Social Prescribing / Expert Patient Programmes (SP/EPP) - FAQ

Introduction

Healthy London Partnership (HLP) is supporting London's Strategic Transformation Groups (STPs) to develop their Sustainability and Transformation plans and, to that end, is recommending specifically the increased use of Social Prescribing (SP) and Expert Patient Programmes (EPP). HLP has been working with i5 Health to apply the Commissioning Opportunity (COP) module:

  • To identify, using existing secondary care data sets, the population who may benefit in London from SP and EPP initiatives.
  • To calculate the return to the NHS in London on investment in implementing SP and EPP initiatives to March 2021.
  • To visually represent the opportunity calculations by SP initiative in a dashboard as heatmaps.

General questions

In August the HLP Transforming Primary Care team issued their Strategic Commissioning Framework (SCF) Financial Model, developed over three months by PwC who worked closely with the programme, and with CCG teams. The purpose of the model was to provide an estimate of the cost to set up and recurrently deliver ten key initiatives from the Strategic Commissioning Framework, and the impact on the wider system and in terms of ROI. This model included an initial view of the expected cost and impact of social prescribing – using an example of best practice delivery from Rotherham.

Rotherham published evidence (September 2014) demonstrating the effectiveness of Social Prescribing in reducing patient’s use of hospital resources by a fifth in the 12months following referral to a Social Prescribing scheme. This translates into a potential positive financial return to commissioners within two years following the initial referral. It is on this basis that Social Prescribing was rightly included as one of ten primary care initiatives within the TPC financial model, where the findings from Rotherham have been applied to London to provide forecast savings.

HLP Personalisation & Self-Care programme have furthered the social prescribing modelling, to provide a more detailed and focused analysis - taking the form of population health and financial modelling for Expert Patient Programmes, Social Prescribing and combined data for both initiatives at an individual London CCG and STP level year on year until March 2021 - and can be used to update the costings in your SCF Financial model, if helpful, as the SCF financial model can be used as a live tool to inform your planning over the months and years as costings become more defined.

The data included in this social prescribing modelling commissioned by the HLP Personalisation & Self-Care programme includes the latest available Hospital Episode Statistics (HES) data covering London’s 32 CCGs, local Market Forces Factors and applies fresh evidence from more recent good practice in City & Hackney (September 2015) and Bristol (March 2016). The data is extractable at a CCG level so is available for additional local analysis and can also be exported to the TPC financial model to calculate the net benefits of a range of primary care initiatives.

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The data is based on Hospital Episode Statistics (HES) for the Financial Year Ends (FYE) of 2014/15, 2015/16 and 2016/17. Each FYE covers 01 April and includes activity up to and including 31 March e.g. 2016/17 starts from 1 April 2016 and ends in 31 March 2017. As of June 2017, the data is only 3 months old.


For more information on HES data please see NHS Digital: Hospital Episode Statistics

The data dictionary of the source data that is provided can be found by clicking on the “Data Dictionary” tab in the Spreadsheet.


The full data dictionary is shown below:


The calculations for each intervention that is part of the analysis can be found in Appendix 1 - Social Prescribing: Patients cohorts by Initiatives and Appendix 3 - Expert Patient Programme: Patients cohorts by Initiatives. Both appendixes provide the rules criteria that is used to identify patient cohorts suitable for each SP and EPP for which acute costs are aggregated for the last three years.


The savings covered in the COP reports and Cost Calculators are based on the cost of avoided hospital activity in A&E, Outpatient and Admitted Patient Care (APC). They are based on 2016/17 PbR tariffs and include Market Force Factors (MFF) at provider level.

Patients identified from benefiting from specific Social Prescribing (SP) interventions had preventable activity in hospital that could have been avoided if the patient would have received an effective SP intervention.

The savings in the COP reports and Cost Calculator reflect the total Opportunity Cost if all patients that were identified would receive an effective SP intervention and is therefore the most optimistic saving – the Upper Limit (UL). Depending on the effectiveness of patient selection and efficacy of the SP intervention, it is likely that a lower gross saving will be achieved.

Most case studies relating to each of the interventions will include effectiveness and efficacy findings that generally improve during the SP service delivery.


The tools provided support you with the overall opportunity that exists in your local health economy for each social prescribing intervention and feeds directly into your organisation's Benefits Realisation strategy.

In evaluating the potential benefits you need to ask the following key questions:

  • How well will the change itself be effected?
  • How will the way we deliver services changed?
  • When will we realise the strategic benefits anticipated in the Business Case?


