The West Cheshire health system and local patients are set to benefit from a radically new model of care that will be piloted locally.
GPs have come together to form an umbrella organisation called Primary Care Cheshire, and they are among only 29 vanguard sites selected nationally to trail blaze the development of a ‘Multi-Speciality Community Provider’ as set out in Five Year Forward View for NHS England.
A Multi-Speciality Community Provider permits groups of GPs to combine with nurses, other community health services, hospital specialists and mental health and social care to create integrated care in the most appropriate place or setting. The Countess of Chester Hospital NHS Foundation Trust in partnership with West Cheshire Clinical Commissioning Group, Cheshire and Wirral Partnership NHS Foundation Trust is backing the bid which has been recognised for its innovation.
The proposal for West Cheshire builds on work and learning to date within a cluster of GP practices that have switched their scheduling of home visits to frail elderly patients from late afternoon to early morning. This approach has enabled the GPs to send poorly patients to hospital sooner for investigations and a faster turnaround. It increases the likelihood of getting patients home safely by the end of the day with wrap-around care packages in place, instead of them needing to be admitted to hospital unnecessarily because of it being late at night.
As part of a competitive bidding process involving 269 applications, lead GP for Primary Care Cheshire Jonathan Gregson recounted the impact of the changes he was seeing for his patients to a panel of assessors in London. He talked from the heart about how he has seen a small multi-disciplinary community team and strengthened links with hospital clinicians making a difference in supporting falls patient Deirdre staying well at home and helping cancer patient Geoff die in the company of his wife at the end of his life. You can see the presentation here: https://www.youtube.com/watch?v=0zVQOyHxQuU&list=PL9gq4FCbIiJWh7Mg2G3SEPeeMV83CWQJs&index=12
Reflecting on the news that the West Cheshire GPs had been successful in their bid, Dr Jonathan Gregson said: “I believe that what we presented was authentic. Patient care usually falls down at interfaces or points at which the person is passed from hospital back to the GP or vice versa. This is an opportunity to focus our efforts on building personal relationships between small community teams that have easy links to hospital clinicians.
“I want us to take time to stop and think about each other more as individuals – not as faceless organisations that communicate only by letter or email. Within the last year we’ve already seen a step change in how GPs are working with community geriatricians at The Countess and the conversations we now have regularly have prompted much learning on both parts. We don’t yet know how our ‘vanguard’ vision will work in reality but the principles of healthcare professionals knowing each other, trusting each other and sharing the risk to apply common sense and do the right thing for our patients is straightforward.”
Clinical director for urgent care at The Countess of Chester Hospital Dr Frank Joseph said: “We know that people are living longer, many with multiple complex long term conditions – and the reality is that it is getting more and more difficult to manage the pressures this places on frontline hospital services as they are currently designed. When we admit elderly and frail patients to hospital for lengthy periods of time, they risk losing their independence and are susceptible to infection. We cannot carry on delivering healthcare services in this way. The development of a Multispecialty Community Provider presents a real and exciting opportunity to do something different, and we will do everything we can to support Jonathan and other clinical colleagues in primary and community care to make this work.”
The changes and new models of care will build on work to date that the hospital has been developing in the following areas:
• The establishment of a summary integrated healthcare record to support improved communication between hospital clinicians, GPs, community services and social care.
• The introduction of an ambulatory care unit at the Chester site that is providing faster access to rapid clinical assessment, diagnostic services and treatment planning for patients who do not need to be admitted to hospital.
• Increased use of an early supported hospital discharge team looking after up to 100 patients in the community on a daily basis with nursing and therapy input, this is of particular benefit for patients with respiratory conditions that worsen during the cold weather.
• The opening of a new Centre for Healthy Ageing at Ellesmere Port Hospital that is running daily ‘drop in’ support for older, frail patients as part of a partnership with the voluntary sector Age UK.
• The development of a Centre for Integrated Healthcare Science in partnership with Chester University to support research, innovation and training in service improvement methodology.