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A Long Term Plan for joined up care

by in Funding, News

The big talking point of the last week has undoubtedly been the publication of the latest NHS Long Term Plan.

The 136-page, 10-year plan sets out how a £20.5bn annual budget increase promised last year will be spent. A number of key areas are in line for a funding boost including the digitisation of care delivery, better access to mental health services and, crucially, the ramping up of community health services. Indeed, spending on out-of-hospital care through primary medical and community health services will be £4.5bn higher in five years’ time. Older people – understandably a focal point for the NHS – will be supported through more personalised care and stronger community and primary care services.

The plan, in typical wordy government organisation fashion (yet still lacking in real detail), states that the £4.5bn of new investment will ‘fund expanded community multidisciplinary teams aligned with new primary care networks based on neighbouring GP practices that work together typically covering 30-50,000 people’.

As part of a set of multi-year contract changes, individual practices in a local area will enter into a network contract, as an extension of their current contract, and have a designated single fund through which all network resources will flow. Most CCGs have local contracts for enhanced services and these will normally be added to the network contract. Expanded neighbourhood teams will comprise a range of staff such as GPs, pharmacists, district nurses, community geriatricians, dementia workers and AHPs such as physiotherapists and podiatrists/chiropodists. Importantly, the Plan specifies that those organisations above will be joined by social care and the voluntary sector.

Safer through collaboration

The £4.5bn investment – which the Plan states is a guaranteed minimum – should perhaps come as no surprise given the large volume of time and resources put into three years of testing alternative integrated care ‘Vanguards’ and Integrated Care Systems in the Five Year Forward View. NHS leaders say they now know enough to commit to a series of community service redesigns everywhere. The Vanguards received less than one tenth of one percent of NHS funding, but made a positive impact on emergency admissions, and demonstrated the benefits of proactively identifying, assessing and supporting patients at higher risk to help them stay independent for longer.

Indeed, the NHS made the statement last year that New local health and care partnerships save lives and accordingly took measures to reduce unnecessary patient tests and improve working between hospitals and GPs and social care. In a nutshell, they gave health and care staff better and faster access to vital information about the person in their care, so they could determine the right action as quickly as possible.

Dr Simon Eccles, chief clinical information officer for Health and Care, said: “Sharing information for people’s individual care can be lifesaving by quickly providing staff with the details they need, from patient histories to previous test results and care plans.

“The public already assume their GP Practice and hospital can see their records. Through Local Health and Care Records we will start to make this possible.”

In recent years a number of small scale projects, created by local organisations, have done this successfully. In many cases this is supporting integrated health and social care teams who are working together. Collaborations include:

  • In Rotherham patients are leaving hospital faster. Community nurses know when their patients have been admitted to hospital so they can start conversations earlier about what needs to happen so patients can be ready to go home.
  • In Dorset care for elderly patients is a smoother and less stressful experience. A 96-year-old with a number of long-term medical conditions is reassured that if they are taken ill, or fall over the emergency services will already understand their conditions and not need them to repeat the information.
  • In Leeds GPs benefit from a window into the hospital. They can see when their patients have appointments, which patients are in hospital and view letters and results that may not yet have arrived at the practice.

Beyond barriers

Another successful project that NHS bosses no doubt had an eye on when it came to drawing up the Long Term Plan was the CQC ‘Beyond Barriers’ initiative. This looked at how services are working together to support and care for people aged 65 and over.

The project looked at how hospitals, community health services, GP practices, care homes and homecare agencies work together to provide seamless care for people aged 65 and over living in a local area.

One of those areas was Staffordshire, where it was found that older people had varied experiences of health and social care services.

“There were variations in what was available to them depending on where they lived, which meant that people’s experiences of care and the support they received were inconsistent,” a CQC spokesperson told us. “While there was a shared vision from leadership in the county’s Sustainability and Transformation Partnership (STP), this did not transfer to those at an operational level.

“In addition, our review found many examples of good practice, but also highlighted a number of areas where improvements are needed to ensure those responsible for providing health and social care services work better together. Some of these areas had already been recognised by the system’s leaders and plans were already being developed, or were in place, to ensure those improvements took place.”

Some of the key findings made by the CQC in Staffordshire were:

  • There were local variations in what was available to people and consequently experiences of care and support were inconsistent.
  • There were instances of people attending A&E because they couldn’t get GP appointments and A&E attendance for people over 65 living in care homes (January to March 2018) were higher than both national and comparator areas.
  • A&E experiences were much improved at Royal Stoke Hospital.
  • Person centered services for people with Dementia were very positively received.
  • Although there had been recent improvements, people were still more likely to be delayed coming out from hospital. There were examples of people who experienced avoidable harm due to delays in their discharge from hospital.
  • People still had a limited choice in respect of care homes rated good.
  • There were good relationships between senior leaders in the Staffordshire and Stoke Sustainability and Transformation Partnership (STP) and, importantly, there was good political support from the County Council for the STP.

This review makes a number of suggestions of areas where the local system should focus on to secure improvement including:

  • Though there was a clear vision and strong leadership at a senior level services delivered remained fragmented and dependent on the area of Staffordshire people lived in. A whole county joint commissioning strategy needs to be further developed so there is consistency of provision throughout Staffordshire.
  • The Health and Wellbeing Strategy for 2018- 23 should be completely inclusive and refer to how all people, including those of different faiths, beliefs, gender, sexuality, or with physical and/or learning disabilities, will be included in the development of services.
  • A whole county dementia strategy needs to be developed to ensure the needs of people with dementia are consistently supported across Staffordshire
  • The system needs to develop a strategy to ensure services are developed with input from the people who will use them.
  • Nationally validated models of GP support for care homes need to be rolled out more quickly to ensure they are ready for winter.
  • People living in Staffordshire must have equal access to services; such as the intravenous antibiotics administered in their own home and falls prevention services.
  • A system-wide approach is needed to find better solutions to manage patient discharge; such as the virtual ward, meaning people have a full range of services available to them by clinical professionals form home.
  • eLearning from serious incidents and complaints should be shared across the system.

The above is just a small snapshot of one small, local service. It’s important, however, because the NHS looks all set to drive joined-up, integrated, local care delivery – and GP practices will most likely be the hub around which systems will be built. What those integrated models will look like, who knows?

What do you think of the Long Term Plan’s push towards integrated care delivery? Are you involved in any local systems? What works and what doesn’t from your perspective? Let us know by commenting below or head to the Practice Index forum here.


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