Why patients prefer community based services

What is the economic impact of age related hearing loss?

In 2010-11 NHS England spent £450 million managing hearing problems, a figure that will inevitably increase as the population ages. There are also long term costs that need to be considered as comorbidities begin to develop.

For example, age related hearing loss increases the risk of depression, dementia and falls. Treating depression costs the NHS more than £520 million a year: £237 million for hospital care, £230 million for antidepressants, £46 million for doctors’ time and £9 million for outpatients’ appointments. Preventing depression by addressing hearing loss, as well as other risk factors, will help reduce the clinical and economic burden imposed by depression.

What do you think are the main patient and commissioner benefits of a community based adult hearing service and what differences do they make to commissioners’ population groups?

For patients, community based hearing care services provide greater accessibility and flexible appointment times. Also, importantly, the stigma of wearing hearing aids is removed, which is often associated with treatment in a medical setting. Typically our patients don’t see hearing loss as an illness, so treatment in a community setting is welcomed. Also, with walk-in access to unlimited aftercare, patients are more likely to adapt to, and continue to use their new hearing aids, than abandon them out of frustration or a lack of access to immediate aftercare.

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For commissioners, there is the benefit of being able to treat hearing loss promptly by using a community provider – typically within 16 days of referral. Not only are patient outcomes improved, through convenient access to aftercare and ongoing support, but cost savings are made.

This includes in related areas: addressing age related hearing loss can, for instance, help reduce unscheduled hospital admissions from falls. GPs are also provided with a full summary of patient activity undertaken by Specsavers for each GP practice. We also include local waiting times and patient satisfaction scores.

How has the commissioning of community based hearing services been going?

All areas are performing particularly well with high numbers of GPs referring patients. Commissioning groups are very committed to delivering patient care where patients want it, and crucially to improving outcomes which is reflected in the communications they carry out at both GP and patient level. 

We have found that once they have information on the nature of age related hearing loss, GPs are open to change to improve patient service. GPs recognising that age related hearing loss is a condition that will come to us all rather than an acute or chronic illness has led them to view this as much less contentious than many of the other changes happening across our NHS – this a condition that is best solved outside of the hospital. 

How does Specsavers take into account feedback from GPs and commissioners?

GP feedback has been critical in improving services. An example of this would be the improvements we have made to our referral processes. We have recently implemented directly bookable “choose and book” capabilities and will be embarking on a national rollout over the next few months.

‘Challenge yourselves and your providers to ensure you are making as many savings and efficiencies as possible that will ultimately benefit your patients’

We survey commissioners regularly to evaluate our service and check that we are aligned to commissioner group priorities. Ninety per cent of commissioners surveyed agreed that doing business with Specsavers is simple, easy and effective.

Our clinical commissioning group-level insight reports add real value and depth to our local performance but also keep local commissioners in the loop with local innovation and improvements we are making to drive greater local value.

One of the big changes we have made based on this survey is to start localising our approach by working with commissioning groups to align our NHS hearing service to some of their core local priorities, for example extended opening hours, including weekends.  We welcome feedback on an ongoing basis. GPs and commissioners can contact us by calling 0800 077 8603 or by email.

What’s been challenging? Why do you think some CCGs are still reluctant to commission community based hearing services?

This is more difficult to answer as, on the face of it, the benefits of community based hearing care appear hard to ignore. Patients prefer a localised non-medical service to access hearing services and GPs recognise that a non-medical intervention that patients can access in a high street setting with unlimited access to aftercare does improve outcomes.

However, we are aware that in a period when one of the most complex organisations in the world is undergoing the most significant restructure since its inception, CCGs have had to prioritise other services. It’s our job, and the job of organisations such as the National Community Hearing Association to ensure that commissioning adult hearing services provides a quick win for CCGs, for GPs and most importantly for patients and the local community.  

What do you think the future is for the commissioning of community based hearing services?  

Innovation through local community services has proved a great success so far in those areas that have been early adopters, but improved access and choice remains available in only 50 per cent of current CCGs areas. We would like to see equity for all patients and encourage the other 50 per cent of CCGs to improve access and choice in adult hearing services in their areas also.

How many contracts for adult hearing services does Specsavers currently have in England?

At the moment we have 31 contracts, which provide services to 95 CCGs. Within that portfolio we have delivered over 100,000 NHS patients pathways.

What four key points would you make to commissioners to help them offer the best service possible for their population groups?

First, consult with patients and look at what the deliverables are for patient outcomes

Second, take a look at the service you are providing and ask yourself what’s the opportunity to meet saving requirements, while still driving quality outcomes upwards

Third, read the Hear and Now report, which explores the economic, physical, and psychological impact of age related hearing loss and challenge yourselves and your providers to ensure you are making as many savings and efficiencies as possible in other areas, as well as audilogy, which will ultimately benefit your patients

Finally, commissioning age related services in the community is relatively simple and a straightforward process which can deliver real savings and real benefits to the local community –

Tom McKnight is head of NHS contract development at Specsavers