Primary Care Navigators

Reducing demand for health services

14 November 2012

Why it’s well-regarded

The Primary Care Navigator model meets a needProvides integration across health, social care and third

sectorMakes a real difference to the experience of patients and

cliniciansFlexible, adaptable, scaleableIs effective and efficient

Meeting the need15 million people with LTCs50% of GP appointments70% of acute and primary care budgetsDH predicts a rise of 25% in people over 65 with one + LTCs by 2050Cuts to local government spending have led to raised eligibility for

funded servicesConsequence is more pressure on secondary and primary careKing’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

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

Our response

A ‘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

Makes a real difference

What 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

Flexible, adaptable, scaleable:

Piloted in primary carePilot underway in a mental health team liaising with primary

careFits into Out of Hospital and Integration agendaCan sit in health, social care, third sector, community –

structured around local strengthsDoes not require a complex infrastructure with associated costsEconomic for a very small team, and robust for a larger one

Effective and Efficient: Average healthcare use6 months before and after intervention start

Outpatient

Out of hours

A&E

GP contacts

Inpatient

Significant drop

Significant drop

Significant drop

Significant drop

Significance test=Wilcoxan signed rank test

Potential cost savings per patientIndicative, based on 6 months pre and post

Savings

Average cost per contact

Average contacts 6 months pre intervention

Average contacts 6 months post intervention

Saving: Difference £ Saving

GP £25 8.6 4.6 -4.0 £99Inpatient £1,825 0.4 0.08 -0.3 £584Outpatient £160 2.9 2.3 -0.6 £96Out of hours £45 2.3 1.2 -1.2 £52A&E £152 1.4 0.6 -0.8 £116 £947Costs 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

Abbotts Hearing Aid centre Campden Charities Floating Housing Support Occupational Therapy

ACKC - friends & neighbours Carers Counselling Freedom pass Opthalomogy

ACKC befriending referral Carers KC Osteopathy Optician

ACKC benefits check Carers UK GP Orthopaedics Dept - St Mary's

ACKC Dementia Team CARS HF Hammersmith Hospital Palliative nurse

ACKC 'food & friends' Chelsea Theatre Health Trainers PALS

ACKC outings Chemist home delivery Healthcall (home opticians) Parkinson's Society

ACKC Practical Help CLCH Wheelchair Service Healthy Homes Peabody Tenant Support team

ACKC Shopping Service Community Alarm Service Hepatology Pepperpot

ACKC Support Broker Community Dementia Team Homeshare Scheme PhysIotherapy

ACKC Toe nail Cutting Community Diabetes Team Housing Opportunitues Team Podiatrist NHS

ACKC Toe Nail Cutting Service Community Mental HealthTeam Incontinence Service Practice Nurse

ACKC-Info & Advice Community pharmacy K&C Cruse Psychiatric Services

ACKC Escorting Cook & Taste sessions at Chelsea Theatre KCMS Quest

ACKC - Respite care Cooperative Funeral Care Learning disability Occupational Therapy Red Cross

ACKC Wayfinder Counselling Library Re-enablement Team H & F

ACKC Ageing Well sessions Crossroads Care Library Home Delivery Service Retinal Clinic

ACKC At Home Community Rehab Team Local colleges RNIB

ACKC Memory Café Cruse KC local sports facilities Samaritans

ACKC Volunteer CX Transport & Carer service Macmillan Centre at Chelwest Social Services

ACKC Decluttering Day Services Meals on wheels Stroke Association

ACKC Garden Guardians Depression Alliance Memory Service Substance Misuse Counsellor

Admiral Nurses Dietician MIND Sudanese Women's Assoc

Alcohol Resource Centre Disability Living Foundation Miranda Barry Day Centre Taxicard

Attendance allowance District Nurses Mulberry Place Activity Centre Thames Water Finance assistance

Binbrook House Support staff Dossett Box (chemists) New Horizons TMO

Blue badge DVLA appeal process NHS Direct Transport for All

British Heart Foundation Falls clinic Notting Hill Trust Vitalise Crossroads Care

Burgess Fields Support staff Falls Service Nucleus Westway Community Transport

Citizens Advice Bureau Fitness for Health Nutritionist Wiltshire farm foods

Open Age World's End Neighbourhood Advice

ContactCynthia DizeChief Officer

Age UK Kensington & Chelsea1 Thorpe Close, London W10 5XL

020 8969 9105cdize@aukc.org.ukwww.aukc.org.uk