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Should we do more with integrated care?

Should we do more with integrated care?The integration of health and social care has been the goal of many successive governments – and it’s to see why. The desire to achieve service improvement, a holistic approach, better use of resources and meeting the needs of a changing demographic are compelling reasons for tying together care delivery.

Despite the fact that integration makes sense, most practice managers would agree that delivery of services is still fragmented. All too often GP services are not connected up with hospital services. Community services are not joined up with social care. We have separate processes, separate budgets and separate ways of working. This leads to missed opportunities to intervene early to support somebody to lead a healthier and more independent life.

However, the wheels are in motion to change this, with a commitment that all health and social care provision should be integrated by 2020. This is supported by initiatives such as Paperless 2020, NHS England’s Five Year Forward View and the Sustainability and Transformation Plans (STPs), launched in 2016 and covering 44 footprint areas across the whole of England.

This week, plans received a further boost with the news that a specialist GP has been appointed to help spread NHS innovations which integrate health and social care throughout England. Dr Karen Kirkham, who runs a practice in Dorset and specialises in women’s health, will work with the wider GP community to spread tried and tested innovation and transformation techniques across the country.

Dr Kirkham has been instrumental in setting up the trailblazing Dorset Integrated Care System where a new approach to integration of care for patients, bringing together staff from local hospitals, community staff, general practice and the local authorities is starting to pull the local health system together.

Successful initiatives

One of the successful initiatives introduced in Dorset is the ‘virtual ward’ concept, which has led to a reduction in unplanned admissions to Dorset County Hospital, the lowest rate of the three acute Trusts in the county and this same approach is starting to be seen across the county. Doctors, nurses, social care staff, physios and others in West Dorset discuss patients who are put on a rolling ‘virtual’ list each week, if thought to be at risk of hospital admission.

Elsewhere, NHS patients struggling with debt and benefits are being given urgent assistance thanks to special hotlines installed in GP surgeries. Health chiefs in Manchester last month installed dedicated phone lines in half of the city’s surgeries, which put patients straight through to Citizens Advice workers. The move, which was piloted in 2016, is designed to help those whose visit to a doctor is linked to other social issues that could be impacting on their wellbeing. More than 80 percent of patients who have used the service said these issues had impacted their health. Half of the calls have been found to relate to problems with benefits.

Research by Citizens Advice found that eight out of 10 GPs felt they had too little time to focus on clinical care during appointments as patients were asking them to help with writing debt plans or filling in benefits forms.

Dr Umar Tahir, a GP at the Manchester Medical surgery in Moss Side, said: “As doctors we know there is no separation between what’s going on in people’s lives and how that can affect their mental and physical health. ”All too often, anxiety-related conditions are caused by or exacerbated by the need for practical help for concerns related to benefits or other worries. Practical advice combined with medical care is a more holistic approach for patients and their families.”

Holistic approach Patients who need extra support at one of the 33 participating surgeries are told by the HP about the hotline so they can use it after their consultation. GPs can also refer patients directly to Citizens Advice for confidential help. The project funded by Manchester Health and Care Commissioning – a partnership between Manchester City Council and NHS Manchester Clinical Commissioning Group – covers each of the 12 neighbourhoods in the city.

Further examples of integrated care can be found on the NHS England website here.

Welcome support through partnerships

The good news for under pressure GP practices is that integrated care brings together various different organisations who can provide help, support and, in some cases, funding.

Southend-on-Sea Borough Council is a good example – it is seeking to drive forward technology-led initiatives that transform the way health and social care is delivered. It is seeking to exploit ‘Technology-Enabled Care’, which it hopes will deliver better outcomes for end-users and boost efficiency around health and social economy.

The aim is to make health and social care services work together to provide better support at home, which revolves around using technology to help people with long-term conditions and/or disabilities to administer their own care. In turn, this should ease the much-publicised pressures on GP surgeries and hospitals.

At this stage the council has started an engagement process to discuss with suppliers how technology can be used to deliver enhanced care, with four key aims:

  1. Reduce numbers of GP visits caused by ‘loneliness and social isolation’
  2. Cut A&E admissions from ‘underlying long-term conditions’
  3. Enable sufferers of long-term conditions – particularly respiratory problems – to self-manage their care regime – intervention of professionals will be triggered by automatic alerts
  4. Find technology that helps older people live independently for longer.

The council is also working with the local Southend CCG and South Essex Homes to roll out a pilot where a residential independent living facility is turned into what it is calling a ‘Living Laboratory’. Within the lab various assistive technology will be used ‘to address the issues of loneliness, self-management of long-term condition, and falls’.

Meanwhile, this video from NHS England illustrates the example of Wealden District Council and Herstmonceux GP John Simmons working together to secure a health and wellbeing coach based at the GP surgery. The difference with other schemes is that patients are referred directly to the coach for one to one support and follow up.

It’s initiatives like those above that Dr Kirkham will spread the message about in her new role as National Clinical Advisor for Primary Care with the NHS England transformation team. She will visit places and learn about their innovations and take them to other areas, encouraging health professionals to adapt or ‘lift and shift’ the successful models and spread good practice. Given the fact that health and social care have very similar challenges but continue to remain fragmented, that can only be a good thing for practices and patients alike.

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