FIGURE 5.1: A UNIVERSAL SERVICE SHOULD BE THERE FOR EVERYONE BUT NOT THE SAME FOR EVERYONE Patient segmentation model designed and used in north-west London
Age
‘Mostly’ healthy (rest of the population)
One or more physical or mental long term conditions
0–12
1. ‘Mostly’ healthy children
13–17
2. ‘Mostly’ healthy young people
18–64
3. ‘Mostly’ healthy adults
6. Adults with one or more long term conditions
4. ‘Mostly’ healthy older people
7. Older people with one or more long term conditions
65+
Cancer
5. Children and young people with one or more LTCs or cancer
8. Adults and older people with cancer
Serious and enduring mental illness
Learning disability
Severe physical disability
Advanced dementia, Alzheimer’s, etc
Socially excluded groups
9. Children with intensive continuing care needs N/A 10. Young people with intensive continuing care needs
11. Adults and older people with SEMI
13. Adults 12. Adults and older and older people people with with physical learning disabilities disabilities
14. Adults and older people with advanced dementia and Alzheimer’s
15. Homeless individuals and/or families (including children, young people, adults and older people), often with alcohol and drug dependencies
Source: North West London Integrated Care (2015) Note: Mental health is present across all components
CASE STUDY: BROMLEY BOW CENTRE AND SOCIAL PRESCRIBING
The Bromley by Bow Centre in the East End of London was established in 1984 as an innovative health living centre. The centre includes a GP practice which places high value on social prescribing – a process whereby GPs prescribe non-clinical forms of care, ranging from debt support to community therapy. The practice works with over 2,000 patients a month, and only 30 per cent of its prescriptions are clinical. Once referred by a GP, patients have an in-depth consultation with social prescribing link workers, who assess their needs and point them in the direction of services or projects that may be of help. In early 2017, the programme was also extended to cancer patients via a partnership with Macmillan. Embracing social prescribing as a tool for primary care has been remarkably effective since it enables practitioners to reach into the social determinants of care. As professor Sir Michael Marmot’s 2010 review, Fair Society, Healthy Lives, demonstrated, the majority of health outcomes can be explained by non-clinical, socio-economic factors. Giving general practitioners the tools to have a more holistic approach to care and to help tackle the root of patient needs has significant potential to reduce healthcare costs in the long run and improve quality of care. Although there is a limited amount of robust, comprehensive empirical evidence on social prescribing, case-specific results suggest that there have been improvements in self-esteem and psychological wellbeing (Kimberlee 2013) and even a reduction in the use of acute and primary care (Dayson and Bennett 2016).
IPPR | The Lord Darzi Review of Health and Care: Final report
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