Q Exchange
We Wait Well – Collaboration To Improve Wellbeing While We Wait
- Winning idea
- 2023
Meet the team
Also:
- Alan W - patient waiting for an orthopaedic operation
- Jane Barclay-Trott - lead volunteer Health Champion
- Rachel Hodges-Cox - Social Prescribing Link Worker (SPLW)
- Rachael Banfield - Health and Wellbeing Coach (H@WBC)
- Ziad Suleiman - PCN Lead Pharmacist
- Rachel Merritt - PCN Business Manager
- Vinay Takwale - Consultant Orthopaedic Surgeon and local NHSE Waiting Well lead
What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?
There are long waits after referrals from primary to secondary care and further delays to planned operations. Patients are often distressed and in pain, become isolated and inactive, resulting in deconditioning ahead of their operations, which can cause further delays. In the meantime, demand on already overstretched GP services rises, causing worsening access for all patients and adversely affecting staff morale.
Our project will actualise NHSEs Elective Recovery and Personalised Care ‘Waiting Well’ work. Aligning with the Fuller Stocktake, we will use Population Health Management principles to identify the target cohort and co-produce a ‘care bundle’ of interventions to optimise prehab. A Waiting Well Coordinator will work alongside our Living Well teams (frailty nurses, social prescribers, wellbeing coach and volunteer Health Champions) to facilitate peer support activities, access and enhance community assets, and arrange targeted health checks. Reliance and demand on primary and secondary care services will reduce.
What does your project aim to achieve?
Our aim is to enable patients waiting for orthopaedic operations to maintain and improve their physical health and mental wellbeing during the prehab phase, reducing the risk of delays to their treatment. Utilising existing and newly developed community assets, patients will achieve goals based on What Matters to Them. Engaging in activities such as exercise classes, nature walks, healthy eating groups, meditation, accessing peer to peer support and increasing social connections, will improve wellbeing and reduce reliance and demand on primary care services. We aim to learn from and build on existing hospital prehab initiatives.
Targeted health checks will ensure medications are optimised, blood pressures to target and chronic diseases well controlled.
In order to reduce health inequalities, we will use primary care ethnicity data, cross referenced with known areas of deprivation within our neighbourhoods to better understand and risk stratify our cohort of waiters.
How will the project be delivered?
We have a well-considered idea to test and improve in our PCN, in order to develop a model of care that we can upscale and spread to our locality.
In order to deliver this piece of work, our project team will draw on the diverse skills and knowledge of hospital consultant colleagues, 2 GPs (a Deputy Medical Director for NHSE and our PCN Clinical Director), PCN Pharmacy and Living Well teams, volunteer Health Champion groups, colleagues at Active Gloucestershire and, most importantly, our patients.
We will use expertise developed from a successful PCN QI project providing a personalised, proactive and coordinated approach to patients nearing the end of life, and our previous successful Q Exchange bid (Churchdown Connections), both of which have transferable themes.
We will be supported by AHSN and ICB colleagues to measure impact and our PCN Business Manager will oversee the project to ensure value for money.
How is your project going to share learning?
We already work closely with the PCNs at Locality and County level, and regularly share learning and ideas. We have lead and undertaken several successful projects and initiatives which, with training and digital support from our ICB, are now actively spreading across Gloucestershire in Primary and Secondary Care.
We believe that this project will allow us to develop and deliver a new ‘care bundle’ model for this patient cohort, and then use the model to support those waiting for pulmonary rehab and pain clinic appointments. We will measure impact in various ways; process measures, wellbeing scores (MyCAW), health outcomes, Theoplots for service usage, numbers of social connections, and staff and patient surveys. Our project team will gain QI skills and share learning to upskill PCN colleagues. We will continue to learn from what we have achieved to date, sharing our success and challenges with our locality, ICB and further afield.
How you can contribute
- Please do read our proposal and give feedback on our ideas
- Please help us develop our 'care bundle'; what should we include in our offer to those waiting for operations?
- Please help us develop our evaluation measures?
- Are you working on a similar proposal; can we share ideas and knowledge?
