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Mental Health Concern

Ways to Wellness

What is Ways to Wellness?

Ways to Wellness is a service for people in the west of Newcastle whose daily lives are affected by certain long-term health conditions (COPD, asthma, diabetes, epilepsy, heart disease and osteoporosis). Mental Health Concern and First Contact Clinical are commissioned to deliver this service.

GPs and their primary care teams refer patients to Ways to Wellness, as it complements the medical support that their patients receive and helps patients to feel more confident in managing their long-term conditions and making positive lifestyle choices.

Each Ways to Wellness participant works with a link worker, to helps them to identify and work to overcome their current barriers to managing their long-term conditions. The link workers help participants to produce an agreed action plan, which may include one or more of the following:

  • Getting involved in local groups and activities
  • Developing positive relationships
  • Accessing specialist services and support
  • Healthy eating and cooking
  • Getting more active
  • Getting support around benefits and welfare rights

The actions plans have all kinds of positive outcomes, including:

  • Improvements in participant self-management
  • Improvements in participant’s health compared with predictions
  • Reduction in hospital usage
  • Reduced visits to GPs
  • Reduced reliance on prescription drugs for some conditions (such as those for depression)

Why is this service needed?

Over 15 million people in England suffer from long-term health conditions. People with long-term health conditions experience poorer health outcomes and reduced quality of life as a result, and they are proportionately higher users of health services (GP appointments, prescription drugs, outpatient services, and in-patient hospital bed days).

55% of GP appointments are with patients with one or more long-term health conditions, with 70% of national NHS spend related to treating these conditions.

Evidence from community health interventions, both locally and nationally, has shown that a contributory factor to health and wellbeing is being linked into a local community and reduced social isolation.

Who is Ways to Wellness for?

Ways to Wellness is aimed at people with long-term physical health conditions, who live in the west of Newcastle and are served by one of the 18 general practices that were originally part of Newcastle upon Tyne West Clinical Commissioning Group.

Ways to Wellness is for patients who are aged 40-74 and are on the relevant QOF Disease Register for any of the following long-term conditions:

  • COPD and asthma
  • Diabetes type 1 or 2
  • Coronary heart disease
  • Heart failure
  • Epilepsy
  • Osteoporosis

GPs are asked to prioritise those people who:

  • Have poor understanding of their condition
  • Are socially isolated
  • Have poor adherence to prescription
  • LTC has identified above with depression/anxiety
  • Have poor health but scope to improve with lifestyle change (not end-stage illness)
  • Are frequent attenders at GP or hospital
  • Have poor English literacy
  • Are obese and/or inactive

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