LiveWell: Reducing admissions through community-led peer support

Key benefits and outcomes:

• Improvements in patients’ physical and mental wellbeing
• Decrease in primary and secondary care usage
• ROI projected to cover 100% of programme costs within 12 months
• Organic growth of community support offers

Overview

Rushcliffe Primary Care Network (formerly Principia) is a partnership of GP practices, patients and community services in Rushcliffe, Nottinghamshire. The network identified a gap in supportive and preventative services for people with serious mental illness, especially for people who frequently used acute and emergency services due to crises, and those who underused services and were isolated, excluded or chronically unwell.

What the organisations did

In 2017, the Rushcliffe Primary Care Network (formerly Principia) engaged Imroc, a charity that facilitates community-led approaches for improving health and social care experiences and outcomes, to help meet these needs.

Imroc uses co-production, working with local communities to develop different ways to make use of local assets and support people to live full lives.

Imroc formed a coproduction forum in Rushcliffe, initially comprising service users and staff from GP practices and other local health and care providers. They discussed who needed support, what support would make a meaningful difference, which interventions had worked elsewhere, and how support offers could be coproduced.

The forum opted to use peer support workers, judging that people who have lived experience of serious mental illness and have found a way to live well would be effective advocates, role models and support workers for others. They agreed that referrals should be seen within 48 hours so people would not lose faith in the process.

A local GP was appointed as overall primary care lead, with a health coach made available to each participating GP practice. A senior member of the Imroc team managed the project and facilitated fortnightly coproduction forum meetings. These continued throughout the project including an ever-widening range of local services, facilities, activities and citizens, with a membership of 120 by the end of the project.

The project manager also recruited and led the training of 15 peer support workers. Training covered safe and appropriate therapeutic relationships, and how to engage people in conversations about their wellbeing, draw on experiential knowledge, and support people through practical problem-solving skills.

The health coach in each locality was the first point of contact. They undertook initial assessment which included the Patient Activation Measure to understand more about clients’ health needs. If further support was assessed to be beneficial, they referred onto the most appropriate peer support worker who used this insight to start a conversation about what changes would make a difference. These could range from exercise goals to personal issues, like wanting to get back in contact with a relative or ambitions like finding a steady job.

Over the course of the programme, Peer Support Workers developed a booklet, ‘The Green Book,’ that supported clients to set goals and measure progress.

The programme aimed to intervene to reduce the risk of admissions by working ‘upstream’ to build community capacity, confidence and understanding, enhancing individuals’ self-management and coping skills and supporting them to achieve their own goals in and with their local communities,

Results and benefits

1,483 referrals were received in the first 13 months. An evaluation undertaken by Nottingham Trent University resulted in 630 usable responses at baseline, 178 at a four-month follow-up and 63 at a final eight-month follow-up. There were improvements in patient wellbeing after the initial four-month period which were maintained after eight months.

There was also a decrease in primary and secondary care usage over the evaluation period and a reduction in crisis calls to ambulance services which was attributed to individuals receiving support from a peer worker. Discharge of patients was enabled by the provision of support in the community.

An economic assessment attributed savings to both the improvements in participants’ health and the reduction in care usage. Return on investment analysis suggested 100% of programme costs would be recouped within 12 months, based on an initial return-on-investment of £0.34 per £1.00 invested after a period of four months.

Interviews with GPs, health coaches and support workers identified improved social connectedness as driving improvements in health and wellbeing, even for clients with specific health concerns.

The coproduction forum grew over time, with community members seeking to offer time or assets. Ultimately up to 120 members met fortnightly, including representatives from local churches, sports halls and businesses. Support included free access to Tai Chi, a group for bereaved men, healthy eating groups, courses on sleeping well, and signposting to the local soup kitchen.

Takeaway tips

• Having an impartial partner coordinate the group can help foster a spirit of collaboration: no commissioning body or service provider should have more power than another.
• A facilitator with coproduction expertise is necessary since the coproduction group is crucial for building and sustaining community support offers.
• Building networking opportunities into coproduction meetings helps enable offshoot projects to grow organically.
• High quality training for peer support workers is vital, including practical client-facing tools such as the ‘5 ways to wellbeing’
• Responding to people referred in person within 24 hours to arrange a meeting as soon as possible is critical for ensuring buy-in and effective crisis management.
• One challenge of the coproduction model was providing a clear message. Some GPs reported having only a basic grasp of the project created the lack of clarity was reported as the main reason for them failing to refer to the programme.
• Another challenge at the time was to identify and utilise savings achieved through the programme because these were spread across multiple sectors and providers. Pooled budgets could have helped demonstrate savings and secure future investment in the programme.