Salutogenesis – In Primary Care….? Dr James Fleming MBChB MSc FRCGP College of Medicine September Supported by:

Solutions to social problems when no other agency can help

Kate 30F  ‘Am I depressed?’ sick/fit note  Rock bottom, drinking  Rent arrears, debt, poor housing  Little self-esteem,  Not worked for years  Educational problems  Repeated attendances at GP Anti-depressants? Fit note? Counselling? Alcohol Services? CAB? Job Centre? Well-meaning Advice? Nothing? What do you do?

GDP alternative o Identify barriers to increased QOL o Contact JC+, go with her o Liaise c landlord, HMRC, DWP, Welfare Rights o Involve in one of our projects, build confidence o Documents, correspondence, CV o Access Training and coordinate o Lifestyle and health issues, Now self-employed after 6 years

Triad of Support: ‘The underlying approach to the Green Dreams Project is one of empowerment and enablement … a reduction of just chemical based intervention, to a more holistic view of the person’. (UCLAN, March 2013)

Elderly and Isolated Bingo, self funding Day trips – self funding Meet old friends, laughter Health seek behaviour change Also, home visit, befriending, craft, voluntary organisations, walks, computer, procure space, Art Group, Theatre Group, Knit and Knatter

Figures GDP well-being 22 surgeries 120,000 patient pop, 7 towns, 1000 referrals per year GDP nursing 17 surgeries Burnley East, West, Central Governance, partnerships, CCG, NHS East Lancs, Public Health, LCFT, Local Partnerships, Police, Troubles Families, Princes Charities

Outcomes Client outcomes Client satisfaction Stakeholder satisfaction Non-bias GP Data Commissioner outcomes Non-bias research Cost-benefit analysis – us and CCG Q Reports

Intended outcomes: · Health and wellbeing · Social cohesion and engagement · Social health · Work, education and learning 17 common outcome headings: · Mental health/prevention of deterioration · Physical health/prevention of deterioration · Financial stability/debt situation · Housing situation · Benefits situation · Demand on healthcare services · (re)offending · Resilience · Employment · Skills and experience for work · New skills / expanding knowledge · Sense of choice/autonomy · Social isolation · Relationships · Links with the community · Volunteering · Community services available

Stats Improved: QOL: 90% Mental health: 85% Well-being: 75% Engagement c others: 44% Motivation: 40% Life skills: 14% Housing situations: 12% Work, ready, volunteer 20% Physical health: 25% Financial situation: 33% Reduced: Freq. GP/hospital appts: 37% Depression/anxiety med: 31%

Independent Evaluation University of Central Lancashire March 2013 Study completed by a team of researchers from the UCLAN ‘School of Health’ who independently interviewed a range of key stakeholder and examining project data monitoring forms. Findings were cross referenced with a literature review to support conclusions. Stakeholders independently reported that the project is extremely beneficial to all service users. > Mood > Self esteem and confidence > Coping skills < Social isolation < Primary care attendance < Dependence on medical care

20% sample of clients from 1 surgery Approx. £81,610 of social value generated We looked conservatively at what social costs might be incurred if our intervention had not taken place…….