Heywood Integrated Care Organisation (HICO) Demonstration Site Update 15 th December 2010 Dr Michael Taylor, York House Surgery, Heywood, OL10 4NN Email:

Heywood Integrated Care Organisation

(HICO)

Demonstration Site Update15th December 2010

Dr Michael Taylor, York House Surgery, Heywood, OL10 4NNEmail: [email protected]


The Glass That is Half Empty


Introduction: Aims

Clarify wellbeing services Increase public awareness Facilitate easier access Help the work vulnerable Maximise self care Guide people to appropriate support


Introduction: Objectives 1

Use population approach Improve physical care of those with

wellbeing issues Improve liaison between GP and

PCMHT Reduce stigma


The Population as a Patient


Introduction: Objectives 2

Reduce frequent attenders Reduce frequent flyers Sign post to wellbeing services


Complete de-stigmatisation Paperless referrals Short waiting times Seamless care achieved! No, really!! Attendance rates of 82% Simple feedback loop to adjust the

volume of referrals.

Process Outcomes


Methodology: Organisational diagram

Senior Commissioning TeamNHS HMR

Mental Health Commissioning Team

HICO Stakeholder Group HICO Mobilisation Team


Methodology: Team

Two Heywood GPs A Project Manager, Public Health, (Chair) An Operational Manager, PCMHT A Graduate Mental Health Worker A Practice Manager A Senior Commissioner, Rochdale MBC A Lead Commissioner, NHS HMR


Methodology: PDSA


Methodology: Questionnaires

Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS)

Patient Health Questionnaire 9 (PHQ9)

General Anxiety Disorder Assessment (GAD 7)


Mental health worker Nil

Wellbeing worker 1/3

Medication 1/3

Watch and wait 1/3

Patient choice of treatment


Evaluation: Problems

Rochdale MBC support difficulties. Cultural differences especially

PCMHT and GP. Wellbeing Worker overwhelmed. Scarcity of Wellbeing Worker. WEMWBS completion difficulties in

waiting room.


Evaluation: Lessons Learned

Wellbeing is not stigmatised. GP practices are suitable

environments for wellbeing workers. Wellbeing leaves responsibility with

the citizen. A better, quicker, cheaper service is

realistically achievable. Roll-out is easy.


Evaluation: PCMH perspective

60% of patients referred complex. WW reported being overwhelmed. WW compared and contrasted the

cultures. Better liaison with the GP practice

about patient population was a learning outcome.

Invaluable learning experience.


Evaluation: Academic 1

Services provided are seen as positive alternatives.

Access to psychology via Wellbeing Worker is more acceptable.

Relational and cultural tensions were addressed.

Understanding was improved. Increased awareness of wellbeing

services.


Speed-dating event was innovative and cost effective.

Regular PDSA meetings were challenging and important.

The WW role should be reviewed. WW’s should be more involved with

the GP practice. GPs to realise to abilities and

limitations of the WW.

Evaluation Academic 2


Conclusion: Patient perspective

No stigma Full consultation Choice Quick help Local help Place of comfort Seamless care (“no glitches”)


Conclusion: Practice Perspective

In house Need to understand the WW Need for signposting Reduced DNAs Prioritisation of work-vulnerable of

great help


Conclusion: PCMH perspective

Location crucial More capacity needed Different solutions for different

practices Incorporation of learning into IAPT


Conclusions: L.A. Perspective

Can include greater numbers of citizens.

Responsibility for self-improvement. Builds up community assets. One stop health and social care in

citizens interest. Demonstrates benefit of joint

commissioning.


Conclusions: NHS Perspective

Better, quicker, potentially cheaper. Transformation not additional. Different ‘populations’ may have

different needs. Uses assets as well as services. May reduce secondary care

demand.


Next Steps:

Five Ways to Wellbeing website. Supporting community assets. Commissioning in-house services. Incorporating wellbeing into IAPT.

York House Surgery

Website: www.5w2w.org


HICO Outcomes

Wellbeing score 39.6 Regional average 55.5 Wellbeing not stigmatised Seamless care Opportunity to be better, quicker, cheaper


Relationship between WEMWBS scores and PHQ-9 scores

0

10

20

30

40

50

60

70

PHQ-9

WE

MW

BS


What WEMWBS Scores Mean

60-70 Life treats you well

50-60 No big worries

40-50 Life has its ups and downs

30-40 Life can be a worry

20-30 Life’s a big hassle

14-20 If you are not already in treatment see your GP now


Focus of treatment

Focus of recovery

The Glass That is Half Full

Disorders of mood

Wellbeing


(HICO)

Dr Michael Taylor, York House Surgery, Heywood, OL10 4NNEmail: [email protected]

Demonstration Site Update15th December 2010

Documents

Heywood Integrated Care Organisation (HICO) Demonstration Site Update 15 th December 2010 Dr Michael Taylor, York House Surgery, Heywood, OL10 4NN Email: