- Embedding self-management support through the three strands of the Co-creating Health programme.
- Working with people with depression being seen in primary care.
- Ran from September 2007 until November 2012.
- The team took a whole system approach, embedding self-management across the work of the trust at all points in the care pathway.
- Both statistical and anecdotal evidence were important to the team to assess the impact of the project.
The aim was to introduce positive benefits from efficient self-management thereby improving people’s quality of life, and reducing the burden on health and social care services. To achieve this they rolled out the three elements of the Co-creating Health programme:
- Self-management Programme (SMP) for people with long-term conditions
- Advanced Development Programme (ADP) for clinicians
- Service Improvement Programme (SIP) to redesign services.
The team were positive about the results having successfully embedded self-management into primary and secondary care services, changing the way health professionals worked.
Evidence collected clearly showed that the SMP reduced contact with secondary care, demonstrating the potential cost saving of supporting self management.
The team reported that clinicians not only embraced the ADP training but recognised improvements and success because of it. Feedback from clinician to clinician led to a high number of GPs signing up to the programme and anecdotal feedback from people whose GPs had attended was that their consultations changed to focus more on working in partnership.
The team worked hard to improve attrition rates on the SMP, revising the referral pathway to ensure appropriate referrals. All GPs who undertook the ADP referred consistently onto the SMP due to the excellent feedback they received from patients.
Referrals to the SMP were further boosted by the power of patient’s voices – telling their story at meetings across the whole organisation – the team found that the site reporter played a key role in evaluating the impact of this.
At the end of the project the team felt that to take the programme further new targets and measurements tools would need to be developed to meet local need, including the needs of commissioners.
This project was twinned with the Co-Creating Health project at South West London and St George's Mental Health NHS Trust.