Primary Care based assessments are usually targeted at one of three levels:

• Generic or population: This examines the overall health needs of either the whole practice population or a community served by the practice.
• Client group specific: Used to examine the health needs of a specific group within the practice population.
• Disease or intervention specific: Used to examine how well the needs of patients in a specific disease area are being met, either from the patients perspective or in terms of clinical effectiveness.

However, these levels are not mutually exclusive. You may decide to begin with a broad assessment at community or practice population level and then move on to examine the needs of a specific client group in more detail. Alternatively an assessment which focuses on a specific intervention or disease area such as stroke, may raise wider questions.

In deciding which approach would suit your needs best it is helpful to consider the following:

• What interests and knowledge can be built upon?
• What previous work can be used?
• What is your reason for undertaking the needs assessment?
• What time and resources do you have available?

Your team

HNA should never be a solitary activity. Working in a small team with colleagues from different professions or even different organisations will almost certainly result in your HNA being more comprehensive and more relevant, and it will enable the workload to be shared.

The size and composition of your team will vary according to the size of your population and the type of HNA you are undertaking. There are no hard and fast rules, but teams of 3 to 6, including at least one GP, a nurse, a manager or information manager and a member of your administration or reception team often works well.

If you are thinking about a community based HNA you might want to involve a colleague from Community Services or colleagues from Social Care. If you are keen to look at a particular client group or disease area then it may be helpful to work with a practitioner knowledgeable in that area.

Whatever the size and composition of your team it is important to make sure that all the team members are keen to get involved and are committed to using the results of the assessment to improve services or practice.

Time and resources

HNAs can be time consuming, but it is a very cost-effective use of time, because it can not only produce demonstrable improvements in services to patients it can also enhance job satisfaction within the practice.

From the outset it is important to be realistic about the time and resources your team can commit to the work. If you know that most of the team can only give one or two hours each week to the assessment, it may be better to begin by focusing on one disease area or client group, or accept that it will take six months not three.

If the HNA is being undertaken as part of a wider project, it may be possible to set aside more time. Either way, it is helpful if you can create some protected time. It can also be helpful to set aside a small budget to purchase a few key books or papers or perhaps to cover the cost of a postal survey.

Information requirements

When thinking about the information you need, there are a few important points to remember:

• Keep in mind why you are undertaking the HNA and how you hope to use the results. There is no point in collecting information simply because it is available or it might be generally interesting.
• Although it is the quality not the quantity of information that is important you may want to consider obtaining data on the same issue from different sources so that you can validate or cross check it.
• You may also want to think about the balance between quantitative information, for example how many patients were referred to the Community Mental Health Team in the last year or how many consultations there are each week for low back pain, and qualitative information, for example what do local people feel are the most pressing health issues in the community or how well do younger disabled people feel their needs are being met.
• Ensure that the information will actually tell you something about needs and is not misleading. For example, information about utilisation rates may tell you more about the availability of a service than the need for it.
• How to collect the information

It is likely that much of the data you are interested in already exists but getting hold of it in a usable form may not always be easy.

There are three important sources of data for HNA:

Practice and CCG based data; Routinely available local and national statistics which may be found on the internet e.g. NHS Information Centre, Health Observatory, Office for National Statistics etc.
Information collected especially for the HNA e.g. via a survey
The information from a survey can be collected via a number of different methods. Click on the links below for more information:

Questionnaires
Interviews
Focus Groups

If you need to collect data specifically for the HNA, then it is important to consider the most appropriate and practical approach to getting that information given the time and resources available to you. If a particular piece of information is likely to be difficult or time consuming to collect or extract, you may have to consider using a proxy or applying national estimates.

Once you have decided how to collect the information you want, you need to plan your ‘fieldwork’.

It is important to decide at the outset who is going to be responsible for obtaining the different pieces of information. If you can, try to make use of the skills or connections of your team members.

You should also think carefully about timescales. If you plan to undertake surveys or interviews you will need to allow time to pilot them. Where you are asking other organisations to supply you with data you may need to give them some time to compile it in the form you want. You will also have to allow for the possibility that some of the information will not be available and so you will need to consider alternatives.

It can be helpful to use the process of collecting the information as a chance for the team to learn new skills, and get to know colleagues in other organisations. It can also provide an opportunity to learn from and involve patients and the wider community. This can be particularly valuable if you are looking at the needs of a group or community who feel that in the past they have had little say in the services they receive.

This process can be almost as important as the information itself, and if handled well can lay good foundations for future work or relationships.

The approach you take to analysing and reviewing the information you have collected will depend very much on the type of HNA you have undertaken. There are no hard and fast rules, but it is important to take a systematic approach.

It can be helpful to group the information you have obtained into categories. For example if you have been looking at the health needs of older people, you may want to begin by using four groupings: demographic and social information, data on the use of secondary care services, use of primary care resources and patients perceptions and priorities. Using such categories can be particularly important if you have a lot of qualitative information to analyse.

When analysing and presenting quantitative information, it is helpful if you can express the information in three basic forms – the total number, the number as a percentage and the number as a rate. For example, if you are looking at the health needs of children under 15, you may have established that there were 2430 consultations by children under 15 in the previous year and that this group of patients accounted for 25% of all consultations in that year. You could also say that you have 630 children under 15 registered with your practice and in the last year 96 out of every hundred consulted their doctor at least once.

Analysing and presenting information in this form helps to set the numbers in context but it also provides a basis for comparisons with other practices or district and national figures.

Don’t feel that you have to undertake sophisticated statistical analysis. Simple bar charts are a perfectly adequate starting point for discussions.

Your aim should be to use simple approaches well and produce information which is relevant and readily understood.

You will probably find that as you have collected and analysed the health needs information, your ideas about the key issues to be addressed have developed. You may even have started to identify possible solutions to any problems which emerged.

How you take forward these ideas and agree priorities will depend on your original aims and the culture within your CCG and/or GP practices.

To help you compare or judge the proposed changes it is helpful to agree a simple set of criteria against which they can be measured. These will vary with local circumstances, but they are likely to cover issues such as the health benefits that will be gained, the cost, and the feasibility of achieving the change.

Your priorities may not be the same as those of your patients and the local community. You may therefore need to address their priorities before your own, if you want to secure their support, particularly if your Health Needs Analysis is being used to support a business case for new premises, an extension or new services.

In drawing up your action plan it is important to set measurable targets and agree realistic timescales in which to achieve them. You may find it helpful to use the SMART acronym below:

• Specific
• Measurable
• Attainable
• Realistic
• Timely

Where possible try to describe the outcomes you are hoping to achieve. You should be able to quantify the outcome in some way, even if this is expressed in qualitative terms such as a change in patients perceptions.

You should also agree who is going to lead each action and identify the resources require to achieve it.

You may wish to share your action plan with other local providers, or to integrate your plan into your business case or bid to demonstrate how you will achieve health improvements within the specified population.

Health needs assessment is all about making the best use of resources and improving services for patients. It is therefore vital that you set regular review dates to consider the effect of the changes you have implemented.

Ideally your audit should include some sort of quantitative analysis of the outcomes which you stated were aiming for in step 4.

Once you have completed an audit it may be necessary to go back to step 3 so as to start the audit cycle once again.

A reminder of the traditional audit cycle is given below:

• Review/define standards
• Collect data
• Compare with standards
• Change