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An assessment of need for health visiting in general practice populations
1Public Health Department, Norfolk Health Authority, Thorpe St Andrew, Norwich. nick.steel@norfolk.nhs.uk
Insights
Health visitor allocation in the UK is not need-based. A new index using routinely collected data can help equitably deploy health visitors based on population needs.
Area of Science:
- Public Health
- Healthcare Management
- Health Services Research
Background:
- Health visiting services are crucial for population health.
- Current deployment of health visitors in the UK lacks a needs-based approach.
- Routinely collected data can inform health visitor deployment.
Purpose of the Study:
- To develop an index for assessing health visiting needs in UK general practice populations.
- To inform equitable deployment of health visitors.
- To compare a new needs index with current allocation methods.
Main Methods:
- Developed a consensus-based index using indicators: under-5 population, under-5 admissions, low birth weight, and under-65 deaths.
- Calculated rates per 10,000 registered general practice patients.
- Converted indicators to Z-scores, summed for a composite need score.
- Compared index-derived allocation with current allocation and workload profiles.
Main Results:
- Health visitors are not currently allocated based on need at practice or Primary Care Group levels.
- The developed index showed a weak correlation (r=0.37) with current allocation.
- The index correlated strongly (r=0.76) with health visitor workload profiles in one area.
Conclusions:
- Current health visitor distribution relies on historical patterns, not identified need.
- A simple, data-driven method for determining general practice-level need is presented.
- This method facilitates equitable allocation of health visiting resources.
Background:
An index of the need for health visiting in general practice populations in the United Kingdom was developed, using routinely held data, to inform decisions about the deployment of health visitors.
Methods:
The following indicators of need for health visiting were developed by consensus among health visitors and others: the population aged under 5 years; elective admissions under 5 years; births under 2,500 g; deaths under 65 years; all expressed as rates per 10,000 people registered with general practices in Norfolk. All indicators were compared with the number of health visitors per 10,000 people, obtained by a postal survey of health visitors. The indicators were converted to Z-scores and summed to produce a composite score of need for each general practice. The results were compared with the results of a workload profile using data compiled by health visitors within one Primary Care Group.
Results:
Health visitors are not allocated according to need at either the practice or Primary Care Group level. The Pearson's correlation coefficient between the allocation suggested by this method and current allocation is 0.37 (p < 0.01). The correlation between this method and the allocation suggested by health visitors' workload profiling in one Primary Care Group was 0.76 (p < 0.01).
Conclusions:
Health visitors are currently distributed according to historic patterns rather than need. This paper describes a simple method of determining need at general practice level, which can be used to allocate health visitors equitably.