Plan timeline
| 28 Mar 2023 | Project proposal finalised |
|---|---|
| 28 Jul 2023 | Staff and volunteer engagement |
| 31 Aug 2023 | Identify cohort of patients for intervention |
| 31 Oct 2023 | Consultation with patients complete; care bundle offer agreed |
| 31 Oct 2023 | Outcome measures agreed |
| 31 Oct 2023 | Waiting Well coordinator appointed |
| 31 Dec 2023 | All patients contacted and MyCAW scores sent out. |
| 31 Mar 2024 | Evaluation at 3 months |
| 30 Jun 2024 | Evaluation at 6 months |
Project updates
17 Jan 2024
Our project We Wait Well is progressing well and in line with our proposed timeline. We have appointed a project manager/co-ordinator, Fiona Bell, and have developed a project team comprising GP, project co-ordinator, health & wellbeing coach (HWBC), 2 support administrators and physiotherapist. We are in the process of recruiting a patient representative to the team.
Fiona and I have attended the 3 evaluation workshops offered by the Health Foundation and used their suggested framework to develop a draft process map and data audit, see pages 1 and 5 on this jamboard;
https://jamboard.google.com/d/1_u7Fe3Nvfj36yAJIffJsE1GUmmMLrSWa-q2abFHn93U/edit?usp=sharing
We have developed a potential raft of evaluation measures which we plan to refine with the help of the Matter of Focus group in phase 2 of their support programme.
We liaised with the local hospital to identify the initial patient cohort of people waiting for hip and knee operations, and invited them to an introductory meeting held in mid January. During the meeting we outlined the aims of the project, enjoyed some seated exercise and mindful breathing sessions, and invited the attendees to work in small groups to identify their personal aims and objectives.
We also asked the patients present to complete 3 evaluation scores (MyCAW, pain score and WEMWBS).
We are now working on developing a programme of personalised support based on the learning from the group meeting and goals identified in the MyCAW questionnaires. This will include monthly meetings with seated exercise sessions led by one of our physiotherapists, an opportunity to chat with each other to increase social connections and peer support, and time to speak 1:1 with our HWBC. We will also invite a different external speakers to each session, based on needs of the group. For example, a few patients are concerned about how they will manage post op so we may invite an occupational therapist to one session. Losing weight is also a common goal so we will invite someone to lead a session on healthy eating.
In addition to the meetings, all patients will be shown, and then have access to, the online prehab programme (HOPE) and invited to the weekly surgery “Walk and Talks” led by our HWBC.
Medication and blood pressure checks with a practice pharmacist will be offered. Other opportunities could involve guided meditation as well as support accessing local community offers such as the weekly Chatty Cafes organised by our volunteer health champions.
Each patient who attends will be given a “What Matters to Me” orange folder (widely used in Gloucestershire) to hold any documents which the patient or carer chooses, eg an exercise leaflet, list of community resources, a personalised care plan (developed in our PCN).
Learning so far;
- The project is already a lot of fun and the idea has been met with enthusiasm by the project team and patients who have attended the first two meetings.
- Basing an intervention on What Matters to the Person ensures we are personalising the programme but has been challenging with limited time for planning. We have decided to plan a series of sessions based on the original common goals identified in the MyCaw surveys, plus one to one chats with the attendees of the first 2 meetings, and then see what the feedback is after a few sessions.
- The Matter of Focus evaluation workshops were very helpful and we look forward to phase 2. It would have been helpful to have been able to access the support earlier in our project timeline as we feel it would have saved time in the planning stage, and helped fine tune our evaluation plans before the initial meetings with the patient cohort.
- We need to keep potential health inequalities in focus. For example, 24 out of 81 patients in cohort attended the first meeting. We are concerned that we may be missing the group who would most benefit from intervention. We have as a result asked our HWBC to contact those that declined or unable to attend to see if different approach would be helpful. We may consider asking a small group of patients to attend a focus group meeting to explore barriers and ideas further.
Comments
Derek Laidler 23 Feb 2024
Hi Hein,
If I'm not to late, please contact Lorn and Oban Healthy Options who have developed exactly this service and more over the past 12 years - they have a huge amount of learning about sustainability, spread, measurement and evaluation etc and are very keen to share their learning Lorn Healthy Options
Chloe Pulo 20 Jul 2023
This project sounds absolutely brilliant and I'm looking forward to seeing how you progress through. It would be great to speak with some of the leading team around our work (Surgery Hero) within prehab. We focus on the digital side of personalised prehab support, with each member of our programme being assigned their own health coach who they meet with once per week. Alongside this interaction, they also have access to our prehab app with self directed videos and reading content.
Its great to see more being done in the prehab space, in the future if you are looking to expand your service with a digital collaborator we could potentially collaborate.
Kind Regards, Chloe
Sharon Drewett 10 Jan 2024
Hi Chloe. Sorry for the delay in replying but thanks so much for your comments; Surgery Hero sounds amazing!
Our project is now underway and it would be great to chat if you have time? What is the best way of contacting you?
Emma Sutton 18 May 2023
I really like this idea - this really extends the traditional view of 'pre hab' with exercise classes, but also interventions that I can see may have been suggested by people who have waited a long time for surgery, and may get great benefit from a broader holistic approach - the nature walks, healthy eating groups, meditation, accessing peer to peer support would be fantastic.
Emma Sutton 23 Mar 2023
I like the sound of this idea! I am connected through a colleague to the Leicestershire prehab programme for orthopaedic surgery which is going really well but this idea of Exercise classes, nature walks, healthy eating groups, meditation, accessing peer to peer support and increasing social connections sounds quite different - will you garner evidence from 'traditional' tri modal or multi modal prehab programmes (based on models introduced by Franco Carli in colorectal surgery) and compare outcomes with your model? So interesting to see how prehab can be delivered in such different ways - good luck with your project!
Hein le Roux 27 Mar 2023
Thank you Emma and like Sharon I was not aware of this work so will see how we can integrate it. From our point of view in the community, we all refer patients to secondary care but have never cohorted them to look at a bundle of care that we can offer them. Anecdotally, they often see us again for ongoing symptoms but we have never quantified this and we have never gathered their views on what a long wait means to them in terms of wellbeing. Again anecdotally we all know it is negative and that forms the basis of our intervention to help them cope much better by being proactive with our waiting list coordinator and developing the bundle of offers to support them. Including patients and linking up to secondary care could be so impactful for all of us.
Sharon Drewett 27 Mar 2023
Thanks so much for your helpful comment Emma. We weren’t aware of the Leicestershire programme and look forward to finding out more about it, and use learning from their programme to inform our offer.
Although most of our planned outcome measure are related to pre-op health and well-being measures, it would certainly be interesting to measure the impact on post-op outcomes such as length of stay, and compare to the impact seen with existing trimodal programmes. We’ll try to build it in, thanks for the idea!
Rachael Banfield 22 Mar 2023
As a Social Prescriber I have had first hand encounters of how 'waiting well' can be a positive experience for patients. Introducing fitness and nutrition regimes into the life of a particular gentleman enabled him to have a hip replacement. He had been waiting for 5 years and struggling to live a normal and active life. A nine month programme of exercise and healthy eating took his mind off the waiting process and gave him another focus. He lost 7 stone and had his surgery. He is now living his best life and has a strong feeling of self worth and motivation to help others taking on a similar journey.
Rolling out a programme to help many more patients to 'wait well ' is desperately needed. Engaging in social activities can improve self worth, longevity of self-care commitment, less isolation and improved mental health
Hein le Roux 27 Mar 2023
Thank you for sharing that powerful story Rachael and adding to what Sharon said, if we focus on 'what matters to me' it is amazing what patients can achieve if we support them to achieve their aims. We all have these anecdotes, but this project offers us the ability to systematise this for many more patients .
Sharon Drewett 27 Mar 2023
Wow, the power of a patient story! It is unlikely this patient would have achieved such good outcomes with a ‘traditional’ short prehab programme and is a great example of how we can work with our hospital colleagues to improve outcomes for patients and the system as a whole.
