Health Service Focus

Transforming health and care: the Dorset story

Phil Richardson, Dorset STP lead director, explains why primary and community care are at the heart of the area’s transformation efforts.

As one of the recently announced accountable care systems, Dorset STP is fortunate to have a working partnership arrangement involving all health and local authority organisations that provide services in the county. Partnership working started prior to 2014 with the focus on the Better Care Fund. Acknowledging the increasing pressures on quality, safety and workforce, the CCG initiated and funded a Clinical Services Review (CSR) to cover all services and providers across acute and community settings. Whilst focused on health, it also included the interface with social care. 

The CSR took a clinically-led, population need, evidence-based approach. Mixed clinical teams developed the models of care working in groups of between 100-150 clinicians. At least a third were GPs. The work was developed further in monthly cycles by individual organisations and specialist clinical groups. Parallel work was carried out by a selected public, patient and carer group (PPEG) that was representative of our diversity, demography and geography. This was further augmented by regular engagement with the public, a Supporting Strong Voices forum (bringing together over 150 organisations) and GP practice visits by the senior team. At the same time, we launched comprehensive reviews of both the acute care pathway for mental health and dementia services. 

Governance was in two parts: decision-making at governing body level for Dorset and West Hampshire CCGs, and the leadership for design and planning delivered through five key reference groups. These groups comprised chief executives; chairs and council leaders; operations and finance; clinical; and digital. Each group was chaired by Dorset CCG. 

Agreeing the models of care – with a clear focus on delivery closer to home and including best practice, such as adopting the Keogh review – became more challenging when developing the settings of care. Significant effort went into planning for the acute settings, where we adopted a one acute network view, and in the community, where detailed design work was done in each CCG locality. With hindsight, the community work could have been started earlier. A significant amount of senior horsepower was absorbed in reconfiguration and capital planning. 

Like many other systems grappling with the challenges of delivering safe, high-quality and sustainable services where there are significant workforce pressures, Dorset’s proposed design includes community-based hubs centred around community hospital sites. Our primary care strategy, a key component of the integrated community work, has identified the need for practice settings working at scale in our 13 localities and the likely need for at least one super practice.  

Pioneering work in Weymouth in the west of the county has seen the initiation of a successful community urgent care centre and a community hub delivering improved care. Both of these were GP-driven and supported by working in close partnership with the NHS community services provider trust. A new community hub in Christchurch in east Dorset, led by Royal Bournemouth & Christchurch Hospitals NHS FT, pioneers the inclusion of care home beds. Poole Hospital, which currently hosts the cancer centre for Dorset, is building an outreach radiotherapy bunker in Dorset County Hospital in Dorchester. Dorset County Hospital is itself a key driver of accountable care communities and Dorset HealthCare, the community trust for the county, is working hard to bring serious mental ill health out of the acute setting into the community front rooms and retreats. The lines between primary, community and secondary care have blurred through real leadership and true partnership. 

The core of our system plan focuses on three key areas: one acute network, integrated primary care and community care, and prevention at scale. It is the digital and new way of working designs that will truly transform the system. Creating a paradigm shift in design thinking will make a significant contribution to the patient experience, the staff experience and the clinical outcomes. For digital, instead of thinking about creating a major emergency and hospital, we need to create a digitally-enabled hospital that delivers the major emergency services. So much more than including IT, it is a transformation in the way we would work. It is what happens after interoperability, shared care records and joined-up, cyber secure systems have been implemented. Imagine an intelligent built environment that senses and responds to the needs of patients, staff and visitors. In Dorset, experiments are already underway looking at home-based virtual reality for self-monitoring cognitive function, and gamification, through app development, to reinforce positive prevention in children. 

Digital opens up the opportunity for the Dorset system to do things differently. Current work spans a range of key enablers such as Arbinger as a method to build stronger relationships; the creation of a health and care learning system with a medical school; integrated research at scale; a primary care workforce centre; innovation as business as usual; and working with the expert help in the voluntary sector. 

GP-driven innovation in COPD, MSK and eye health, coupled with embedding collaboration standards using ISO 44001, are all in the current mix. The Dorset story, with primary and community care at the heart of the transformation, will be different.

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