Primary care and population health management Nav Chana, Chairman, National Association of Primary Care Stephanie Lamb, Co-founder and Medical Director, the Well Centre

Primary care and population health management Dr Nav Chana

The Quadruple Aim Improving the health of populations Improving the individual experience of care Reducing the per capita cost of care Improving the experience of providing care - Increasing joy and meaning for the workforce Sikka et al (2015)BMJ Quality and Safety - http://qualitysafety.bmj.com/content/early/2015/06/02/bmjqs-2015-004160.full 3

Determinants of population health outcomes www.kingsfund.org.uk/time-to-think-differently/trends/broader-determinants-health

Value Allocative value Technical value Personal value Muir Gray 2015 BMJ Value

Primary healthcare

Better health for all through… Primary Healthcare Better health for all through… Reducing exclusion and social disparities Organising health services around people Integrating health into all sectors Pursuing collaborative models Increasing participation WHO Definition 2008

Multispecialty community provision Mental Health Secondary care Social care Community services Primary care Integrated provision Appropriate ‘place’ for care delivery Voluntary services

The Primary Care Home 1 Whole population health management An integrated, multi- disciplinary workforce Financial drivers aligned with the health needs of the whole population 2 3 Focus on 30,000- 50,000 people 4 © 2016 National Association of Primary Care

Population health management A proactive  approach to managing the health and well-being of a population Incorporates the total care needs, costs and outcomes of the population It involves segmenting the population into groups of people with similar needs Targeted interventions for population segments and the individuals  within.

Population cube Self care Informal care Generalist care Childhood Adulthood Older age Essentially well Long Term Condition(s) Higher Complexity need Generalist care Specialist care Informal care

Long Term Condition(s) Generally Well Long Term Condition(s) Complexity of LTC(s) and/or Disability Children and Young People Working Age Adults Older People

Multidisciplinary Squad with Generalist Values Life Course Subdivisions Generally Well Lower Higher Risk Risk Long Term Conditions Lower Higher Risk Risk Complexity of LTC(s) and/or Disability Lower Higher Risk Risk Children and Young People Neonates Infants Toddlers Children Adolescents Working Age Adults Young Middle Aged Older working age Older People 65-80 80-90 90+ Multidisciplinary Squad with Generalist Values Neurological (e.g. CP) Respiratory (e.g. CF, Asthma) Learning Disability Mental Health Problems Inactivity Alcohol Smoking CVD Resp. D Cancer Dementia Frailty

Dr Stephanie Lamb

Integrated care Voluntary partnership between Primary Care, voluntary sector and CAMHS. Open for “Drop-in” 3 afternoons a week- 3.30-7pm. staffed by GP (adolescent health experienced), 3 youth workers and Band 7 CAMHS nurse. YP can drop in or have booked appointment.

Youth work outreach activities at other times Regular counselling sessions in local schools School assemblies and PSHE Activities and groups – anxiety group, voice collective, Girls Group

Why does it matter? 80% of lifetime cannabis and alcohol use is initiated by the age of 20 50% of lifetime mental illness starts by age 15 8/10 obese teenagers become obese adults 8/10 adult smokers start as teenagers Strong links between different risk-taking behaviours: <16 yrs who are sexually active are more likely to abuse substances

Remember this 70% of adult preventable deaths are the result of behaviours initiated or reinforced in adolescence.

And yet….. Adolescents get shorter consultations than adults … And in the latest HBSC survey, although 80% had visited their GP in the last 12 months 48% felt uncomfortable discussing personal issues with the GP.

Teen Health Check Biopsychosocial assessment based on validated HEADSSS model Adapted for use at the Well Centre Abridged version developed for Primary Care consultation – Emis, read coded

Teen Health Check Health risk factors Vulnerability Health Inequalities

Well Centre Data

Well Centre Data

Well Centre Data

Well Centre Data

stephanielamb@nhs.net