Home Truths: How well do you understand GPs?

18th April 2013

 

The basics of Home Truths

A group of councils (10), CCGs (2), INLOGOV, HSMC and iMPOWER working together

Aiming to demonstrate that understanding and improving relationships with GPs can improve social care outcomes and save money, in particular by reducing unnecessary admissions to residential care

Wave 1 commenced in December and going into implementation in April/May. Initial evaluation in October

Further councils are commencing wave 2 and a Scotland group in April-June

 

A theory of change is emerging

The future of sustainable social care, and local public services generally, depends on the ability to transform the

relationship between citizens and the state

To deliver this kind of change we need a much deeper level of insight and evidence on individual values and

motivations, influences and relationships right across the system

We can build evidence for this by focusing in on one relationship first. GPs/social care is an under-exploited

relationship

 

Building a new evidence base

A key principle of the programme has been the value of building a different kind of evidence base

It is valuable to know and track knowledge, trust and motivations of stakeholders

So, before we tell you what we have found, a few questions (show of hands)

Q1 – How many meetings have you had with your CCG(s) in last month?

Q2 – How many meetings have you had with GPs (other than those in CCG lead positions) in the last month?

Q3 – Would you describe relationship with GPs as very good, good, bad or very bad?

 

Do you understand GPs? Can you play your cards right?

Have spoken to more than 250 older people, 150 GPs, over 100 GP surgery staff, social care CCG acute and community staff, hospital discharge teams

Surveyed 150 GPs. 10% across 6 sites

 

Question 1 – Higher or lower than 50%?

56%

My relationship with social care is poor

 

Question 2 – Higher or lower?

41%

I trust hospital discharge teams to make decisions in the best interests of my patients?

56%

 

Question 3 – Higher or lower?

41%

I can make a better assessment of need for residential care than social care?

41%

 

Insight 1

Lack of trust exists, and

matters

“Social care is (perceived as) inaccessible (and) remote”

 ”I don't feel confident that care packages & support services can be relied on to provide services at short notice (especially

on Friday afternoons!)”

 

Question 4 – Higher or lower?

73%

I trust Social Care to make decisions in the best interests of my patients?

41%

 

Question 5 – Higher or lower?

92%

I would value closer links with Social Care?

73%

 

Insight 2

The desire to improve

relationships can be tapped

in to with positive

feedback“GPs aren't told about when Homecare services start …

better communications may make GPs/ District nurse feel more confident that an elderly patient remains safe at home”

“I can make a referral but often there is no feed back until there is a crisis”

 

Question 6 – Higher or lower?

46%

I would rate reablement as unsatisfactory or very poor

56%

 

Question 7 – Higher or lower?

59%

I don’t believe any telecare services exist

46%

 

Insight 3

There is value in

understanding the perception gap as well as service gaps

“I am not aware and up to date with what is available”

 

Question 8 – Higher or lower?

68%

A reduction in home visits would motivate my advice to patients regarding residential care?

59%

 

Insight 4

Incentives and tensions in the system have

not been explored

thoroughly enough

“ … ‘urgent' seems to mean a different thing to us and Social Services”

“The big concern for me is that cuts ... will lead to . ..cost shunting”

 

Question 8 – Higher or lower?

46%

Financial incentives would motivate my advice to patients regarding residential care?

68%

 

Insight 5

GPs are different.

Those you see are generally not the ones you want to influence

“Of course money wouldn’t incentivise us”

“Clearly they could have been managed at home with the right support”

 

How are we using the insight?

Developing a new set of tools for a different kind of change

Perception gap reductionInfluence realignmentMotivation pathway reconfigurationGP personalisationTension management

Growing business case for savings and improved outcomes

Building momentum for a new starting point for “health and social care integration”`

 

Discussion questions

Do any of the GP responses surprise you?How do you think your area compares with

these findings?56% Rate the quality of relationship with social care poor or very poor41% trust hospital discharge team to make decisions in best interests of their

patients57% believe social care can make a better assessment of need for residential

care than GPs (41% said GPs make better assessment)73% trust adult social care to make decisions in best interests of their patients92% would value closer links with social care, 56% strongly value46% of those who knew about the service thought reablement was unsatisfactory

or very poor59% said they are aware of no telecare service available68% said a reduction in home visits would motivate their advice to patients on

residential care46% said financial incentive would motivate their advice to patients on residential

care

 

For more information

For more information:On the findings, analysis, solutions from Wave 1Or on Wave 2 commencing in April to June

Contact:jcooper@impower.co.ukwreynolds@impower.co.uk0202 7017 8030www.impower.co.uk