to bring about an enhanced quality of life, general well-being and subsequent improved medical outcomes. The co-ordinators work across the practices – engage and seek the views of the patients themselves to add value and support and work with them to identify shared interests and activities within the local community that they can participate in and be part of.
Where there are gaps the co-ordinators work with the patient and the community to organise activities appropriate to the individual’s needs – anything from first aid courses and gardening projects, to mosaic classes and tea parties (including a ‘20,000 Year Tea Party’ event which saw the collaboration of the biggest over-75 patient group in the history of the NHS). This not only promotes the development of friendships and self-confidence but also reduces the reliance of the individual on the one person they previously saw as their sole, trusted confidante – their GP.
Seeing is believing
How successful has it been? Through communication and engagement with the over-75s – and the use of the Prime Monitoring and Impact Tool – the number of GP appointments made by those identified as potentially lonely and/or social isolated and subsequently seen by the co-ordinators has reduced significantly by between 20-30%, which can be easily interpreted in terms of hours saved to the GP for non-medical appointments. This has resulted in the appointments booked across participating practices being completely necessary in terms of medical needs – not only providing confidence to GPs but also ensuring that those patients who are in genuine need of medical attention are prioritised.
The keys to success
A key element of the success of this project has been engagement between practice staff, patients and the local community, as well as the acknowledgement that change is not something that happens with just one appointment but when a genuine, trusting relationship is built which replicates that which the patient has with their doctor. The Prime75+ model thus demonstrates the importance of a single point of contact within the GP practice who is an expert in supporting older patients and who understands the community and the social support available.
If rolled out on a national basis, taking into account an average cost of £35 per ten-minute appointment, a CCG with a population of 200,000 could potentially save 88,800 GP surgery appointments and £3.1m per year. For the NHS as a whole, this would mean a saving of over 24m appointments and £236m in avoidable admissions.
Ultimately, Prime75+ is a simple yet hugely effective model which is having such a significant impact on patient satisfaction, access to GPs (and subsequent workforce pressures) and occurrences of avoidable hospital admissions. With vast improvements to health, wellbeing and morale this initiative has the very real potential to bring about major change across the NHS as a whole and to successfully tackle the loneliness and isolation agenda.