1. Ways to Wellness A Newcastle Social Prescribing Model
Dr Guy Pilkington
Clinical Chair of Newcastle West CCG

2. Chair - Professor Chris Drinkwater
CEO – Tara Case

3. A short history Year of Care How to respond to peoples wishes?
Having better conversations
Shared decision making
How to respond to peoples wishes?
Social aspects
What matters to you
NESTA grant

4. Ways to Wellness: structure, operations and governance
Big Lottery Commissioning Better Outcomes Fund – £2m
Cabinet Office Social Outcomes Fund - £1m
Social Outcomes Contract
Social investors
Referral of people with long-term conditions
Bridges brings at-risk support, and also project finance
16 GP practices providing referrals
WtW is 100% owned by the WtW Foundation
Performance Management is provided by Ways to Wellness (WtW) funded by central costs. WtW has budget in place to fund:
Full time CEO and FD
Robust Management Information System
Marketing activities
General admin support
Chair, Treasurer and an experienced board
Service Delivery Contracts
Service Providers deliver Link Workers to provide the social prescribing intervention

5. Referral Criteria
Registered with a GP practice in Newcastle West (18 practices, 140,000 population, 14,229 on LTC QOF Register)
Long-term condition (LTC):
COPD, Asthma, Diabetes (Type 1 or 2), Coronary Heart Disease, Heart Failure, Epilepsy, Osteoporosis
40 to 74 years of age
Further prioritised referral criteria:
social isolation
poor understanding of condition, frequent attender at GP or hospital, poor adherence to prescription
anxiety or depression (in addition to one of the above LTCs)
poor health but with scope to improve with lifestyle change
poor English literacy
obese or inactive

6. How it works Link workers 26 FTE across 2 Providers
(NHS Band 2-3-4)
26 FTE Link workers
across 2 providers
(NHS Band 2-3-4)

7. Ways to Wellness service characteristics
18-19 months average length of time on service
4 - 5 goals average per patient
60% of patients are signposted, averaging of 2.3 sign-postings each
Average Link Worker case load around 100
Quantitative and qualitative data shows patients referred have a high level of complexity*:
high historical use of hospital services
higher levels of co-morbidity
problems with stress, anxiety and depression
multiple social and economic issues including: debt, housing problems, low income and unemployment  

8. Service metrics: patient numbers
Referrals to date (to 31 March 2019): 6,025
Engaged patients to date (to 31 March 2019): 4,463
Currently engaged patients (at 31 March 2019): 2,919
Practice Referral Rate (per 1000 of Eligible Population):

9. Outcome metrics Well-being StarTM (30%)
Average improvement over 1.5 results in an agreed outcome payment
Secondary care costs (70%)
Savings in scheduled &
unscheduled admissions,
out-patient and A&E costs
compared against a matched cohort results in an agreed outcome payment

10. Outcome 1: Impact on Well-being
2,639 patients have completed two or more Well-being StarsTM assessments as of early (typically 6 months apart), allowing for measurement of change
The average patient improved 3.1 points, more than double the target of 1.5 points
Clients who previously described themselves as "finding out how they can improve things in their life to feel more in control“ are moving to "making changes”, or even "managing their lives pretty well"

11. Outcome 2: Secondary Care Costs Changes in non-elective activity

12. Outcome 2: Secondary Care Costs Changes in elective admissions

13. Impact on Secondary Care Costs
Ways to Wellness’ impact on secondary care costs is measured by comparing the full eligible Ways to Wellness cohort with a similarly matched cohort in the north and east of Newcastle
The average annual hospital cost per patient across the full Ways to Wellness cohort was 7.5% (£86 per head) lower than the comparison cohort last year (2017/18).
Across the full eligible Ways to Wellness cohort (14,300 patients), this difference equates to annual savings of over £1.2 million in 2017/18. The annual net savings for the CCG was approximately £440,000.

14. Quotes from Patient & GP Satisfaction Surveys
Patient: “I was grateful for any help to get well. Manageable targets and other useful suggestions helped me.”
Patient: “I began to see there were ways to move forward regardless of my ongoing medical problems ”
Patient: “The Link Worker had knowledge of activities and their benefits in my area. I wouldn't have known where to look for these. “
GP Practice: “Excellent service – it has helped our patients in ways that other services have been unable to.”
GP Practice: “The team are really friendly, approachable and adaptable; it has become an important service to many of our patients.”
Patient: “I felt at ease with my Link Worker and she listened and offered advice to help my situation “

15. Summary Unusual funding model (SIB)
Attempt to change the routine offer
Large scale
Long term
Targeted – pros and cons
Embedding deeply in primary care
Generating the evidence we need to change the way we engage in supporting people

16. Evaluating ‘Ways to Wellness’ Link Worker Social Prescribing
Social Prescribing in Southwark
16th May 2019
Suzanne Moffatt
Josephine Wildman
Newcastle University

17. Impact of social prescribing Qualitative research: 14 women, 16 men
Health related behaviours
physical activity
diet
Mental health
loneliness and social isolation
depression
anxiety
Long-term condition management
taking account of multi-morbidity and condition fluctuations
aged 40–74 years, mean age 62 years,
24 white British/Irish; 5 from black and minority ethnic communities
Four in paid employment
All but one reported more than one condition including non WtW conditions such as Fibromyalgia, Cirrhosis, Meniere's disease, Kidney stones, Visual impairment, Plantar fasciitis, Tinnitus, Irritable Bowel Syndrome and musculoskeletal pain
Conditions often combined with low confidence, social isolation and weight management
“I was at rock bottom when I got referred to Ways to Wellness”

