Commissioning Impact

Effective interventions for long term conditions
Impact provides effective complementary interventions for a range of long term conditions, including:

1. Mental health conditions, including anxiety and depression
2. Musculoskeletal disorders
3. Back pain
4. Chronic pain
5. Gynaecological and menstrual disorders.

Our flexible, whole person services can address effectiveness gaps in primary care. Research has demonstrated that 91% of GPs feel they have inadequate treatments available for the patients with musculoskeletal disorders, and 45% feel there are gaps for the treatment of depression. 32% of GPs find conventional treatment for chronic pain is unsatisfactory. In all these areas, Impact’s interventions – acupuncture, chiropractic and homeopathy – can be effective, and are very popular with patients.

“I believe that the work carried out by the team for myself has prevented me from taking up valuable time of the other health professionals in my area…other than routine check ups I have hardly accessed my GP since receiving support from Heather. This speaks for itself and demonstrates that a service such as Impact plays an important part in modern day health care.”
Impact comments book

Potential for cost savings
Commissioning Impact’s services is very likely lead to savings in practice budgets. Over the last three years, we’ve treated more than 320 patients with long term conditions in the Radford and Hyson Green areas of Nottingham. Most of our patients have previously received a considerable amount of conventional primary and secondary care. However, after completing treatment at Impact;

1. 87% of patients taking medication report reducing or stopping medication, as it is no longer required
2. 76% go to see their GP less often, including patients who were previously frequent attenders
3. Some patients no longer require secondary care, including spinal injections and orthopaedic surgery.

Audits from complementary medicine services in other parts of the country demonstrate that they are cost-effective; a PCT audit of a chiropractic service in Wilmslow has found that for every 22 patients referred, £10,000 was saved – 8 out of 10 patients waiting for orthopaedic appointments no longer required them. A revaluation of the integrated health services supplied by Glasgow Homeopathic Hospital (which involved scrutiny by the Health Board and parliamentary committees) found that long-term demands on the NHS were reduced with significant reductions in GP visits, new investigations and drug use.

The national commissioning agenda
The recently published Health Reform in England: update and commissioning framework document calls for “the health and care system to focus far more effectively on promoting good health, independence and well-being.” Impact’s health outcomes demonstrate that we are achieving exactly that. Our work can also contribute to success in achieving the following aims outlined in the commissioning framework:

1. A more personalised service for patients
2. Better, more sensitive provision for vulnerable and excluded members of society
3. The development of more collaborative work, across clinical divides, to construct care pathways around the individual needs of patients
4. The provision of choices which reflect the individual’s beliefs, values and preferences as well as clinical need
5. The availability of choices around the type of treatment as much as about the place of care
6. Strong engagement with patients and the public.

The recent Department of Health musculoskeletal services framework, ‘A joint responsibility – doing it differently’ recommends that chiropractic treatment is made available for all patients with MSDs.

Commissioners now have the opportunity to make bold decisions that introduce innovative ways of working, extend choice and access to patients, and forge a new partnership between NHS providers and Third Sector organisations like Impact.

“Almost all of the patients I have referred to Impact have made a point of reporting to me the improvement in pain levels and mobility they have experienced, and clearly therefore improvement in their quality of life… The ability to refer into such a service has also added to my ability to offer holistic care to a wider group of clients. I do hope that the area which you cover can be widened so that more patients can experience the benefit and equity of care can therefore be achieved.”
Practice Nurse

Tackling health inequalities
The Impact team understands how health inequalities impact on patients’ health and wellbeing. 48% of the patients we’ve treated so far come from Black and Minority Ethnic (BME) communities, in an area where 28% of the population are from BME groups. We’ve also treated asylum seekers and refugees, all of whom were dealing with the physical and psychological effects of torture. 30% of our patients consider themselves to have a disability, and 38% are men.

“You know it’s working when 38% of your patients are men. Men don’t normally get too bothered about their health, but with this they turn out. The feedback has been very good indeed and there are people using Impact who would not usually access the normal service. It’s extremely impressive.”
Roger Williams, Director of Partnerships and Health Improvement, Nottingham City PCT

Patient Choice
Many patients would like access to complementary medicine. One Impact patient, with endometriosis, has written to her GP to outline the difference that a referral to Impact has made to her life:

"…the greatest help that you have given me was by a referral to ‘IMPACT’ Integrated Medical Project and to Heather Fitton – Acupuncturist. Since March 2006, this regular on going support and treatment has not only improved my condition and strengthened my general health but just as importantly helped me to manage my coping strategies. I would like to elaborate this further below… CONDITION BEFORE NOW PAIN Extremely painful – similar to labour, unbearable pain twisting, pulling, cutting. Relatively painless. MENSTRUATION Long, irregular bleeding, clots, very irregular cycle. Light, short, regular cycle – 32 days. FATIGUE Apathy, shattered, unable to move, bedridden. Much more energy! Zest for life! EMOTIONAL WELLBEING Lack of clarity, depressed, apathy, unhappy, tearful, flat. Happy, positive, cheerful, able to move on - to plan ahead WORK SICK DAYS Bedridden for at least two days per month. No days taken off from work LESS DOCTORS APPOINTMENTS Many Endometriosis related Doctors appointments No Endometriosis related Doctors appointments PSORIASIS Large, increasing patches on legs, arms and body Smaller patches, clearing up, using Propolis cream

The Impact team
Impact is a locally-owned social enterprise; all profits are re-invested in the service, enhancing the quality of care. Since 2002, we’ve worked closely with Nottingham City PCT to ensure the highest standards of clinical governance. All Impact practitioners are registered with the relevant professional organisations, and the relevant locality office holds details of our qualifications, registration, insurance and criminal records checks. Each practitioner is engaged in a programme of continuing professional development. Risk management and patient safety are integral to our approach; acupuncture, homeopathy and chiropractic are low-risk interventions. All relevant health and safety requirements are strictly adhered to.

You are welcome to contact us to discuss how we can work together to enhance the services you provide, to provide truly integrated healthcare. Examples of the care pathways that we’ve developed are available for download below. Our nationally-recognised team are fully committed to ensuring that NHS patients are able to access complementary interventions, whenever clinically appropriate, whatever their financial status.

Downloads

Suggested Primary Care Back Pain Pathway (pdf - approx 100kb)
Suggested Primary Care Musculoskeletal Disorders Pathway (pdf - approx 100kb)