一般財団法人オレンジクロス
日本版「社会的処方」のあり方検討事業（仮題）
第３回委員会資料（2018年10月9日）

The Frome Model
Dr Julian Abel
Director, Compassionate
Communities UK1

Introduction• 3 major components• Internal hub in GP surgery for identifying andmanaging people in need of support• Health Connections Mendip community
development service• Implementation and change methodology

2Benefits
3 main outcomes• Improved working lives for clinical teams• Improved patient outcomes in both healthand well being• Reduction in emergency admissions – 16%
real terms, with Somerset emergency
admissions increasing by 30% during sameperiod
3

550
13000

500
12000

Frome emergency
admissions
Somerset emergency
admissions4

q3 2017

q2 2017

q1 2017

q4 2016

q3 2016

q2 2016

q1 2016

q4 2015

q3 2015

q2 2015

q1 2015

q4 2014

q3 2014600

q 2 2014700

q1 201418000

q4 2013750

q3 201319000

q2 2013800

q1 2013

q3 2017

q2 2017

q1 2017

q4 2016

q3 2016

q2 2016

q1 2016

q4 2015

q3 2015

q2 2015

q1 2015

q4 2014

q3 2014

q 2 2014

q1 2014

q4 2013

q3 2013

q2 2013

q1 2013

Quarterly emergency admissions
Frome and Somerset 2013 - 7

17000

650
16000
15000

14000

Cost implications of Frome Model• Cost of all admissions Frome in 2013 - 2014 =• Cost all admissions Frome 2016 -2017 =• Reduction Frome between 2013 -4 and 2016 - 7 =£5,755,487£4,560,421£1,195,066.

This is a 21% reduction in actual cost between 2013 and 2016
• Cost of all admissions Somerset 2013 - 2014 =• Cost of all admissions Somerset in 2016 - 2017 =• Total increase in cost in Somerset =£86,535,551£104,804,840£18,269,289

This is a 21% increase in costs of admissions in Somerset
excluding Frome.

Application of Frome model would have saved Somerset £35
million – total budget £700 million
5The comparative impact of social
relationships on reduction in mortality

6Longevity and social contact• Biggest single factor in longevity, particularly face toface contact (Pinker 2015,The village effect: How faceto-face contact can make us healthier and happier) issocial contact• A fundamental aspect of what keeps us alive, part ofhuman evolution, part of 60 million years of primateevolution• A new dimension into medicine• We have found a way of making social
relationships/compassionate communities become aroutine part of clinical practice in Frome
7

Health Care – The New Essentials
3COMPASSIONATECOMMUNITIESGENERALIST2 CARE
41

CIVIC PROGRAMMEFOR COMPASSIONATECITY CHARTERSPECIALIST CARE

8

The Hierarchy of Well Being
NEGATIVE
CONSEQUENCES
Poor work experience, increased social
isolation, stress, lost work and schooldays, disenfranchised grief andcaregiving

POSITIVE
OUTCOMES
Civic actions

Bedrock of support, engagement
post bereavement, increased socialcontact, social cohesion & inclusion
Resilient supportive networks,
strengthened relationships intobereavement, increased socialinteraction, reduced hospital use

Carer exhaustion, increased comorbidities for patient and caregivers, emergency admissions, long term
psychological trauma, long term illhealthCompassionate
community
actions

Poor care planning, poorcoordination, emergency
admission to hospital, poor
symptom control

Generalist careactions

Good long term condition
management,, good,
coordinated care

Poor symptom control, lack ofequity, poor outcomes,
increased institution usage

Specialist careactions

Good disease management,
integrated with primary care,good coordination
9Compassionate Communities rather
than social prescribing• Social prescribing is community focussed –people going out into community• Compassionate communities builds
community resource, enhances naturally
occurring networks and links all of thistogether

10A new dimension• Whole population intervention – the changes
that have taken place are across the wholepopulation• Equally as valid to a teenager as to an elderly
person• This is not solely a medical intervention – it is theunion of new models of primary care withcompassionate communities.
• Use of IHI quality improvement methodology iskey to change management11

4 key steps1. Identifying those in need of support –whatever that means
2. Patient centred goal setting and careplanning, including admissions avoidance
and resuscitation discussion
3. Enhancement of naturally occurring
networks
4. Linkage to community networks
12