Keep Well Programme Annual Report 2012 – 2013
Table of Contents
Summative Statement 3
Rationale 6
Resource deployed 6
Keep Well Programme Activities and Outputs 8
Outcomes & Results 14
Contextual Factors 17
Implications and Programme Learning 18
Summative Statement
Keep Well is a pathfinder programme in NHS Grampian, and part of our Health and Care Framework to deliver our 2020 vision. It is a key driver in building an infrastructure to support primary care in sustaining and developing an inequalities sensitive service.
In progressing the programme, in 2013-14, we aim to integrate the programme more fully within evolving local structures and processes, with internal and external partners.
Our main focus in 2012-13, was to build on the experience of Keep Well in Aberdeen City (commenced September 2008); the Well North programme in Moray (commenced January 2009): the Keep Well Community Pharmacy pilot in Aberdeenshire and Moray (October 2010), and extend and embed Keep Well across NHS Grampian in each of the Community Health Partnership (CHP) areas.
In 2012-13, the majority of health checks were delivered via 33 GP practices.
Other delivery routes and sites included: Community Pharmacy (Aberdeen City and Aberdeenshire); Aberdeen Sports Village; The Healthy Hoose (Aberdeen City); Kessock Clinic (Fraserburgh); Turning Point/Northern Horizons (Peterhead) and Leanchoil Hospital in Forres.
Achievements:
· Exceeded the annual performance target, delivering 1633 cardiovascular health checks against our NHS Grampian target of 1500.
· 33 GP practices signed up to deliver Keep Well in Grampian.
· An inequalities protocol for internal resource allocation for Keep Well
· New delivery streams commenced in Aberdeen City, North East Aberdeenshire and Moray.
· 4 new delivery pathways established for vulnerable groups.
· Increased the number of staff trained to deliver in community settings.
· Reviewed the Health Coaching Service, ‘The first 50’.
· Increased commitment to Keep Well performance.
· Used Business Objects Universe to report National Indicators.
· Used community radio and local newspapers to promote programme.
· Increased use of Public Health services by other professionals.
· Maintained sign up of all deliverers of Keep Well, year on year.
· Provided the development ground and workplace supervision for our trainee health psychologist, securing the Keep Well Health Coaching Service and a Health Psychologist post in Public Health.
· Delivered strongly through Community Pharmacy in North Aberdeenshire
Benefits accrued:
· Generated significant new activity increasing the range and number of deliverers and support for patients.
· Demonstrated to colleagues how the programme could support other health improvement activity and work with other patient groups, leading to increased engagement and support from Public Health Coordinators.
· Increased pan-Grampian working through our KW Operational Group
· Developed and increased partnership working within NHS Grampian and with voluntary and 3rd sector partner organisations.
· Increased access to a health check for patients in less urban areas.
Main local challenges:
· Reducing the length of time between initial sign up, and health check delivery. This time varied considerably and was influenced by a number of factors. In primary care, these included ‘practice readiness’, (non)-existence of infrastructure, involvement of key staff, identification of eligible population, and preferred delivery model.
· Ensuring the inclusiveness of Keep Well by enabling practices to participate at varying levels (e.g. engagement only, with health checks delivered out with the practice).
· Developing and implementing new delivery pathways for vulnerable groups generated an intensity of activity to identify local vulnerable populations and where they present to services. In particular, the significant effort and cost to develop the pathway for Gypsy Travellers, set up within a very short timescale in North Aberdeenshire, ultimately, yielded a small number of Keep Well health checks (5). Lifestyle checks (18) were delivered to individuals who were not eligible for a Keep Well health check. Whilst this investment was not reflected in number of health checks per se. it improved engagement with this key group. There was positive engagement with the Gypsy Traveller communities, and enhanced working relationships with partners to establish a clear pathway
· Work began in December 2011, to set up the offender pathway and health check delivery in both the prisons located in Grampian, HMP Aberdeen and HMP Peterhead. Prison staff were trained in both Peterhead and Aberdeen. Frustratingly, internal challenges within each prison made delivery impossible in the year 2012-13. However, we have been tenacious in building on our earlier efforts, to commence streams in both prisons.
· Ensuring effective systems, roles and responsibilities in an evolving organisational environment at a time of programme transition.
Achievement/findings relating to the key principles
Our programme is reaching individuals in our most disadvantaged communities. In 2012-13, 86% of the patients who received a health check were in the most deprived Quintiles (1&2).