The NHS has developed many support tools for Benefits Management that are based on two building blocks:

  • Benefits Realisation Strategy
  • Benefits Realisation Action Plans


Depending on your organisation, you may already have a locally adjusted benefits management process that entails those tools.

NHS Digital has released the "Mobile investment toolkit" in 2013 that is often used as a template for local modification: https://digital.nhs.uk/media/744/Benefits-realisation-plan-template/xls/Benefits_realisation_plan_template.

The Health Research Authority has also published updated training material in 2015 to support Benefit Realisation Planning which can be found here: http://www.hra.nhs.uk/documents/2015/03/benefits-realisation-plan.pdf


Each intervention has a specific set of inclusion and exclusion criteria based on diagnosis and acuity of a patient that is contained in the reference links provided. The criteria for each intervention can be found in Appendix 1 - Social Prescribing: Patients cohorts by Initiatives and Appendix 3 - Expert Patient Programme: Patients cohorts by Initiatives.

Patients that are suitable for an initiative may have been admitted Planned or Unplanned where Planned patients cover Inpatient (APC) and Outpatient (OP) and Unplanned cover Inpatient (APC) and Accident and Emergency(A&E). Unplanned care relates to Non-Elective care and Planned to Elective care as per NHS Data Dictionary – Admission Method

Click Here for Data Dictionary

In the workbook there are several tabs which include pivot tables you can adjust.

Summary tab
Top left hand corner, you can adjust;

  • Care Type: Planned v Unplanned v Both
  • Financial Year: 2013/14 to 2016/17



Cost Calculator tab
Top left hand corner, you can adjust;

  • Care Type: Planned v Unplanned v Both
  • Financial Year: 2013/14 to 2016/17



Top right hand corner, you can adjust;

  • London Population Growth: (free text)
  • PbR National Tariff Uplift (pa): (free text)
  • Alternative Service Cost: (drop down list or free text)
  • Savings forecast by Initiative: select single initiative v all



In the workbook

Summary tab:
Top left hand corner, you can adjust care type; Planned v unplanned v both

Cost Calculator tab:
Top left hand corner, you can adjust care type; Planned v unplanned v both

Initiatives List tab:
Top left hand corner, you can adjust care type; Planned v unplanned v both

Commissioning Opportunity PDF Report:
The yellow sections are Unplanned Care (NEL) and blue are Planned Care (EL)

Check the options which have been chosen in the drop down/pivot boxes. It may be you have more than one year selected, or that you want one form of care and both are selected.

See also: What can I adjust in the workbook to help me take the right decisions for my area?

The criteria have been chosen based on the evidence relating to initiatives and with the expectation that such initiatives are likely to be of most benefit to people with low to moderate levels of acuity. This does not mean that others with more or less severe acuity would not benefit.

Each CCG will have different levels of current investment, and may decide to use different models at different costs to introduce these initiatives. With such potential variability it was decided to include a cost per patient per year (pppy) that a CCGs / STP can set in the Alternative Service Cost field. The London Population Growth, PbR uplift and Alternative Service Cost pppy can either be entered or selected from a dropdown list, see below.





Once the pppy cost in £ has been entered, the Return on Investment (ROI) is shown in the time series chart of the Cost Calculator - Excel tool - as shown below.



SUS and HES have been used rather than QOF, Community and Mental Health as the data from these sources is less useful when calculating changing service use – the key variable being considered here. QOF does not include sufficient service use data and the others are based on services largely funded by block contract – so any reduced service use does not bring an associated reduction in costs.

The data presented relates to use of secondary care acute services. People with mental health conditions are not recorded as using a lot of secondary care – those with long term physical health conditions may experience mental health conditions, but they are often not diagnosed or recorded in relation to secondary acute care.

All of the conditions listed are ICD10 diagnoses, and appendix 2 gives the ICD10 code. “Z” codes are from chapter XXI “Factors influencing health status and contact with health services“.

The initiatives were chosen on the basis of the evidence that was available. A whole range of resources and initiatives can contribute to health and well-being. If they are not included here that does not indicate the HLP or i5 Health holds any views about their value or effectiveness.

References can be found in the latter section of the COP report that you have received via email and which is also downloadable for London, STPs or CCGs from the links provided in the Cost Calculator Excel tool.

The references provided are for the provision of general commissioning and implementation information about an intervention and is often non-scientific. Scientific evidence can be found in online resources such as MEDLINE®, PubMed®, Cochrane or Elsevier.