09.12.16
Dudley CCG: MCP model success requires time, commitment and trust
Source: NHE Nov/Dec 16
Paul Maubach, chief executive officer at Dudley CCG, discusses the early success and challenges of the Dudley Multi-specialty Community Provider (MCP) vanguard, the benefits of GP-led teams to deliver better integrated care and how the use of shared technology is improving outcomes.
The heart of the NHS starts with the local population registered with their general practice, which is why general practice is at the centre of the MCP model.
About one-third of our population are living with at least one long-term condition (LTC). The FYFV identified that ‘long-term conditions are now a central task of the NHS; caring for these needs requires a partnership with patients over the long term rather than providing single, unconnected ‘episodes of care’. In a recent public consultation with our local population in Dudley we identified that this cohort of the population, as well as good access, also want effective continuity of care with a professional they can trust.
Within that population of people with LTCs, we have an ever-rising cohort of individuals living with frailty and complex-comorbidities (as evidenced often in their utilisation of hospital-based care) who, in addition to access and continuity, also need effective co-ordination of health and social care. Effective care planning, taking into account the whole needs of the person, is essential to ensure all individuals supporting a person’s care work effectively together.
Our care model in Dudley takes these main themes of access, continuity and co-ordination and then determines which services support their delivery both at the local level around each general practice; then at a system level across a wider population; and then how both components need to interact with each other.
One of our initial successes in implementing this approach is the development of our multidisciplinary teams (MDT) around each GP practice to enable the co-ordination of care for our most complex patients. Our success came as a result of making two key changes:
- In order to maximise the potential for staff to work effectively together, all the relevant staff work with the same population of patients so that they can communicate with each other effectively, and also take a shared interest and responsibility in the outcomes for those people. It isn’t sufficient to merely have a GP-led process – the community-based services are structured in teams so that they now work with the same population. The results: staff morale has significantly improved, and they are more effective and efficient because they are empowered to decide between themselves how to share responsibility for how they work to meet the needs of their patients.
- Secondly, we introduced one new component to the MDT – the voluntary sector link worker. These individuals came with no professional boundaries and so enabled the teams to look at the whole needs of the person, not just their health requirements. Individuals who were previously socially isolated are now connected back into their local communities; small non-health related problems are resolved, which then gives confidence to individuals and reduces their utilisation of healthcare (up to a 30% reduction in primary care visits); patients report how their quality of life has improved; and many now contribute more by being part of social groups and thus adding social value back into their community.
Similarly, with continuity of care we developed a new outcomes framework for general practice – all evidenced-based on the areas that matter most to our population so that all a patient’s LTC requirements are addressed as a whole package and the individual contributes in setting their own goals to be measured, thus encouraging a shared responsibility in the achievement of outcomes for the individual. This is underpinned by a single GP IT system which has been programmed with a standard set of templates and workflow-processes to enable a consistent approach to be adopted for every patient in every practice across our CCG. Intelligent standardisation and use of technology enables us to make a consistent offer of service to our whole population whilst also enabling our practices to work more efficiently – over half of our practices are changing their skill mix, using more practice nursing and health care assistants to deliver care.
The development of an MCP is just that – a developmental process. It is complex and challenging because we are endeavouring to bring together many services that have previously been fragmented and run by different organisations to different agendas. This process requires time, commitment and trust. However, our underlying objective is to bring together those services so that we can genuinely enable our frontline staff to work more effectively in teams – coming together in the best possible way to meet the changing needs of their patients.
In the future, this new way of working will be further underpinned by the new MCP contract. Currently it is only the GP who is funded on a capitation basis, incentivised to achieve a set of outcome-measures. By contrast, many specialists who also provide LTC management to patients are not contractually required to take a shared responsibility for improving outcomes and are instead paid for on an item-of-service basis. So the new contract creates the opportunity for a much wider set of services to be incorporated into the same shared capitation-based funding, properly aligned to general practice, working to the same shared outcomes.
FOR MORE INFORMATION
W: www.dudleyccg.nhs.uk
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