The programme is helping to embed inequalities sensitive practice in primary care by combining non clinical and clinical support, putting the patient at the centre and facilitating access to other appropriate help.
We can demonstrate the health check takes a holistic approach through the provision of referral and signposting opportunities to a range of health and non health services offered to support patients to build on their individual strengths to support behaviour change.
We can demonstrate we are targeting specific vulnerable groups as required by the national guidance, and have set up new delivery pathways for individuals affected by substance misuse and for Gypsy Travellers.
In one setting, we have Keep Well embedded in a Care Standard, and we wish to encourage this approach for specific groups.
During 2012-13, we increased the number of deliverers and delivery settings for individuals to access a health check.
Keep Well has presented us with the opportunity to model ways of working e.g. Community Pharmacy. Some of the modelling e.g. Gypsy Travellers has not produced volume health checks. However, its value in supporting engagement on inequalities has been inestimable.
Rationale
Following Keep Well (KW) Extension Programme Guidance for NHS Boards, and building on Keep Well Wave 2 pilot in Aberdeen City, for urban areas the core target population was based on the population resident in the 15% most deprived data zones in Scotland (SIMD 2009 Overall rank and Health Domain rank).
For less urban areas in Aberdeenshire and Moray, the core target population was based on a protocol using SIMD 2009 quintiles and risk factors, to ensure that the most deprived individuals were offered health checks.
For resource allocation within NHS Grampian, we followed the Scottish Government’s approach to allocation of programme funds to Boards; 50% based on SIMD 2009 15% most deprived data zones (overall rank only) and 50% based on proportion of individuals in a Board area who are income deprived. The resource proportions for Aberdeen City, Aberdeenshire and Moray, respectively, are 64%, 25%11%.
Resource deployed
Financial Summary April 1st to 31st March 2013 / £k / £kDelivery of Health Checks
Local Enhanced Service (GP's) / 111.6
Pharmacist Interventions / 3.6
Bank Nurse Delivery / 7.9
123.1
Programme Support
Programme Management & Coordination / 48.9
Data Management / Systems Support / Practice Advice / 21.6
IT Technical Support / 2.2
Administrative Support / 10.8 / 83.5
Health Psychology / 18.6
Health Coaching / 1.2
Follow On Services
Healthy Weight - Dietetics Input / 26.8
Devolved CHP Functions
Coordination, Support and Roll Out across Grampian
(including development of services for vulnerable groups etc) / 59.4
Transport / Travel / 4.5
Equipment / 3.9
Total / 321.0
In kind investment
In addition, during 2012/13, there was considerable in kind resource, estimated value £103k, which contributed to the delivery of the Keep Well programme across Grampian. This included contributions from NHS Grampian; partner organisations and 3rd sector partners.
Approximately £63k supports the planning, organisation and coordination of Keep Well roll-out across Grampian while sustaining and developing existing activity in Aberdeen City. Input has been provided from a range of disciplines and areas including Public Health, Pharmacy, Allied Healthcare Professional’s, E-Health, Corporate Communications, CHPs. Prison Health Services, and Practitioner Services.
NHSG, in competition with other boards, secured its third successive Health Psychology trainee to support the programme and provides matched (£19k) funding with NES.
Work for vulnerable groups has benefited from a range of NHS inputs including the Aberdeen City Alcohol and Drug Partnership Support Team, Pharmacy, CPN Team Leaders, Learning & Development and Public Health Coordinators.
Aberdeen City CHP Health Improvement Fund invested £16k to help develop Keep Well support for vulnerable groups and services for Ethnic Minorities by funding a Gypsy Traveller Health Engagement Worker and a Multi-Ethnic Link Worker. In addition, the Keep Well Wellbeing exercise classes at Aberdeen Sports Village (a joint partnership between Aberdeen City Council; University of Aberdeen and Sport Scotland), are funded through the Health Improvement Fund and Keep Well programme. A number of Voluntary Organisations and third parties have also contributed including VSA, Foyer, Cyrenians, Drugs Action, Aberdeen Council of Voluntary Organisations (ACVO), Aberdeen Recovery Community (ARC) Recovery Workers and Aberdeen Sports Village. Our patient representative on the Keep Well Steering Group contributes her own time to participate in programme discussion and decision-making.
Other in kind resources were committed in respect of the Wellbeing agenda, Smoking Cessation and Cash in Your Pocket Partnership. Aberdeen Sports Village has been very supportive in providing support and facilities free of charge to enable health checks to be delivered in its state of the art facilities.
