Anticipatory care

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• Anticipatory care ..what is it, and what might
  it mean for Dundee?
• Lucy Rennie Drew Walker
• Strategy and Performance Manager Director of
  Public Health
• Dundee CHP NHS Tayside

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BUILDING A HEALTH SERVICE FIT FOR THE FUTURE (THE
KERR REPORT)

• preventive, anticipatory care rather than
  reactive arrangements. The NHS should work with
  other public services and with patients and
  carers to provide continuous, anticipatory care
  to ensure that, as far as possible, health crises
  are prevented from happening.
• targeted action in deprived areas to reach out
  with anticipatory care to prevent future
  ill-health and help reduce health inequality.

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DELIVERING FOR HEALTH (SCOTTISH EXECUTIVE
RESPONSE TO KERR REPORT)

• We will pilot this approach in 2006/2007 in five
  CHPs, place CHPs at the centre of work on
  tackling health inequalities and use the evidence
  .. to inform more general and widespread
  application of the anticipate and prevent
  approach elsewhere, for other people at risk
  through deprivation.

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DELIVERING FOR HEALTH (SCOTTISH EXECUTIVE
RESPONSE TO KERR REPORT)

• The Welsh GP Julian Tudor Hart advanced the
  inverse care law that the availability of
  good medical care tends to vary inversely with
  the needs of the population served some thirty
  years ago.
• anticipatory care .. by Dr Tudor Hart built on
  proactive case finding, preventive interventions,
  regular follow-up and audit.

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PREVENTION 2010 THE PROGRAMME

• Two phases of pilots from 06/07. Timing
  flexible. Money available from April 06.
• Testing new approach in areas with greatest
  health problems. More general application across
  Scotland to follow.
• New investment to bring added value building on
  other related policy initiatives.

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THE SCOTLAND EFFECT

• Improving social and economic conditions for the
  poor will not in itself narrow health
  inequalities in a short timescale

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Health Improvement and Health Inequalities
Health Improvement and Health Inequalities
Health Improvement and Health Inequalities
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OBJECTIVES

• Shift to a preventive/ anticipatory approach
• Maximum impact on inequalities
• A focus on those with most to gain

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PREVENTION 2010

• Practice based initiative
• Identify people in age group 45-65
• Engage them
• Assessment of risk factors
• Management of risk factors
• Follow up and monitoring
• Evaluation

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A NEW AND ADDITIONAL APPROACH

• Locality based
• Centred on practices
• Help not more work
• Community outreach
• GP engagement via QOF
• Funding for extra staff nurses and others
• Information from and for practices
• Links to outcomes prescribing

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DELIVERY

• Nurses and other staff into practices and beyond
• Clear guidelines for clinical management
• Engage external agencies
• Robust baseline and audit of change
• Plan roll out in NHST
• Ensure whole system sustainability

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Community Planning Community Regeneration Joint
Future Dundee Festival Wellbeing Go Dundee
Dundee Healthy Living Initiative The Corner The
Web PRTC Young Carers DAAT

Dundee CHP
Public Health Nurses Zone Leaders Health
Improvement Network/Healthy Dundee Fuel
Poverty Spotters Referrers Alcohol
Interventions Smoking Cessation Winning
Weigh Employability Framework Pilot Studies Unmet
Need Men's Health

• Service Redesign
• Community Health Facility
• Dentistry
• Audiology
• Physio rehab
• CHP Committee
• 2º Care
• Independent contractors
• DCC
• Primary Care Teams

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ASSESSMENT

• Demographic details, past history, family history
• Smoking
• Alcohol use
• Diet, Physical activity
• Height, weight, or waist measurement
• Blood pressure
• Random glucose
• Total cholesterol and HDL
• Mental health
• Literacy, Benefits
• Prioritise those with unknown risks/known risks
  not addressed

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ENGAGEMENT

• Assessment clinical case managers
• Maintenance outreach workers
• Appointments out of hours/in other
  venues/telephone follow up
• Electronic flagging of records
• Involvement of community pharmacy
• Involvement of Dundee Healthy Living Initiative
• Consult over best approaches

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CLINICAL CASE MANAGERS

• Coordinate assessments
• Oversee invitations
• Community venues coordinate, risk assessment
• Do some assessments
• Train other nurses to do assessments
• Track patients who need follow up
• Liaise with outreach workers

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OUTREACH WORKERS

• 11 support for people at high risk who find it
  difficult to access services
• Phone reminder/transport issues etc
• Work with practices to remove barriers where
  appropriate
• Develop links with voluntary orgs
• Support access to community projects
• Recruit and train lay people to provide
  additional support

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SMOKING CESSATION

• Build on existing programmes and local strategy

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WEIGHT MANAGEMENT

• Use counterweight model

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ALCOHOL

• Training for practice staff
• Enhance capacity in primary care
• Brief intervention at assessment
• Link to other services, both NHS and voluntary
  sector

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MANAGEMENT AND NEXT STEPS

• Steering Group
• Project Co-ordinator
• Work with statutory and voluntary partners
• Consultation

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ISSUES

• Clarity about what P2010 can deliver
• Exit strategy / sustainability
• Timescales