Linking Mental, Physical and Social Health to care for ‘Nobody’s Patient’


Chair: Dr Tony Downes, Extended Role GP


Board Members:

Jennifer Ward, Lived Experience

David Williams, Carer

Daniel Phillips, Psychological Trauma Therapist

Paula Curtis, Senior Practitioner Occupational Therapist

Rebecca Bertram, Finance/Yoga Teacher

Deborah Jones, Secretary

Kevin Meyrick, Practice Manager

Alan Owens, Information & Technology

Adrian Johnson, Advanced Nurse Practitioner, Company Secretary


Betsi Cadwaladr University Health Board Quay to Well-Being (Q2W) Co-operative:

A Proposed GP-Practice (GMS) ‘Plus’ Service

‘Not for Profit’ company that operates on Co-operative principals


This Bevan Exemplar project is designed to provide high quality, prudent GP services AND high-quality innovative care for people whose problems fall between the gaps of health and social care services in Wales.


Background


Despite the enormous benefits of modern disease management, the culture and organisation of modern medicine has excluded a substantial number of people, worsening their symptoms and experiencing considerable, unnecessary costs.

  • Up to 50% of hospital outpatient appointments

  • Up to 10% of hospital admissions

  • Up to 40% of GP appointments

The overall cost has been estimated at £3 Billion to the NHS, 10% of the NHS Budget and £14 Billion to the UK economy.


There is a considerable body of research (including the Adverse Childhood Events study), which has demonstrated the need for a psychological and social-trauma-informed approach to care, which links mental, physical, social and spiritual health to the quality of relationships.


The Q2W co-operative has been co-produced in partnership with community members to care for ‘Nobody’s Patient’; those people whose problems fall between mental and physical health services, between primary and secondary care services, between health and social care services and between various third sector services. Q2W is integrative, innovative, transformational and scalable; a model of care fit for the 21st century.


A short explanation of how my mental and physical symptoms were connected and linked to my life experiences was like a light bulb coming on. Nobody has ever explained things like this, which really helps.‘Nobody’s Patient’ (Anonymous)


Aims


The primary aim of the project is for health and social care professionals to take the lived experiences and personal histories into account when engaging with people and patients. Q2W builds on the origins of the NHS as a miners’ co-operative to be a modern-day co-operative with the additional benefit of 21st century science & technology.


The work of Q2W includes:

  • Putting the lived experience at the forefront of health and social care by encouraging community engagement and participative democracy.

  • In addition to chronic disease management, assisting people suffering the effects of psychological/social trauma and a range of debilitating persisting physical symptoms such as chronic pain, fibromyalgia, chronic fatigue and stomach and bowel symptoms.

  • Creating an intermediary well-being hub that encourages collaborative working and co-production for prudent healthcare.

  • Providing education and training as well as treatments, therapies and social interventions, across boundaries and at scale.

  • To be carbon neutral and utilise evolving high-tech healthcare technologies: integrated data and technology to improve the delivery of effective health and care services with improved communication to the patient and health professional.

  • Business intelligence, analytical services and effective communication technologies designed around Q2W’s evolving healthcare.


Challenges


A major barrier to successful implementation of Q2W is the hospital, secondary care model, which dominates in governance and funding compared to primary care/GP practice. Against this background, Q2W was created and implemented despite minimal resources due to the altruistic nature of the Q2W Board members and collaborators. In order to transform the NHS and social care, there is a need for leadership, resources and funding to be directed to support innovations such as Q2W.


Outcomes


Although the Q2W concept has been developed and refined over the past 20 years, during the past year it has been incorporated and implemented with positive outcomes for patients and services. Our work has been presented at 5 UK national forums on MUPS and psychological trauma, and we will be presenting our work to an all-Powys, primary care training event in 2019. A proposal to move a GP practice under the Q2W Co-operative is currently underway. The GP is also involved with research into traumatic stress and medically unexplained physical symptoms and represents general practice in the development of the All-Wales Post Traumatic Stress/Complex Post-Traumatic Stress Disorder service.


Next steps


In order for Q2W to meet its objectives and scale up, Welsh Government, the Public Service Board and health board need to invest and support the Q2W Co-operative as a matter of urgency.


The Q2W Co-operative is to replace a GP partnership and provide GP services (GMS) as well as services for persisting unexplained physical symptoms and other problems that arise from psychological/social trauma and adversity (Plus).


Q2W intends to scale-up locally and nationally through training and technology, and to continue to work with Public Health Wales, Glyndwr University and a range of collaborators, including secondary care mental and physical health services, and social care.



Part of cohort Bevan Exemplar Projects 2017-18


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