We are so lucky to have you on board Rachael; your skill and experience in health coaching will be so important in helping us develop this programme.
Nathalie 22 Mar 2023
Such a fantastic, patient focused idea which will bridge the gap between secondary and primary care with the aim of positively improving patient experience and outcome
Sharon Drewett 27 Mar 2023
Thanks so much for your support Nathalie. As a frailty nurse in our Living Well team, your skills and enthusiasm will be key to the success of the project. Let’s hope our bid is successful and we can get going!
Hein le Roux 27 Mar 2023
Spot on Nathalie, we really need to work closer together for the benefit of patients and include them in that. The advent of ICBs really lends itself to this way of working but we need to develop new models of care which we intend to do and then share.
Chris Davis 22 Mar 2023
Apologies. I think I may have accidentally replied to someone else where I was in fact aiming to leave a fresh comment. Here it is:
This sounds like a fantastic project. As an advocate for the role of physical activity in the health space, the idea of co-produced health and wellbeing initiatives is really exciting. There are so many dots to connect and this project could be a great way to form a package of support that wraps around each person with a 'bundle' of things that are available to someone in their space, place and context. There are some fantastic local resources to support people from things like strength and balance to community led physical activity programmes for people living with persistent pain.
Such projects will no doubt have some wide reaching impacts with both intended and unintended consequences through the very nature of co-production and the 'ripple effect' of community action. I really hope this project gets the green light.
Hein le Roux 27 Mar 2023
Thank you for your positive comments Chris, agree with everything you have said. As you point out, the idea is to develop a 'bundle of things' to offer patients who are experiencing long waits to help them cope better and be in better shape (emotionally & physically) through optimised and coordinated pre-hab for when they do have their procedure. Amazingly, up to now we have not coordinated our efforts with patients and between community and secondary care, so using PHM principles we intend to change this.
Guy Stenson 21 Mar 2023
Really positive to see this collaborative approach centred very much around the individual and their network and what matters to them, and building upon the considerable success of strengths based approach adopted widely in Gloucestershire.
Hein le Roux 21 Mar 2023
Thank you Guy, yes we are building on our previous work and also the great work and mindset of collaboration that exists in the wider Gloucestershire system with a view to upscaling and spreading this way of working. We have so many community assets already out there and we just need to find ways of connecting people up to these which will be at the heart of our project should we be successful.
Caroline Stone 21 Mar 2023
I have been involved with 'Fit For Life' the local Balance and Exercise group in Brockworth for 2 years. As a Social Prescriber I have seen first hand how regular physical activity together with social interaction with the local community can improve both physical and mental wellbeing. Testimonies from our participants have proven that they have become stronger and able to do more than they could before they joined us. Levels of pain has improved and mood has become more positive. There is a sense of belonging and a will to meet their individual goals. It is a successful and positive place to go to improve frailty levels and mood. I know other similar groups exist and I'm sure new ones evolving will all bring similar positivity to those who need it most, particularly those awaiting procedures and surgery on long waiting lists. I also know that for those sitting alone waiting for something to happen are less likely to see a positive outcome long term. Our participants said they have visited their GP and primary care staff less often as they generally feel better mentally and physically.
Hein le Roux 21 Mar 2023
Thank you Caroline and I feel lucky to work with your amazing team. Not everyone outside of a practice or PCN knows or understands the power of social prescribing and you have described it so eloquently. I think the next step in our journey is to offer a social prescribing care or support bundle in a more systematic way to whole patient cohorts and that is what this project will endeavour to do. One of the exciting things will be to work out what is in that 'bundle' of support and should we be successful in this bid then the waiting list coordinator will be crucial to developing and maintaining our 'well waiting' register, then connect people up with your great work. If we can connect our efforts up with secondary care initiatives (as set out by Sarah Bakewell) then we can develop a whole system approach which will benefit us all.
Leighla Davenport 21 Mar 2023
Sounds like a great project. Really hope you are shortlisted. This team and PCN have delivered many successful projects and are always very open and proactive in sharing the results. I have no doubt we would benefit from this project as Inner City Gloucester, should it go ahead.
