A community service

Source: NHE Jul/Aug 2017

Louise Watson, NHS England director of the New Care Models programme, discusses the emerging success stories from the vanguard areas across the country.

Primary and community care play a vital role in a robust and effective health service, which is why the New Care Models programme has focused on transforming the way care is delivered in the community. 

The Multispecialty Community Provider (MCP), which is a population health-based model of care, is being developed in 14 vanguard areas across the country and we are now seeing emergent success stories for both patients and the health service itself. 

By working more closely together, organisations are seeing better communication between professionals and less duplication of services, making their work more efficient and cost-effective as well as offering a better patient experience. 

At Southern Nottinghamshire’s Principia partnership, some examples of the twin benefits for both the health service and patients include last year’s launch of a new gastroenterology pre-assessment pathway, which in its first two months saw 28.7% of referrals returned to the GP with advice rather than the patient needing to go to hospital. 

Principia has also seen an improvement in response times to ambulance green 1 calls (which aim for responses within 20 minutes) thanks to the deployment of a new community response car working with integrated community services. This has meant 85% of patients are seen within 30 minutes, up from around 60%. 

According to figures from December 2016, Principia has also achieved a 19.4% reduction in GP referrals for outpatient first attendances for trauma and orthopaedics, and the development of a community gynaecology service has reduced outpatient first attendances by 21.5% in that specialty. Its model of enhanced support to care homes has also contributed to a 29% reduction in A&E attendance, and a 23% reduction in hospital admissions from residential and nursing homes.  

In Sunderland, the All Together Better vanguard takes a three-pronged approach to tying together the various strands of health and social care. One of these is community integrated teams (CITs), which link together community nurses, social workers, GPs and voluntary staff in five different localities across the city; and enhanced primary care, which is designed to better guide patients with long-term conditions in managing their own illnesses. 

The development of CITs has placed its workforce at the heart of service redesign. Over the last year, a programme of organisational development has promoted the importance of staff engagement across ‘the system’, particularly this new system. Team members received one-to-one, person-centred, co-active coaching sessions, which helped address the specific needs in each team. As well as a more involved, proactive team of staff, this has led to a shortlisting for a Chartered Institute of Personnel and Development award. 

Sue Hughes is a district nurse who works as part of All Together Better’s joined-up team. She works as part of the North of Sunderland area CIT and says the new way of working has led to real benefits for both staff and patients. “Since we have been working as part of All Together Better, I have seen a lot of changes,” said Hughes. “Referrals from a GP for district nursing are much quicker, so care is more rapid; we are sharing much more relevant information so there is less duplication of effort for both patients and the staff attending to them.  

“Patients really are right at the centre of care, as I am one of a team of professionals who sit on a multidisciplinary team, where we discuss a person’s needs holistically: their health and social care, as well as their wellbeing. We can really see that working this way has meant we can plan much more effectively and get the right care to people when they need it most, keeping them as well as possible and out of hospital.” 

The truly multidisciplinary, cross-specialty nature of the work carried out by the vanguards over the past two years has been the key to achieving both better quality of care for patients and greater efficiencies in the health service. It may seem a minor detail, but there can be a significant impact from colleagues from different disciplines being able to physically be together in the same room when either discussing or administering a patient’s treatment. 

The whole ideology of the New Care Models programme has been built on a shared vision and endeavour: the challenge for teams up and down the country has been to translate this into operational reality. Spreading the learning from the New Care Model sites across the country is vital, especially at a time when the system is facing significant challenges. This is one of our key commitments as we embark on the third year of the programme. 

The statistics quoted in this article were provided by the individual vanguards.




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