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Prime 75+ - One year on

In July last year, the BGS Newsletter introduced Prime 75+, a dedicated initiative in GP practices, identifying lonely, socially isolated and frail older individuals within local communities and offering proactive services to improve socialisation of the ageing population. Now, one year on from the programme’s inception, we find out how it is faring.“It’s not just something that happens in one appointment. The most powerful impact begins to happen following on from the relationship being built, similar to that of the trust built with the doctor. Now patients are coming back and we’re seeing the difference the service is making,” says Amanda Cogley, Prime 75+ Manager 

This hugely positive testimony marks the first twelve months of a pioneering project launched to improve socialisation and reduce dependency on the healthcare system by the ageing population and, just one year on, it is clearly having a profound impact.


Developed and delivered by PrimeGP, a healthcare organisation bringing together a unique blend of clinical and commercial expertise, Prime75+ was commissioned by NHS South Warwickshire CCG in January 2015 and has since been trialled across four GP practices across South Warwickshire. With a primary focus on alleviating the issues faced by a rapidly-growing and ageing population, the scheme  moves away from a traditional model of care which focuses purely on health issues, and instead looks at the overall physical, and mental, needs of those aged 75 and over.  

A dedicated over 75s Coordinator works alongside clinical and reception staff to identify those who are lonely, socially isolated (and in some cases frail), and offers health, social and voluntary care interventions to bring about an enhanced quality of life, general well-being, and subsequent improved medical outcomes. They seek the views of the patients themselves about the support and level of engagement required, and the Coordinator works with them to identify activities within the local community that they can be participate in and be part of. This not only promotes the development of friendships and self-confidence, but reduces the reliance of individuals on the one person many saw as their sole trusted confidante – their GP. 

As far as the success of the project goes, the statistics really do speak for themselves. Since launching, the scheme has facilitated contact with over 690 patients from across the four practices and has conducted more than 280 initial assessments.   The Coordinator has liaised with more than 43 per cent of the total population of over 75s, has completed full assessments with 18 per cent of those individuals, and has identified approximately 21 per cent who are lonely. Through communication and engagement with the over 75s, the project has seen the number of GP appointments by those seen by the Coordinator reduced by over a third – providing confidence to the GPs and ensuring that those patients who are in real need of medical attention are prioritised.

So, what’s the secret?  A personal and proactive service which has people at its heart, the team behind the Prime75+ project puts its success down to the relationships built and nurtured along the way, and support from these has been integral. Partnerships have included the CCG, allied charities such as The Silver Line, and of course the patients, practices and wider communities themselves. It is this collaborative, and forward-thinking, approach that has enabled the team’s real ‘can-do’ attitude and has helped them to overcome and tackle head-on the challenges associated with this innovative model of care, and to identify key aspects of success which it can build on in the future, including:

  • Patient engagement is key to any innovation and successful project implementation and delivery plan 
  • Change is not something that happens with one appointment. The most powerful impact begins to happen following on from a relationship built similar to that of the trust built with the doctor
  • Activities and community engagement with the practice increases patient satisfaction, enhances the standing of the practice within the community, and does make a significant difference to patients’ mental health and wellbeing 
  • Referral routes and processes should be streamlined with single points of access so referring can be made easier and quicker 
  • There should be an enhanced focus on primary care benefits as well as a drive to reduce secondary care access and a strong focus on improving quality of life for patients.

As the project looks ahead to the next twelve months, and with the NHS increasingly in the spotlight, there will of course be a number of additional challenges to face.  But for now, with all of those involved reporting significant improvements to health, well-being, and morale, this innovative project really does look to have achieved what it set out to do… to tackle loneliness, improve socialisation, and deliver real, tangible change on behalf of a healthcare system in crisis.

Tim Coker
Chief Executive, Prime GP 

Prime GP is a comprehensive healthcare organisation and project management service which aims to address the increasing financial and health pressures placed on the NHS. The organisation’s Prime of Life: 75+ Project is dedicated to helping  deliver proactive services to improve socialisation and isolation, reduce patient dependence on GPs in the ageing population, and increase patient self-care and physical and mental wellbeing. 

For more information about Prime GP or the Prime 75+ project call 0330 100 1078, email , or visit

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