Case Study: The Frome Model of Enhanced Primary Care

As part of our Relationships Project, we’re collating a series of case studies from a range of sectors and contexts that demonstrate the benefits and workings of relationship-centred design. Whilst we hope they help build a case for prioritising deep-value relationships, we recognise that – especially at this early stage – we are still learning. We therefore welcome comments, insights, critiques and ideas for case studies from people and organisations across sectors. Please don’t hesitate to get in touch at relationships@shiftdesign.org.

The Frome Model of Enhanced Primary Care (aka Compassionate Frome): Leveraging Community Relationships to Improve Health Outcomes

You can read the full case study below or take a look at and download the infographic here.

Introducing the Frome Model of Enhanced Primary Care

The Frome Model of Enhanced Primary Care (FMEPC) – aka Compassionate Frome – is a project in Frome, Somerset leveraging existing social networks to improve health outcomes. Launched in 2013 as a collaboration between Frome Medical Practice and Health Connections Mendip, it is rooted in the overwhelming evidence that health is heavily influenced by social factors (even more so than smoking, reducing excessive drinking, reducing obesity and any other preventative interventions).

How does Compassionate Frome work?

Compassionate Frome is part of the wider Frome Model of Enhanced Primary Care. It works in three steps.

Step 1: Mapping community assets

From befriending services through peer-support groups, credit unions and exercise classes, the project maps over 400 services and activities in the local community. Crucially, it also identifies gaps.

Step 2: Helping local people fill gaps

To build social capital, the project works with local people, community groups and partners to identify where new services and activities would add value. It then helps people create those assets in a sustainable way, through support with aspects like recruitment, legalities and funding. New groups so far include Macular Degeneration, Stroke and Diabetes Support Groups.

Step 3: Signposting

The final task is to ensure people benefit from these services and activities. This is achieved through multiple channels:

  • Training volunteer ‘Community Connectors’ to signpost family, friends and neighbours to community services that could be helpful.
  • Social prescribing: Patients meet ‘Health Connectors’ to discuss their health, set goals and connect with community services and activities. Patients can self-refer or be referred by their GP.
  • Talking Cafés: people who feel isolated or wish to meet people and learn about community services and activities can pop into a local café and chat with each other and a Community Connector.
  • Letters to suitable patients identified on practice registers.
  • The Health Connections Mendip website.
  • A monthly radio slot.

What impact is Compassionate Frome having?

Social impact

The project’s headline social achievement, confirmed in a British Journal of General Practice paper, is “highly significant reductions in unplanned admissions to hospital,” which from April 2013 to December 2017 decreased in Frome by 14%. Across Somerset, emergency admissions increased by 28.5% in that time. Moreover, despite being a cornerstone of health policy, there is little other evidence of systematic initiatives reducing emergency admissions.

The causal mechanisms here aren’t known for certain, but likely combine actual improved health through social connection with the fact that a considerable percentage of patients admit themselves to hospital because of a lack of social support. Either way, the results fit the fascinating evidence referenced earlier.

It is important to acknowledge that these results cannot be attribute entirely to the model described here. Other health initiatives, such as GPs calling patients when they have been discharged from hospital, have also contributed. Nonetheless, The Frome Model of Enhanced Primary Care is considered an integral part of this impact.

Alongside tons of glowing testimony, from 2018-19 The Frome Model of Enhanced Primary Care has achieved the following impact:

  • 1,057 Community Connectors have had 21,140 signposting conversations.
  • 73,736 website visits.
  • Health Connectors have seen 1,469 patients across 3,243 appointments.
  • 95.6% of those patients felt more able to access community support.
  • 94% felt more able to manage their health and wellbeing.
  • 81% experienced a wellbeing increase.

Economic impact

These social benefits also resulted in a dramatic decrease in healthcare costs. Whereas these increased by 21% across Somerset, in Frome they fell by 21%. This represents 5% of the total healthcare budget (nationally, emergency admissions account for nearly 20% of the healthcare budget).

What can Frome teach us about effective relationship-centred design?

An important aim of Compassionate Frome is increasing the number of relationships between people and community services and activities – ensuring people are well connected. However, being well connected is not necessarily connecting well. Beyond quantity, connecting well requires quality relationships. Compassionate Frome rests on this core tenet of relationship-centred design, exhibiting a number of features we think represent effective relationship-centred design:

Relationships must be valued for people to prioritise  them, and this value depends on many factors

Compassionate Frome recognises this. By mapping such a breadth of services and activities, and training Community Connectors and Health Connectors to navigate that range, the project offers people the space and agency to find opportunities according to their interests and whether they seek emotional, informational, instrumental or other forms of support.

Relationships take many forms.

Compassionate Frome facilitates all four relationship types, or ‘circles’: intimacy, by training Community Connectors to refer loved ones; friendship, through helping to organise peer-to-peer support groups; and participation and exchange, by encouraging patients to engage with free and low-cost community services and activities.

Co-creation and shared goal setting help cultivate strong, mutual relationships.

In working with local people to identify and develop local services, and with patients to set goals through social prescribing, the Compassionate Frome Project emphasises cooperation. This helps build stronger, more mutual relationships between Compassionate Frome staff and community members and between community members as they collaborate on solutions.

Deep relationships can stem from better, rather than more, use of resources.

The Compassionate Frome project has actually resulted in cost savings whilst achieving social impact, by utilising previously untapped community expertise and social capital.

Support and training helps people understand and develop strong relationships.

Training Community Connectors and supporting teams to design new services benefits both Community Connectors and others they will go on to serve.  

What’s next for Compassionate Frome?

There are plans to expand the project into other parts of Somerset, and into Wales. The team is also applying for funding so they can trial a similar model in Minnesota, in the United States.

Want to learn more?

  • Resurgence & Ecologist was first to report on the project’s results.
  • Julian Abel and Lindsay Clarke have expanded on the thinking behind the project in Resurgence & Ecologist Magazine.
  • George Monbiot also covered the project in The Guardian.
  • This British Journal of General Practice paper surveys the results.
  • As does Health Connections Mendip’s 2016 report.
  • There is more information on Health Connections Mendip on their website.
  • And here is an explanation of the Compassionate Communities approach.

 

Has this case study inspired any comments, ideas or critiques?

Please do get in touch with us at relationships@shiftdesign.org if so. An essential part of the Relationships Project is learning from others engaged in thinking about relationship-centred design. We don’t have all the answers, so hope some people reading will contribute suggestions.

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