Hein le Roux 21 Mar 2023
Thank you Leighla, as you say in Gloucestershire we have a long history of working in collaboration for the benefit of our patients and also for our own sustainability. Your PCN neighbours ours and has much deprivation and the health inequalities that stem from this and we all know how committed your team are to improving the lives of the patients you serve. We will of course share any learning with a view to upscaling and spreading the 'why' and the 'what' of our work with other practices and PCNs so then they can focus on their 'how' they can make this work in their area. The Gloucester ILP is such a supportive place to help spread this idea.
Dr Seema Srivastava MBE 21 Mar 2023
Great tp see you building on your excellent work on social prescribing in Gloucestershire. Do you have any data which points to how you would engage inclusion groups (global majority groups, people experiencing deprivation, English not spoken, traveler community) who may experience inequity in care? Will follow with interest and good luck! Seema
Hein le Roux 21 Mar 2023
Thank you Seema, it is such an important point and reducing health inequalities runs right through the heart of our project. Using PHM, we intend to cross reference our 'well waiting' patient list with post codes of known deprivation so we can work out ways of engaging with specific cohorts of patients. We will have to work out how we do this, but the success of the covid vaccine uptake will provide us with some clues. Your question was aimed at how we engage inclusion groups. Previously we did not collect ethnicity data in primary care but this year all PCNs have had an important target to collect 90% ethnicity data which we have achieved and will provide a much richer idea of who the population we serve is. We will be able to use this to really understand a lot more about who our long waiters are.
Sarah Bakewell 20 Mar 2023
I am a Consultant Anaesthetist at GRH and this proposal is very complimentary to the Prehab Project that has been set up by some of my colleagues in secondary care focussing so far on patients with Upper GI, Urology and Colorectal cancers. Their project is evidence based and includes input from physiotherapy, OT, dieticians and psychology. Prehabilitation is the new area of development and discussion in the world of Anaesthesia, and our hope would be to extend it to other Specialties /types of surgery.
The cohort of patients that you are targeting will most likely be waiting longer for their surgery and are at significant risk of deconditioning and general deterioration whilst on the waiting list. We know that there are physical and emotional benefits of these packages of care as well as less chance of cancellation of their surgery and improved postop outcomes.
Therefore, it is very exciting to read about how this project will link in with both Primary and Secondary care with advantages for both. We already know from ERAS (Enhanced Recovery After Surgery) that the various facets of care work best as part of a total care package with everyone singing from the same song sheet.
Good luck with your application and I wish you every success with this innovative project.
Hein le Roux 21 Mar 2023
Thank you for your helpful comments Sarah, we feel the opportunity that working in an ICB offers is that we can join up our efforts for our collective patients and of course include them in developing our bundle of interventions. We would really like to PDSA our offer, working with partners, then look to upscale and spread this way of working to other PCNs and ICBs around the country. This QI project covers so many important areas including using population health management techniques to reduce health inequalities, integration in a neighbourhood based way (the Fuller Stocktake), delivering value and building on our 'what matters to me' work amongst other things.
Are you familiar with social prescribing? To us it is like the new penicillin as it connects us to all the non-medical support that already exist in our communities and which make a real difference to people's lives. Happy to set up a teams call to make more connections. Please also link with Charlie Sharp who is part of our bid and acts like a wonderful hinge between community and secondary care and has ideas about how we can develop this into other areas such as pulmonary rehab.
Zahra 20 Mar 2023
A well thought and much needed initiative. Using patients for peer support is a fantastic idea and the project makes use of the biopsychosocial approach to health and health care which is definitely the way forward.
Sharon Drewett 27 Mar 2023
Thanks Zahra. I am so pleased that as a newly qualified GP you already appreciate the importance of looking beyond the medical model and considering the wider determinants of health.
Chris Davis 21 Mar 2023
This sounds like a fantastic project. As an advocate for the role of physical activity in the health space, the idea of co-produced health and wellbeing initiatives is really exciting. There are so many dots to connect and this project could be a great way to form a package of support that wraps around each person with a 'bundle' of things that are available to someone in their space, place and context. There are some fantastic local resources to support people from things like strength and balance to community led physical activity programmes for people living with persistent pain.
