Developing Live Well

Working with local GPs and the Buckinghamshire Clinical Commissioning Groups, Buckinghamshire Healthy Minds developed the Live Well model in 2014. Healthy Minds is the Buckinghamshire Improving Access to Psychological Therapies (IAPT) service, provided by Oxford Health NHS Foundation Trust.

Healthy Minds – Live Well offers psychological therapies for people who have depression and anxiety disorders and a long-term health condition (LTC), alongside the care provided by their primary care team. Within Healthy Minds – Live Well, psychological therapists are based in GP practices to provide assessments and treatment for people with LTCs and persistent physical symptoms. Basing psychological therapists within the primary care team encourages multidisciplinary working, with psychological therapists able to join GP or nurse consultations. It facilitates communication by psychological therapists attending meetings in the practice and can include clinical supervision for practice staff.

During the first year (2014/5) Healthy Minds – Live Well was piloted in one GP locality, five practices in south Aylesbury. The success of the programme led the CCG to request its roll-out over the next three years (2015/8) across all GP localities in Buckinghamshire as part of the national IAPT-LTC Early Implementer Programme.

Enhanced integrated working has developed hand-in-hand with system-wide changes, with Buckinghamshire becoming an Integrated Care System. Developments have included extending the Healthy Minds – Live Well model by embedding psychological therapists within community and hospital settings. The work has focused on pathways for diabetes, cardiac, respiratory and pain. In future it is hoped to extend this to the cancer pathway.

Measuring the impact of Healthy Minds – Live Well

Between 2016 and 2018, 5,912 clients with a LTC entered treatment with Live Well. This represents 36.7% of all referrals into Healthy Minds for the period. Of those clients with a LTC entering treatment there was an overall recovery rate of 55.69% – significantly higher than the national average.

IAPT services in the Thames Valley (Buckinghamshire, Berkshire and Oxfordshire) have undertaken further evaluation of the impact of integrated psychological interventions on healthcare use by those with a LTC. Use of primary care was assessed through a self-report questionnaire. This showed a primary care cost saving, over 3 months, of £117 per person. Analysis of cost of A&E, out-patient and in-patient health care usage indicated a further cost saving of £212 per patient over a three-month period. Overall, there is a saving in the first three months of £329 per patient. The benefits of treatment are expected to last at least two years, so a longer-term saving of £2,632 would be anticipated.

Embedding the Live Well workforce in primary care has numerous advantages. All Buckinghamshire GP practices have access to psychological therapists trained in working with people with LTCs who are struggling to manage their condition. Live Well therapists offer a range of evidence-based interventions specifically for people with LTCs. These include working therapeutically over the telephone, or face to face, digital interventions –

for diabetes, COPD and chronic pain, and courses such as diabetes wellbeing, pulmonary rehabilitation, LTC self-management and LTC mindfulness.

Dr John Pimm, Clinical Lead for the Psychological Therapies Pathway in Buckinghamshire, said: “The rollout of Live Well has enabled us to work much more closely with our primary care, community and hospital colleagues to best meet the needs of those living with a long term condition in Buckinghamshire. Embedding in services has been key to enabling true integration – made possible by the support of Buckinghamshire CCG and our Buckinghamshire Healthcare Trust colleagues.”

The Healthy Minds – Live Well offer for GPs and practice nurses

To investigate views on the introduction of integrated mental and physical health services, six GPs and practice nurses were interviewed about their experiences of working with Live Well. Qualitative data acquired through semi-structured interviews was analysed to identify patterns and themes. Five areas emerged:

1. Integrated working was perceived as having a positive impact on LTC self-management and providing a vital holistic approach,
2. The accessibility of Live Well clinicians working in GP surgeries was recognised to provide increased opportunities to discuss shared patients with Live Well practitioners and work jointly,
3. Communication was identified as key to working in a truly integrated way. It was suggested integration would be enhanced by a single, co-ordinated, shared electronic patient record system,
4. There was a consensus that integrated working led to shared accountability and a sense of support for professionals in addition to helping patients navigate successfully what can feel like a complicated system,
5. Participants discussed the importance of NHS changes nationally to support those at local level. “Right at the top it is about NHS England saying we will let you do things differently and we will facilitate that with new payment structures, new flexibilities, an Accountable Care System,” one interviewee commented.

Patients’ feedback

Feedback from patients about their experiences of Live Well are key to enabling continuous improvement and innovation. Patients are invited to complete a Patient Experience Questionnaire at the end of their treatment. In 2017/18, 1,237 patients filled out this questionnaire. The response “most or all of the time” was given by.

• “Did staff listen to you and treat your concerns seriously?” – 99.44%
• “Did you feel involved in making choices about your treatment and care?” – 89.92%
• “On reflection, did you get the help that mattered to you?” – 88.68%
• “Did you have confidence in your therapist and his/her skills and techniques?” – 99.54%

Patients are invited to leave comments on their questionnaire:

It is the best treatment I have ever received from this kind of service, free or paid-for. I feel like a totally different person and have learnt so much about myself.

Thank you to Live Well. I really feel that it has supported me in my darkest time, and now I can really see some light ahead.

Tips for success

• The mobilisation of pathways is dependent upon factors including partner engagement, commissioner intentions and desired level of integration,
• Identifying opportunities in system-wide changes such as Integrated Care Systems, Integrated Teams and new pathway developments has enhanced integration,
• Contracting and co-locating Live Well clinics into specific physical health pathways has expedited the development of partner working across trusts,
• The provision of training to all qualified clinicians (Psychological Wellbeing Practitioners and psychological therapists) in working with LTCs has been invaluable in building both competence and confidence service-wide.

Further information can be found on the NHS Oxford Health NHS Foundation Trust website.