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Get a social worker into every practice

Runcorn PBC consortium is shelling out £110,000 so that each of its seven practices can have its own named social worker. Dr David Lyon explains how the scheme works.

Runcorn PBC consortium is shelling out £110,000 so that each of its seven practices can have its own named social worker. Dr David Lyon explains how the scheme works.

In a scheme designed to improve the delivery of social care in our locality, Runcorn PBC consortium is providing around £110,000 funding for three named social care workers to work across our seven practices.

Our aim is to reduce crises among people with multiple problems – the solutions to which are not just medical – and help prevent unnecessary hospital admissions.

41213212Previously, my practice had an attached social worker and this reduced hospital admissions for over-65s by some 22%.

So we knew that it often took a relatively small input from social services, costing very little, to make an enormous difference to people's lives. Patients felt better, needed less medication, had fewer crises and fewer admissions to hospital.

How it works

Runcorn PBC consortium covers seven practices, with 65,000 patients. The model commissioned is for an 18-month pilot to provide social care workers who are employed by Halton Borough Council but based in the GP practices.

Each practice has a named social care worker so that better working relationships can be developed. A named social worker was something local GPs specifically asked for.

A typical scenario might involve a patient visiting the GP who may be concerned about them, or they might tell the GP they are not managing. The GP will then refer to the social care worker – either by speaking to them in person if they are at the practice at that time or phoning them. The social care worker will then make the assessment.

There are six workers who each work half a week – 18.5 hours – in the practices, making three whole-time equivalents. They work the other half of the week in their substantive post.

41213213The scheme started in February 2008 and will run until the end of August 2009, at which point it will be evaluated.

The social care workers often sit with the district nurses and community matrons and are in the practices for different sessions during the week. The amount of time spent in a practice is dependent on the number of over 65s in the practice population and the number of patients with long-term conditions.

Benefits

Most of the work is with adults over 65; altogether the seven practices have about 8,000 patients in this age group. The social care workers also support some younger adults with complex health and social care needs, mostly providing information and signposting for a group which usually needs welfare and benefits referrals or advice about housing.

The social care workers can also refer people on to other council services for younger adults. The scheme is funded by PBC freed-up resources.

The main benefits come from the closer working relationships we have been able to develop between GPs and social care workers. The old way of referring to social services involved the GP filling in a form and faxing it off, and any one of 13 people might take it on. GPs did not always know how the referral was progressing and it could be six weeks before social services intervened. Often there used to be duplication of work between the district nurses and social services, which has now been eliminated.

The situation was also not ideal from the social services point of view. They would often receive forms that were not filled in properly by the GPs, and then find it hard to get hold of the GP to get more information.

When the GPs and social care workers were brought together we realised we both cared about the same things and wanted the same outcome for the patients. With both disciplines together in the same building, things are so much easier. The GP no longer has to fill in a form; they can go and have a chat with the social care worker.

I can walk down the corridor and pick up ideas to implement with ten of my patients who I might have otherwise had to refer. Social workers are also in a better position to make their decisions once they have access to the knowledge we have about the patients.

When a package of care is put in, we can ensure not everyone visits on the same day and duplicates work. This type of team working means resources are saved and a better outcome is achieved by focusing on what the individual patient needs.

The evaluation next year will reveal how much exactly the social care in practice scheme has saved in hospital admissions.

We already know the consortium has saved £1m on hospital admissions in the past year and, in my practice, GPs' visits have fallen by 30 per cent in the past two years. As well as the direct savings on admissions, we have also saved money on prescriptions.

This scheme makes sure that funding is used to provide the most appropriate package of care, which has been tailored for the individual needs of the patient – these people don't want to be in hospital and sometimes being admitted to hospital is not always the best option.

When the money is spent in a different way, the patient gets the most appropriate care and savings can be significant. Patients are delighted with the service.

Dr David Lyon is a board member of Runcorn PBC consortium in Cheshire and a GP at the Castlefield Health Centre

GP Patricia McNully (left) with practice project manager Natalie-Hendry Jones and community matron Hayley Lawson GP Patricia McNully (left) with practice project manager Natalie-Hendry Jones and community matron Hayley Lawson 60-second summary Typical interventions - two case studies The social care view

Natalie Hendry-Jones (centre), manager for Social Care in Practice, offers her perspective


‘The aim of the scheme was to look at modernising services for vulnerable people and strengthening disadvantaged communities. The pilot was set up to establish formal links between primary care and social services so that people with long-term conditions or decreased functional ability could access social care assessments and have personalised care.


‘We anticipate that it will not only facilitate enhanced quality of life for older people but also increase the understanding within health and social care of each other's culture. As we are getting to know our health colleagues, we understand their priorities better and they have a better understanding of our world.


‘We usually offer a full social care needs assessment. Most are done as a joint assessment with another health professional – we go out with the district nurse or community matron so it's a holistic approach.


‘Looking at patients in a multidisciplinary way has been really useful. The patient gets a holistic assessment and we are able to bounce ideas off each other.
‘We can educate each other about our internal systems and develop an appreciation of each other's working practices.


‘GPs feel this way of working cuts out the red tape between organisations because the worker is there and they have built up a relationship with a named person they can speak to face to face. The GPs are getting much more consistent feedback as the worker is based in the practice for part of the week. The worker can also feed back any health concerns about patients to the GP.
‘If the GP is in doubt about whether the patient needs social care, they can come in and discuss it with the worker.


‘Because the consortium are paying for us to be there, we are able to go out on some of the more low-level needs.
‘While these are visits we may not have made before, and therefore additional work, we are being proactive so older patients with complex long-term needs don't reach
a crisis point. In the long term this helps to cut the workload.


‘Three of the six workers are from the intermediate care team so it's much easier for the GP to access intermediate care for the patient.
‘The only problems we have encountered have been with initial set-up – for example, finding office space and phone lines. But we are up and running now.'

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