18. Physical activity/long term condition management
'The instructor here has given me a programme that I'm working on to help build up the muscles for the legs and for my back … I'm managing [my arthritis] with the help of the gym … [also] my sugar levels … [have] come down to 4.9 … [and] my cholesterol was 3.1, which is good … all that had to do with Ways to Wellness and the exercise I've been doing.' (P6, male, 65–69 years)
Depression/multimorbidity/physical activity
'I was really down, so I couldn't go on Friday. It's been like that since I first joined. I've been missing [sessions] because of my COPD … bad turns … chest infections … [but] they [Ways to Wellness] restarted me again, so they've looked after me … they've been really, really good … they've stuck with me.‘(P1, male, years)

19. Long term condition mangement
“I am on the road [to better health] but it is slow … if it was easy I would have
done it years ago … I have been well impressed [with Ways to Wellness] …
because they have a very practical approach and know it has got to be
incremental … you can’t do everything at once … you can’t do everything at once so you have got to start small and build up … they have got the big picture in
mind.” (woman aged years)

20. Outcome measures (for pilot before/after study conducted Aug-Dec 2016)
quality of life (EQ5-D)
long term condition management (LT6)
depression (PHQ-9)
anxiety (GAD7),
loneliness and social isolation)
demographic variables (age, gender, ethnicity, long term condition(s)
Baseline response rate 30.1% (N=101)
3 month follow-up response rate 16.4% (N=54)
We concluded self completion questionnaire was not a feasible method for evaluation

21. Impact of a community based social prescribing intervention on people
Public Health Research Programme: 16/122 Community groups and health promotion
Impact of a community based social prescribing intervention on people
with type 2 diabetes in an ethnically diverse area of high socio-economic
deprivation. Exploiting a natural experiment to evaluate effects on health
and health care utilisation with economic assessment and ethnographic
observation.
Aims to evaluate the impact and costs of a community-based
link worker social prescribing intervention on the health and
health care utilisation of adults aged with type 2 diabetes,
living in a multi-ethnic area of high socio-economic deprivation.
This work is funded by the NIHR, Public Health Research Programme, Community Groups and Health Promotion, grant no. 16/122/33.
The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

22. Statistical data – routinely collected
Quality and Outcomes Framework (QOF) data
The QOF is a GP performance management and payment system.
It rewards GP practices in England for the quality of care they provide to their patients.
e.g. QOF indicator: % of patients with diabetes and history of CVD who are prescribed a statin
Data on type 2 diabetes management, smoking, weight, blood pressure etc.

23. Statistical data – routinely collected
Secondary Uses Service (SUS) data
Used for healthcare planning, hospital payments and commissioning etc.
Information collected whenever a patient or service user is treated or cared for
e.g. hospital visit, admission (routine or emergency), length of stay etc.

24. Treatment and control groups
Treatment: Eligible patients in WtW referring GP practices who have been with WtW for a year or more
Control: patients who have just started with WtW
Group 2
Treatment: Patients in WtW
Control: eligible patients in WtW referring practices who are NOT in the WtW service.
Group 3
Control: Eligible patients NOT in WtW referring practices
Group 4
Treatment: All eligible patients in WtW referring practices (regardless of whether they take part)

25. Using Ethnography (observational methods)
Combination of participant observation, interviews, focus groups, ‘shadowing’
Participants are service users, link workers and onward referral agencies (for PhD study, GPs, practice nurses, health care assistants, practice managers)
Yielding detailed accounts to build an understanding of how and why WtW works and for whom, as well who it doesn’t work for and why

26. Overview of WtW evaluation – July 2018-Spring 2021

27. Conclusions
Social prescribing is highly complex; selecting outcome measures is difficult
Collecting data
Implications for service providers
Implications for service users
Consider routinely collected data (but may not be easily available)
Mixed methods have advantages

28. Research Team Newcastle University
Suzanne Moffatt - Reader in Social Gerontology
John Wildman – Professor of Health Economics
Mark Pearce – Professor of Applied Epidemiology
Jo Wildman - Research Associate
Kate Gibson – Research Associate
Jayne Jefferies - Research Associate
Linda Penn – Research Associate
Bethan Griffiths – PhD Student
Allison Lawson – Research Administrator
Durham University
Tessa Pollard – Associate Professor of Social Anthropology
Northumbria University
Chris Drinkwater - Emeritus Professor of Primary Care Development
Nicki O’Brien – Senior Lecturer in Health Psychology

29. Publications
Moffatt, S. Steer, M. Lawson, S. Penn, L. O’Brien, N. (2017) "Link Worker social prescribing to improve health and well-being for people with long-term conditions: qualitative study of service user perceptions"
Moffatt S, Wildman J, Pollard TM, et al (2019) “Evaluating the impact of a community-based social prescribing intervention on people with type 2 diabetes in North East England: mixed-methods study protocol”
Wildman, J. Moffatt, S. Steer, M. Laing, K. Penn, L. O’Brien, N (2019) "Service-users’ perspectives of link worker social prescribing: a qualitative follow-up study" BMC Public Health
Drinkwater, C. Wildman, J. Moffatt, S. (2019) "Social Prescribing" British Medical Journal Practice