The inverse care law and the potential of primary care in deprived areas
by Stewart W Mercer, John Patterson, John P Robson, Susan M Smith, Elizabeth Walton and Graham Watt
Focused care was mentioned in The Lancet as an example of how to address the inverse care law in general practice:
Tudor Hart not only described the inverse care law but also led the way in showing how it could be addressed, using the possibilities inherent in general practice in the UK National Health Service to pioneer a population approach to clinical care. Subsequent studies in deprived areas, including many Deep End general practices—ie, general practices in places of socioeconomic deprivation—have shown the cost-effectiveness of extended consultations for selected patients; the value of multidisciplinary team meetings, including social care workers, for integrated care; and the importance of co-workers, including mental health workers and financial advisers, who are embedded in general practices, thus increasing the speed, familiarity, and effectiveness of referral to these services. Link workers are an important addition to the generalist function, helping people with complex problems engage with multiple, fragmented, and often daunting services. Focused care workers provide a flexible approach and can help reduce both worklessness and use of hospital accident and emergency services. General practitioners (GPs) in east London, serving one of the UKs most diverse and disadvantaged urban communities, established a digitally enabled collaborative learning health system that improved the quality of care and achieved first place in national clinical performance rankings. Together, these research studies and evaluations in the UK show that disadvantage is not a given to be endured but a challenge that can be overcome.
Poverty as a Health Issue
by Simon Watts, Public Health Registrar on placement with Greater Manchester Poverty Action
Simon Watts writes:
If we don’t tackle poverty as one of the underlying causes of poor health, we will continue to pour money into health treatment services without addressing one of the key root causes of that ill health.
There are positive examples of progress though. Across Greater Manchester there are a range of services which work with residents to help improve their circumstances. One of these services, Focused Care, work with residents to support them with underlying challenges in their lives such as housing issues or benefits; when these issues are resolved residents may then have the space and time to focus on their longer term health
Quantitative Analysis of Focused Care
by GM Combined Authority
The Research Team at the GM Combined Authority completed some analysis of 430 randomly selected Focused Care data records. Owing to challenges with data, evidence did not give statistical significance but did yield some meaningful findings. The following graphs illustrate the positive impact of Focused Care on employment, smoking and alcohol consumption.
Qualitative Evaluation of Focused Care
Focused Care is widely considered to have generated tangible, significant outcomes for a range of chaotic/complex patients, particularly in terms of supporting them with mental health issues. Where outcomes were reported but not (fully) achieved or sustained, this was attributed to the chaos/complexity of the patients and the severe challenges of deprivation. The belief in the effectiveness and additionality of the Focused Care model for patients was extensive among patients, GPs and Focused Care workers. Outcomes were reported to be generated through a holistic approach to understanding a patient’s multiple, inter-linked needs and addressing them in a holistic way.
The Focused Care model is reported to have generated value for primary care in terms of reduced inappropriate appointments, the preventative value of improved physical and mental health for patients, and fewer DNAs; although there are also reports of increased demands on primary care through increased appropriate appointments such as for vaccinations and health checks. There are limited reports of the impact of the model at a system level, for example in reducing inappropriate attendances at A&E. However, support from Focused Care is reported to typically help a patient transition from accessing unplanned care to planned care, which should translate to a saving for the system. The quantitative evaluation may be able to provide quantification of these impacts.
Unconventional health and care: five organisations delivering care differently
by Ben Collins, King’s Fund
Focused Care was featured by the King’s Fund as an organisation delivering care differently. Ben Collins writes:
Laura Neilson, Chief Executive of Hope Citadel, described how one of her Focused Care workers had helped a young woman to escape an abusive relationship with a husband involved in violent crime. A vacancy had come up at a women’s hostel. There was a small window of opportunity to get the woman safely out of the house before her husband came home. The Focused Care worker grabbed a colleague, drove round and quickly helped the woman to pack her bags. In social services, Laura told us, there would need to be risk assessments and approvals. The head of social services would need to be informed. She doubted whether a statutory agency would have been able to respond in time.
Focused Care Data Review
by NHS Heywood, Middleton and Rochdale
The 2018/2019 data review of Focused Care by NHS Heywood, Middleton and Rochdale showed showed significant reductions in A&E, emergency non-elective and outpatient activity following Focused Care intervention.
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