We have created an implementation workbook to support you with implementing UCLP-Primrose. You can also use the resources on this page for additional information. The resources have been co-designed with clinicians to ensure the success of this programme.
Step One: Preparing for implementation
Essential pillars of implementation
The UCLP-Primrose framework has been designed to be adapted to local context and preferences. From our experience of spreading health and care innovations and working in primary care, we recommend the following six essential pillars to ensure successful local adaptation:
- Strategic engagement – system leaders, community partners and patient involvement
- Local clinical engagement to question, understand and adapt the frameworks to local context, supported by UCLP resources
- Supporting workforce transformation
- Identifying key roles to deliver the frameworks
- Conducting a training needs analysis for these roles
- Training for additional roles to deliver the proactive care interventions
- Mobilise levers to drive forward primary care transformation e.g. alignment of local incentive schemes
- Defined data collection including setting key metrics to measure progress and impact
- Governance and project management that drives the work forward and allows agile decision making
Process mapping
Although no one patient’s journey will look the same, we have developed a map of the UCLP-Primrose framework to demonstrate each of the different steps in the pathway, and how a patient might move through the service. The UCLP-Primrose framework is designed to be flexible, so that you can adapt it to your local setting.
Our implementation map will help you to think through what you’ll need to get started. This map can be used to identify which elements of the pathway you already have in your service, for example a Healthcare Assistant providing the annual physical health check for people with SMI, and which elements you will need to bring in, for example a mental health clinician to provide the mental health review or a clinician to provide intensive support for behaviour change. Go through each text box on the map to establish who will do each part of the pathway, and the referral mechanisms between each part.
Watch: Dr Ed Beveridge talk through the implementation map.
Staffing
As part of the implementation process, you will need to identify who will provide the different parts of the package. UCLP-Primrose has been designed to be flexible, to allow you to adapt the model to fit in with your local setting. Therefore, how staff are identified for each element of the pathway will be different for each service. For example, some sites may choose to have one person to provide the whole of the UCLP-Primrose pathway, whilst others will choose a number of people from the existing staff base to deliver each individual element. Below we give some general guidance.
- Running the search tool. this can be done by anyone in the service e.g. practice manager, GP, nurse etc.
- The Physical Health Check. The annual physical health check is the foundation of this pathway and can be provided by anyone with suitable understanding. Some services have used HCAs, others have commissioned VCS to provide both the invitation and the health check.
- The Clinical Review. The clinical review provides a quick response to any clinical issues identified during the health check, and a key opportunity to optimise medications. It can be provided by any suitable clinician already within the service e.g. depending on the needs of the patient this could be a pharmacist, GP, or nurse.
- Intensive Support for Behaviour Change. If the patient and clinician agree that more 1-1 physical health support would be beneficial, then they can be referred to the Intensive Behaviour Change practitioner. This part of the pathway can be provided by any clinician who receives the required training e.g. a peer coach, a HCA, a nurse etc. We have provided a large proportion of the training manuals and videos but you will also need to identify a local training provider who can support with the in-person training elements.
- The Mental Health Review. In most sites, anywhere between 30-40% of patients will not respond to their invite to the annual physical health check. This may be for a variety of reasons. It’s important to try other ways of engaging these patients, particularly if they are in Priority group 1 or 2, and therefore at higher risk of cardiovascular disease. Therefore, we recommend that a mental health professional performs a desktop review of the patients notes to generate an engagement action plan. This may involve outreach, working with carers, or liaison with secondary mental health services. Mental health nurses and Occupational Therapists are often particularly effective with this part of the pathway.
- Peer Coaching. In the original Primrose-A model, peer coaching was critical to the success of the intervention. Peer coaches are best suited to provide a less health-driven appointment and thereby support patient’s mental health and wellbeing. All UCLP-Primrose clinicians should keep in mind that the model is intended to be whole-person and holistic, because when people’s mental health and wellbeing is supported, they are much more able to engage with and be successful in making changes to their physical health. This approach ensures improved physical and mental health outcomes year on year.