Keep Well Programme Activities and Outputs
Our model of delivery is principally through GP practices being encouraged and supported to embed Keep Well. 33 GP practices delivered health checks to the core target population and the vulnerable groups identified in year one of our implementation plan. In addition, we have worked to develop a mixed economy by providing alternative delivery settings both NHS and non NHS, including linkage to NHSG and/or practices (e.g. community pharmacy; community hospital; substance misuse clinics; sports village). In Aberdeenshire, two GP practices in Fraserburgh work with the three local Community Pharmacies. This model - where the practices invite their patients for Keep Well health checks, and the three pharmacies deliver the health checks - builds on the success of the national Keep Well Community pharmacy pilot in NHSG 2010-11.
Activities and actions supporting reach, uptake and referrals for the core and vulnerable populations
Keep Well (KW) Programme Local Enhanced Service Contract (LES) (March 2012), agreed annually through the NHS Grampian Enhanced Services Group and the Local Medical Committee (LMC) and the Keep Well Community Pharmacy Specification comprise the framework of our operation. This is supported by detailed guidance on coding for core and vulnerable group activity; and operating procedures for delivery in a range of community settings.
Planning dialogues were held with each of the three CHPs to support partnership working, agree implementation principles and ensure a sound platform from which to extend the programme.
Contract meetings with each Keep Well practice - Aberdeen City (23), Aberdeenshire (6) and Moray (4) - include the local Public Health Co-ordinators who have become increasingly involved with the operational delivery of the programme. The meetings allow us to reinforce aspects of the LES with practices, learn of any issues/likely issues which may affect delivery, ensure we maintain sound relationships with our deliverers and provide as much support as we can, share good practice, pick up on any training requirements, and advise them of any new information.
Data screening to identify eligible populations is provided for all practices.
Negotiation to release practice lists, where required, to effect delivery in pharmacy.
Recruitment of seven new GP practices: Aberdeen City (1); Aberdeenshire (3) and Moray (3).
Workforce recruitment and development to support delivery out with the GP practice settings and throughout the year training and deployment of Bank Nurses and prison nursing staff.
Specifically, the development of the Gypsy Traveller pathway on authorised and unauthorised sites, required significant effort with partners and a range of agencies - (Aberdeenshire Council Gypsy Traveller Liaison Officer; Community Education; Peacock Visual Arts; Grampian Racial Equality Council (GREC), to engage with Gypsy Traveller communities in North Aberdeenshire.. In Aberdeen, Keep Well health checks for Gypsy Travellers on authorised sites are provided via two GP practices.
In setting up a protocol for the transfer of health check information, we worked closely with NHSG Practitioner Services. This ensured that if the client’s GP practice was out with Grampian, information was appropriately transferred.
In establishing a Substance Misuse pathway, we built partnerships with key providers a mix of health and 3rd sector partners, enabling us to put in place pathways which were additional to, and complemented, the substance misuse health checks delivered within GP practices. Specifically pathways were developed and implemented in two community locations in Aberdeenshire, ‘Turning Point/Northern Horizons’ in Peterhead, and the Kessock Clinic in Fraserburgh with staff at both sites encouraging their clients to attend for a health check, resulting in good attendance rates. The three GP practices in these areas were supportive of the development.
In Aberdeen City, the pathway and infrastructure to deliver Keep Well health checks via a Community Psychiatric Nurse at The Timmermarket Clinic, was set up in conjunction with the Substance Misuse Service for delivery to commence April 2013. The substance misuse team actively promote Keep Well, encouraging their clients to book and attend for a health check. The health check is now embedded in their care standard.
In Aberdeenshire, links were made with Life Skills, an organisation that supports long term unemployed people, and 8 Health checks were delivered. Further health check delivery was planned. However, constraints within the Life Skills service prevented further delivery. This pathway will be revisited in 2013-14.
Carers, as part of the core population, were targeted through GP practices. Additionally, we worked with carer organisations and forums, in Aberdeen City, Aberdeenshire and Moray. In Aberdeenshire, awareness of Keep Well was through the Aberdeenshire Carers Multi-Agency Strategy Group and the VSA Carer service sent out letters on behalf of Keep Well, inviting Carers to attend their GP practice for a health check. Where this was not possible (where the practices were not participating in Keep Well), carer health checks were delivered in 3 locations via Bank Nurses.