Mainstreaming Keep Well

PCIMG 13 April 2011 Dr Linda Leighton-Beck (Programme Director) Dorothy Ross-Archer (Programme Manager)

Overview

• •

What

is Keep Well?

Current position

in NHSG?

• • What is in

the guidance

?

What action

do we need to take?

– Strategic – Operational – Immediate – Short – Medium term

• • • • • •

Keep Well?

Scottish Government

flagship programme to increase the rate of health improvement in deprived areas

(SIMD 2006).

Eligible? 45 to 64 year olds in most deprived areas in Aberdeen City.

Health check

(30-40 minutes) to identify: intermediate clinical risk factors lifestyle risk factors other issues that may impact on health

Support

as required.

Local Enhanced Service HEAT target

= number of completed health checks

Initiation/set up for practice Monitoring ( national & local) Engagement Assessment (Health check) Treatment Preventive interventions

(from menu/directory largely supported from out with the practice)

New disease (identification, treatment, disease register)

Data Screening Job sizing Load KW template Phase patient recruitment Enter data National & local extraction Engage in local evaluation Invite patients Secure appointments.

Follow up non-respondents Deliver health checks Cardiovascular risk ASSIGN Lifestyle related risk Social issues impacting Medical management of risk factors.

Non-clinical management of: Cholesterol Smoking Obesity Management of symptoms eg chest pain Non-health eg Cash in Your Pocket Partnership Hypertension Diabetes CHD (angina)

• • • • • • • • • • • • • • • • •

Milestones so far?

Sept 2007-

NHSG proposal signed off

Dec-March 2008

– Early adopter practices data screened

Aug 2008

– NHSG Local Enhanced Service agreed Aug 2008 – Local evaluation procured

Sept 2008

- First local health checks in KW in

4 practices in City

2008-09 - HEAT target introduced

2008 – *Health Psychology - NES

(1)

Dec 2009 – *Community Pharmacy

(CP) proposal signed off

Nov 2010- First local health checks

in CP

2010 - *Health Psychology - NES

(2)

March 2011

HEAT

target met

April 2011 -

20 Practices and 6 Pharmacies

delivering

in Grampian

.

April 2011 – SG Guidance on Mainstreaming KW May 2011 – Local Evaluation

signed off and disseminated

June 2011- Proposal to be submitted to Scottish Government Sept 2011- Initial Feedback from SG

April 2012 – KW extended * Successful bids for additional monies to support targeted primary prevention

Current providers

of Keep Well

&

Well North

GP practices

• Keep Well in Aberdeen City: 17 • Keep Well/ GRANITE in Aberdeenshire: 1 GP Practice • Well North in Moray : 2 GP practices

Community Pharmacies

• Aberdeen City : 2 • Fraserburgh :3 • Moray: 1

Other venues/models

• G-Meds OOH Nursing • Healthy Hoose • Aberdeen Sports Village • Saturday practice sessions-bank nursing

Existing support for practices

• • •

Menu of interventions

offering referral and signposting e.g.

• Cash In Your Pocket Partnership • Healthwise Aberdeen (health & literacy) • Credit Union’s – e.g. St Machar, Torry, Grampian • Smoking Advice Service • Healthy Helpings • Healthpoint • Wellbeing Circuit Session Classes – Aberdeen Sports Village

Health Behaviour Change Training Health Coach Pilot(s)

Keep Well Steering Group

• Clinical Lead • Public Health Leads - City/Shire/Moray • Nursing Services Manager • Head of ICT Services • Finance Manager • Consultant in Pharmaceutical Public Health • Development Pharmacist • Information Analyst • Professional Head of Dietetics • Coronary Heart Disease & Stroke Managed Clinical Network Manager • Patient representative • Programme Manager • Programme Director (Chair)

National Keep Well Board Scottish Government Performance Management & Monitoring Grampian X system Performance Review Sub Groups Keep Well Steering Group City CHP Committee AHIG Moray CHSCP Community Pharmacy X Grampian Well North Steering Group

Changes from 2012 include…

• Mainstreaming health check in routine practice • Lowering eligible age to 40 • Repeating health check every 5 years • Extending programme to all in 15% most deprived areas; some local flexibility to reach deprived/high risk populations out with those areas • Targeting vulnerable groups

Resource from Scottish Government

• 2012-13 –

circa

500 k* • Nationally Agreed Framework for LES *

Indicative, and subject 10 NHSG 10% top slice of allocation and current % efficiency savings

Guidance on mainstreaming: overview

• Full guidance available at: www.hi-netgrampian.org/keepwell .

Eligible Populations

• Individuals

between 40 and 64

at high risk of CVD (with additional steps to

identify eligible carers

) •

and

• Living

in the most deprived communities

Scottish Index of Multiple Deprivation,

2009

) (Identified through

Specific Vulnerable Populations

(definitions to be supplied) to include: – South Asian ethnic subgroups; – Black and Afro-Caribbean ethnic subgroups; – Offenders; – Gypsy Travellers; – Homeless individuals; – Individuals affected by substance misuse.

Key areas of proposal

• Identifying

core

target population • Identifying, targeting & engaging

specific

vulnerable populations • • • • •

Models

of delivery • Onward

Referral

Procedures

Resource Data

Plan Collection

Implementation Risks

Planning from the pilot

…..

• The Keep Well pilot in Aberdeen City.

• Early adopter practice in Aberdeenshire • Well North pilot in Moray. • KW Community Pharmacy pilot in 3 CHPs.

• KW November Workshop Report.

• Local evaluation of Keep Well.

• National evaluation of Keep Well • KW Steering Group key issues and actions.

Progressing the proposal

• •

GP sub updated

and advised of extension target population (April)

KW briefing note to all GP practices

and identified community pharmacies to support engagement in process. (April) •

NHSG issues flagged

by Keep Well Steering Group and others and progressed (April-June) – Data screening – Scenario planning – IMT systems – Health Intelligence – Resource –

Systematic, integrated model(s)

of inequalities-targeted primary prevention –

Local dialogue on options

 – City Cluster Clinical Leads Aberdeenshire  Moray • •

Agreement on local models

(May)

Proposal discussed with PCIMG

(June) •

Submission of NHSG proposal

(June) • Contacts: linda.leighton-beck@nhs,net ; [email protected]