Working With Voluntary and Community Sector (VCS) organisations – data sharing
If you are working with VCS or any other third parties, you will need to consider how you share data. We recommend carrying out a Data Protection Impact Assessment, establishing data sharing protocols and establishing honorary contracts for VCS staff.
Step Two: Using the search tool
Download the search and stratification tool
The search and stratification tool was built for EMIS and SystmOne, and, once downloaded, begins by identifying all patients with a Severe Mental Illness (SMI). The tool then stratifies all patients into priority groups based on recorded evidence of factors that contribute to cardiovascular disease risk, such as high blood pressure and cholesterol. Patients who have not had a blood pressure check in the last 18 months (as a proxy for a health check) are also identified. This grouping allows practices to prioritise patients for follow up and to safely phase appointments over time. It also helps match patient care to the workforce. You can download the search tool for free using the link below.
Download the UCLP-Partners search and stratification tool
How to run the searches
Once downloaded, running the UCLP-Partners search tool is much like running any other search tool in EMIS or SystmOne. For more information on how to run the searches, please see:
EMIS Web demo
SystmOne demo
How to run a sub search in EMIS
Step Three: UCLP-Primrose training for staff
Training
Once clinicians have been allocated to their respective part of the pathway and agreed mechanisms for communication/referrals are in place, staff will need to work their way through the UCLP-Primrose training content relevant to their role. We have developed training manuals for each part of the pathway. Please see the ‘training’ page to access these.
In-Person Training
The majority of the training content is provided offline via the UCLP-Primrose training page. However, we also recommend that a person/training provider local to your site is identified to deliver the in-person component of our training package. This is a 3.5 hour training session on behaviour change and communication skills, refreshed every 6 months or annually.
We have a lesson plan for this session, with a supporting slide deck. Cheat sheets based on this lesson are also provided, please download them here, or find them under Training and Resources for Clinical Staff.
Step Four: Establishing and maintaining the UCLP-Primrose Framework
Ongoing support
After UCLP-Primrose has launched in your practice, with clinicians having received the relevant training, we also recommend establishing a network or community of practice for ongoing support. This network could include the UCLP-Primrose clinicians within your service or more broadly in your Primary Care Network, and can be used as a place of contact to provide further information, ask questions, and share experiences.
Measuring improvements in processes and outcomes
We are in the process of developing a template for EMIS/Systm1 to support with implementation of the UCLP-Primrose model and data collection for monitoring and evaluation purposes. In the meantime, here are some existing measures you might consider using to capture improvement in processes and health outcomes:
- The standard SMI health check templates to measure outcomes e.g.
- a measurement of weight (BMI or BMI + waist circumference);
- a blood pressure and pulse check (diastolic and systolic blood pressure recording or diastolic and systolic blood pressure + pulse rate);
- a blood lipid including cholesterol test (cholesterol measurement or QRISK® measurement);
- a blood glucose test (blood glucose or HbA1c measurement);
- an assessment of alcohol consumption;
- an assessment of smoking status.
- Plus interventions provided for all abnormal results
- Clinical measures e.g. how many people get put onto a statin, how many people have their blood pressure optimised
- Recording the number of people in priority groups 1 and 2 each year, measured on years 1,3 and 5 (we would expect the numbers in priority groups 1 and 2 to fall each year)
- Uptake of SMI annual health check and completeness (e.g. does use of UCLP-Primrose increase numbers of patients having all parts of the health check measures as well as ensuring reach to patients who had not engaged previously)
- ‘Did Not Attend’ rates for health check appointments
- Number of referrals to physical health support services e.g. alcohol services, smoking cessation
- Outcomes on Long Term Conditions management e.g. diabetes or hypertension
- DIALOG+ (e.g. changes in satisfaction score for physical health)
Contact the team
If you’d like more information or have any questions about the UCLP-Primrose framework, please contact Gemma Copsey, implementation manager, at gemma.copsey@uclpartners.com