Fuel poverty

RCGP Fuel Poverty Referral Pilot (Warm and Safe Wiltshire)

The Royal College of General Practitioners (RCGP) is inviting primary care organisations in Wiltshire CCG to pilot a simple referral mechanism to refer vulnerable patients for help with fuel poverty and cold homes. The pilot is funded by the British Gas Energy Trust Healthy Homes Fund.

Fuel poverty means living in an inadequately heated home. Cold homes can result in high fuel bills, poor health, and cause people to take longer to recover from illnesses, particularly those recently discharged from hospital. In Wiltshire, 20,523 households are in fuel poverty (Department for the Environment and Climate Change, 2015). Primary care is ideally placed to identify them.

Why take part?

  • Improve health outcomes for your at-risk patients
  • Tackle health inequalities in your practice area
  • Potentially reduce the number of GP and community care appointments and hospital admissions.
    (The Gentoo Boiler on Prescription 2014 Pilot in Sunderland saw GP appointments reduce by 28% and outpatient appointments by 33% for some patients.)
  • To deliver on recommendations in NICE guidance on Excess Winter Deaths (NG6, March 2015, QS117, March 2016)

What is the referral?

The referral is to Warm and Safe Wiltshire (WSW), a service provided by Dorset & Wiltshire Fire and Rescue Service  and Wiltshire Council to reduce fuel poverty in the county and make its residents’ homes warmer, healthier and safer places to live.  WSW will contact the patient’s household and offer impartial energy advice support services covering:  how to reduce their energy bills through energy efficiencies in their home; understand how to get the best energy deal and switch suppliers; sign-posting or referral to relevant services (fire prevention, income maximisation, health protection).

Who are we targeting?

Groups who are particularly vulnerable to cold include those with cardiovascular or respiratory conditions, babies and children under five years of age, elderly people, those with mobility difficulties or disabilities and pregnant women.

For the purposes of this pilot, the patient identification tool flags those who have one or more of seven conditions which can be negatively impacted by cold (Asthma, COPD, Stroke or TIA, Coronary Heart Disease, Hypertension, at risk of falls, Depression). It also flags those who are on the “Avoiding unplanned admissions” Register. This may be subject to change if it is found to generate too many or too few referrals. With your feedback, we will be seeking to identify workable parameters for healthcare professionals and patients. Patients living in care homes are excluded from the pilot as they are generally not at risk of fuel poverty.

A warmer home could make their condition(s) more manageable, reduce their risk of illness and help them to avoid hospital stays.

What is involved for the GP practice or Community Care Team?

The time commitment is minimal and participation is voluntary.


  1. GP Practice or Community Care Team registers to participate.
  2. Organisation receives a task to join the Fuel Poverty Group on SystmOne and, once actioned, can start referring patients. Each referral will take 60 seconds or less.
  3. When the healthcare practitioner has an appointment with a flagged patient, the practitioner:
  • Decides whether appropriate to recommend a referral to WSW.
  • If yes, answers the template’s 3 tick-box questions. The final click generates the referral and a patient letter.

Support is available throughout from the pilot’s local clinical consultant, Dr Anna Collings, and from Ardens, the provider of the referral mechanism.

The referral mechanism is free for use by all Wiltshire primary care organisations using SystmOne.

When is this happening?

The project is running from November 2015 to 31 March 2017.

  • Recruitment of primary care organisations: February – March 2017
  • Primary care organisations make patient referrals: February – March 2017
  • Evaluation:  September - March 2017
  • Final report and next steps announced: March 2017.


Sheffield Hallam University will conduct an external evaluation of the pilot to identify if the referral mechanism is effective for primary care (flags appropriate patients, is easy and time efficient to use); for patients (helps make them warmer, healthier and safer in their homes); and for the local authority (helps put them in contact with residents who can benefit from their services). As with the design of the referral process, our aim is to make the time commitment minimal:

  • Referred patients will receive a letter from WSW inviting them to contact a named person at the University if they are willing to be interviewed on their experience.
  • Participating primary care organisations will receive a short electronic survey to complete. Some may be invited to participate in a short telephone interview at a time convenient to them.
  • Interviews with the delivery partners and stakeholder organisations.
  • Analysis of the anonymised data captured from the SystmOne template and WSW patient journeys.

In order to evaluate the outcomes of the initiative, the following anonymous data will be extracted automatically from the participating practices and community team systems: number of patients flagged; number of referrals made/declined; long term condition(s) and age.

Download Data collection for the RCGP Fuel Poverty Referral Pilot (Wiltshire)

Clinical leadership and local support

It is important that this pilot be led from the GP perspective. Dr Tim Ballard, former Vice Chair of External Affairs at the RCGP, and a GP in Wiltshire, initiated the pilot, which he continue to lead jointly with Dr Nina Amedzro, Freelance GP in Leeds, with an interest in addressing local health inequalities.

  • Dr Anna Collings, GP Vice Chair of North East Wiltshire CCG and GP Partner at Pewsey Surgery is thanked for her leadership and support to recruit practices until October 2016.

Wiltshire CCG is supportive of this pilot and is a member of the pilot’s steering committee.


Wiltshire practices and extended primary care teams can register here to participate.

Further information

Contact sarah.pollet@rcgp.org.uk Monday-Thursday office hours.



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