Such projects will no doubt have some wide reaching impacts with both intended and unintended consequences through the very nature of co-production and the 'ripple effect' of community action. I really hope this project gets the green light.
Hein le Roux 20 Mar 2023
Thank you Zahra, agree and much of this is in place already through our social prescribing offer but there is little coordination between PCN and secondary care with this group of patients hence the idea of a waiting list coordinator in the community to identify the cohort and then proactively manage them whilst they wait.
Jacqueline Smith 20 Mar 2023
This is a fantastic idea. This can only prove to help patients massively with the added help of access to primary care for all patients. To help patients who are becoming isolated due to delayed operations is a must.
This project has my full support.
Hein le Roux 20 Mar 2023
Thank you Jacqueline, yes these patients are often vulnerable and also this links to health inequalities. We would intend applying learning to many other areas including for example people with chronic pain and also people with a chronic lung condition waiting for pulmonary rehab. The beauty of this idea is that it has the potential to bring many different strands of system work together.
Eileen Bowden 17 Mar 2023
This is patient focused well-being project is just what is needed during these periods of delay! This will also optimise their success post appointment.
Hein le Roux 20 Mar 2023
Absolutely, optimised pre-hab is so important but not just the medical element of a person's care. The non-medical part of wellbeing is easily forgotten with our often 'medical model' of care and this waiting list coordinator role could really support our patients so much better by identifying them and then proactively linking them to a bundle of interventions which will improve their quality of life whilst waiting.
Anna Burhouse 15 Mar 2023
This work sounds really fantastic and such a bonus for Gloucestershire.
If you have time, you may benefit from looking at two of the previous Health Foundation awards ERAS+ through Scaling Up for surgical pre and post hab in Manchester (find it at: Enhanced Recovery After Surgery Plus (ERAS+) (health.org.uk) and also in S.Tees through PREP-WELL (find it at: Preparing for surgery: The community pre-habilitation and wellbeing project (the PREP-WELL Project) (health.org.uk). John who led the Manchester work and Gerry who led the S. Tees work are both really inspiring in their thinking about this issue.
Hope that's helpful :).
best wishes
Anna
Hein le Roux 20 Mar 2023
Thank you Anna, that is really helpful and I will have a read asap to see what lessons we can learn
:-)
Sharon Drewett 20 Mar 2023
Thanks so much Anna. Both of those projects chime so well with our idea. We are aware of some secondary care prehab courses and would aim to work together. Prehab courses are often planned for the weeks leading up to surgery, whereas we hope to engage with people on waiting lists several months (or years sadly) before their operations. We hope and expect that people would then be in good shape for surgery, which we know also reduces length is stay in hospital and post op complications.
M Bailey 15 Mar 2023
I really like this body of work. I hope it gets through to shortlistings. It would be great to hear what you learn from implemenation so others can benefit.
Hein le Roux 20 Mar 2023
Thanks Mark, I think our work will be fairly generic and so the lessons learned will be applicable to many different areas where patients are waiting for something. The key is to identify the cohort by working with our secondary care colleagues and then come up with a bundle of interventions that will help those waiting using the 'what matters to me' philosophy.
Lucy Cartwright 15 Mar 2023
Really positive to see place based initiatives featuring in this exchange round - a promising approach to achieve better outcomes, during a time in patient's lives which can be really challenging.
Hein le Roux 20 Mar 2023
Thank you Lucy, it is so place based and fits with so many agendas particularly the Fuller Stocktake, population health management, value and of course quality improvement amongst many other things!!!
Elizabeth Shermon 14 Mar 2023
Looks like a positive initiative which will improve the lives and well being of relevant patients. Patient involvement with the project to ensure it is meeting their needs will also be valuable.
Hein le Roux 20 Mar 2023
Thanks Liz, 'patients as partners' is such a key theme in the 'what matters to me' way of working and this will be at the heart of any successful bid.
Comments are now closed for this post.