CHAT Social Prescribing
| Description | A referral service for patients with social isolation and psychosocial issues |
|---|---|
| Setting | GP surgeries or patients’ own homes |
| Populationting | Anyone with social needs that are affecting their health |
| Intervention summary | Talk to patients and identify the most appropriate support for them |
| Outcome Summary | Broaden service provision in GP practices for patients with psychosocial needs and link patients to appropriate support within the community |
| Startup Cost | First year start up costs were £30 000, which included all publicity material and CHAT worker’s salary. |
| Running Cost | |
| Funding | A combination of the old Bradford South and West Primary Care Trust (PCT) Public Health and the Patient and Public Involvement Budget. |
| Started | November 2004, with patients being seen in January 2005 |
| Ended | There is currently an extension to March 2007, but this may be extended further |
| Location | Bradford, England |
| Contact |
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Background
The aim of CHAT is to give primary healthcare workers a resource that enables them to broaden service provision to patients with psychosocial needs and to link patients to appropriate support within the community.
Primary healthcare professionals refer patients with non-clinical needs to CHAT. The CHAT worker then meets with the patient, discuss their needs and identify appropriate support in the community. The CHAT worker is also able to spend longer time talking to a patient than primary care staff (up to three 40 minute appointments).
CHAT coordinates, facilitates and supports links between primary healthcare and the voluntary and community sector, thus increasing their capacity to work together. This, in turn, helps patients to access appropriate voluntary and community sector services and provides follow-up support.
What is the problem you are trying to solve?
CHAT helps patients with social isolation and psychosocial issues, and ensure that their needs are being met, in a relevant, appropriate and timely manner.
What local organisations are involved?
We work with healthcare professionals (GPs, nurses, health visitors and receptionists), social services, voluntary and community sector organisations, and universities.
How many people are running this project and who are they?
One full time worker, Simon White, who is managed by Tracy Higgins, Healthy Partnerships Coordinator
What local population are you targeting?
We are targeting anyone with social needs that are affecting their health and are referred to us by healthcare professionals (GPs, nurses, health visitors and receptionists). The three surgeries taking part in the pilot are The Ridge Practice (with surgeries in Great Horton and Wibsey, Royds Healthy Living Centre, Buttershaw, Bowling Hall Medical Practice, Rooley Lane, Bradford and West Yorkshire). People can also self refer. We cover a range of patients in terms of age, gender, ethnicity, and reason for referral.
How many people are you targeting?
We target as many referrals as the CHAT worker can cope with. Currently, there have been approximately 225 referrals since the project started.
Interventions
What interventions are you using to address the problem?
Clients are seen in a GP’s surgery or in their own homes. After an initial assessment, clients are then usually accompanied on their first visit to a new community or voluntary group.
Is the project design based on evidence? If so, please state reference.
Yes, please see reference list. 1 2 3 4 5 6 7 8
Outcome
What outcomes or planned outcomes are you measuring?
The project has been externally evaluated by Leeds Metropolitan University. They have interviewed both staff and clients, and examined monitoring data.
The evaluation methodology includes a qualitative approach with purposive sampling. There are semistructured interviews with staff and a combination of semistructured interviews and telephone interviews with patients. Data on age, sex, ethnicity, reason for referral and who referrals were from is routinely collected. In addition, we are examining pre- and post-appointment data to assess if the frequency in attendance of patients referred to CHAT is reducing.
Do you have any outcomes or results yet? If so, what are they?
From a healthcare professional’s point of view, we are providing a service that should cut the amount of time with frequent attendees at surgery. This ensures that they can spend more consultation time looking at more medical needs, safe in the knowledge that their psychosocial needs can be looked after by the CHAT worker.
Patients’ initial expectations were varied. The majority of patients (approximately 70%) wanted to feel social inclusion and others wanted to learn new skills and gain qualifications. Healthcare professionals felt that it was important that the patient’s expectation of the service was right, so that their outcomes matched initial expectations.
The referral process was found to be user friendly and flexible. It was personalised and referring was not “into a hole”. Patients were impressed with the speed of referral, but additional information about CHAT from the referrer would have been preferred.
Overall, most patients found the initial assessment beneficial and there was an appreciation for the non-clinical aspect. For some, attending the initial assessment had delivered benefits and was an opportunity for patients to be listened to. The CHAT worker had to be approachable, flexible, sympathetic and empathetic, and these skills were highlighted as helping to elicit information from patients. Healthcare professionals felt comfortable referring patients to CHAT and patients appreciated the offer to be accompanied to the initial session.
Is your project relevant to a government target or guideline?
No.
Feedback
What obstacles did you have to overcome to set up this project?
CHAT is based on a social model of health and some healthcare professionals are only familiar with a medical model of health. Therefore, these healthcare professionals have taken some time to adjust to it.
What have you learned about the project so far?
There is only one CHAT worker, spread over three practices, which obviously limits the amount of time he can spend in each practice. The evaluation has shown that for the scheme to be at its most effective, the CHAT worker needs to be considered an important member of the practice team.
What would you do differently?
There needs to be an increase in referrals to the scheme, and more thorough and rigorous collection of routine monitoring data. Feedback needs to be provided more consistently to original referrers. We are now looking to write a letter updating the progress of a patient to all referrers, immediately after the last appointment or accompanied visit made with a patient.
References:
- Abbott S, Davison L. Easing the burden on primary care in deprived urban areas: a service model. Primary Health Care Research and Development. 2000; 1: 201-206.
- Department Of Health. Saving Lives: Our Healthier Nation. London: Stationery Office (Government White Paper). 1999.
- Grant C, Goodenough T, Harvey I, Hine C. A randomised control trial and economic evaluation of a referrals facilitator between primary care and the voluntary sector. BMJ. 2000; 320: 419-423.
- Gulbrandsen P, Hjortdahl P, Fugelli P. GPs knowledge of their patients’ psychosocial problems: multi-practice questionnaire survey. BMJ. 1997; 314: 1014-1018.
- Hems L, Passey A. The UK Voluntary Sector Statistical Abstract. London: National Council for Voluntary Organisations. 1996.
- Heywood P, Cameron Blackie C, Dowell A. An assessment of the attributes of frequent attenders to general practice. Family Practice. 1998; 15(3).
- Pietroni P, Pietroni C. Innovation In Community Care & Primary Health – The Marylebone Experiment. London: Churchill-Livingstone. 1996.
- Scoggins E. Forging Links: a Report on stage 1 on the Voluntary Sector Primary Care Liaison Project on Making Links with General Practice. Bromley Council for Voluntary Services. 1998.