1. ENGAGING WITH HARD TO REACH GROUPS 27-08-2015

2. An individual or group of people that are difficult to engage with. Within Newham the hard to reach groups comprise of: Adolescents Patients with low heath literacy Patients with complex social needs Patients who require language support Patients managing multiple co-morbidities Defining Hard to Reach

3. Organisational Inflexible and fragmented services Services that are difficult to access and not responsive to the needs of its population Individual Transitional issues Feeling unprepared for the level of responsibility (isolation, stigmatisation etc.) Insufficient understanding of disease Difficulty identifying/accessing support Finding the balance between life & disease management Factors influencing engagement

4. 1.Lack of contact with routine primary and secondary care services 2.Variable engagement with primary and secondary care services DNA outpatient appointments but attends GP DNA outpatient appointments but Skype ± attends GP Yearly GP attendance Types of dis-engagement

5. Profile of 70 ‘dis-engaged’ patients

6. Interviews conducted and attendance/non-attendance explored as part of the ‘patient journey’ Perceptions of Skype: Reassuring – Quote -“I know I can access someone if I get desperate” A means to re-engage – Quote – “I can get seen again without wasting a lot of the doctor or nurse’s time” Minimises reason(s) for not engaging – Quote - “I actually don’t have an excuse for not seeing my nurse or doctor now” Skype and dis-engaged patients

7. GP Collaboration to: 1.Understand the nature of dis-engagement 2.Endorse Skype use as an alternative Peer Support co-facilitated by HCPs to: 1.Identify and address transitional or current issues 2.Build better relationships with patients (confidence and trust identified as key elements for Skype consultations) 3.Inform patients of alternative forms of consultations Strategies to improve engagement

8. Motivated to self-manage Confident to make decisions which may require validation by a clinician Tangible benefits (convenience, time, cost and effort) Skype is a useful tool But Understanding dis-engagement is crucial! Observations of Skype Users