Population Health Management

The population health approach to health continues to grow (2022) throughout the Norwich Primary Care Network (PCN), not only with IMPACT, but also now including the GP high intensity user service, the Age Healthy Norwich programme (supporting over 50s with comorbid hypertension and diabetes) and the INTERACT project. In addition to this, the PCN has taken part in wave three of the national population health management development programme, facilitated by OPTUM, to identify new processes for supporting patients on the elective trauma and orthopaedics surgical waiting list.

The latter of these has involved working closely with the Integrated Care Board (ICB) and acute hospital colleagues, as well as physiotherapists, and other clinicians to establish a new pathway for patients. Aspects of this new pathway are currently being piloted in two practices within the PCN.

The PCN recently procured a two-year license with Ardens Manager, a software package that helps identify patients

who would benefit from a range of interventions linked to the Investment and Impact Fund. Data produced by the software is accessible to both the ICB locality team and PCN team at OneNorwich Practices (ONP) to help identify areas where support can be offered.

ONP intends to develop the expertise within the business intelligence team to make better use of local health data. This will ensure that future project development is more effectively targeted and implemented.