The visit, hosted by the North East Hampshire and Farnham Clinical Commissioning Group, is part of a series of vanguard visits organised by NHS Providers, the NHS Confederation, Local Government Association and NHS Clinical Commissioners to share learning from successful vanguard projects.
There is no place like home. When recovering from treatment or managing a long-term health condition, home is ultimately where most people want to be and they often have better health outcomes as a result. The desire to support people to remain or return home underpins the way services work together to deliver care in North East Hampshire and Farnham’s ‘Happy, Healthy, at Home’ vanguard. The vanguard’s focus is on supporting people to manage their own health and care wherever possible. This is achieved by supporting people earlier and improving the way they access care when they need it. By joining up services effectively, the vanguard is improving patient experience as well as tackling some of the pressures faced by local services.
The desire to support people to remain or return home underpins the way services work together to deliver care in North East Hampshire and Farnham’s ‘Happy, Healthy, at Home’ vanguard.
North East Hampshire and Farnham’s ‘Happy, Healthy at Home’ vanguard brings together the local authority, NHS trusts, voluntary organisations and the clinical commissioning group. The programme has developed from the area’s five year blueprint, which identified a £150m health and social care funding gap. The three year vanguard programme is creating care solutions based on the needs of the community, by engaging with the public through a network of more than 80 local ambassadors and by working with primary and secondary care providers. Improving patients’ journeys through the health and care system has had a big impact on emergency admissions, patient satisfaction and the working environment for teams in primary care, community care – including paramedics and pharmacists - and hospital teams.
Integrated Care centre
As part of a recent visit to encourage learning from successful vanguards, health and care leaders were taken to Farnham Integrated Care centre to see how triaging and carousel clinics have helped to reduce accident and emergency admissions and increased the time that GPs can spend with patients. The triaging has allowed 30% of urgent appointments to be transferred from local practices to the integrated care centre, where an initial assessment of urgent appointment requests is carried out by a trained member of staff. Up to 40% of patients who request urgent appointments can be supported over the phone, while the remainder are triaged into morning or afternoon appointments at the centre. Patient notes from each of the local practices can be accessed centrally, ensuring that patients do not need to repeat their story.
The integrated care centre also hosts adult social care team, district nurses, mental health practitioners and the voluntary sector, , which helps to improve the way that care in the community is integrated and focused on the person and how best to provide their care. The centres have helped to reduce referrals to hospital services by between 10% - 20%, easing pressure on local GP services and freeing up hospital beds; which is particularly important as we head into the busy winter period.
The centres have helped to reduce referrals to hospital services by between 10% - 20%, easing pressure on local GP services and freeing up hospital beds; which is particularly important as we head into the busy winter period.
Home visits by paramedics are also co-ordinated from the centre. This also reduces pressure on local GPs, while using the skills of highly trained paramedics who are used to treating people outside of a clinical setting. Paramedics welcome a different way of working whilst still being able to use their life-changing skills.
Harnessing technology has been a key factor in the vanguard’s success. They are using ‘E-consult’, an online platform through which patients can have virtual consultations with clinicians at the practice. This is improving patients’ access to out of hours services. Patients who seek appointments through E-consult are guaranteed a response by the end of the next working day. The team have found that 60% of patients accessing e-consult do not need to then attend a practice, and the online consultations mean patients can access care more flexibly and conveniently.
The team have found that 60% of patients accessing e-consult do not need to then attend a practice, and the online consultations mean patients can access care more flexibly and conveniently.
As part of the vanguard programme, Surrey & Borders Partnership NHS Foundation Trust is working with the voluntary sector to provide mental health support to the local area. The Safe Haven scheme has supported over 500,000 people since its inception and its success has resulted in its funding being mainstreamed into the area’s commissioning budget. Within months, acute psychiatric admissions fell by a third, and A&E admissions plateaued. Safe Haven, which has now opened a service for children and young adults, is an example of partnership working between a provider, local authority and the voluntary sector in order to reduce pressure and improve access to local services.
These initiatives form part of a broad package made possible through the vanguard programme, and broader innovative working within the North East Hampshire and Farnham health and care system. They have led to improvements in both patient outcomes and satisfaction, and helped to reduce pressure on local services. GP referrals, routine hospital and emergency admissions have all fallen in the lifetime of the programme. Local commissioners feel as if they are heading into winter in a better position than in previous years. And patients can be more confident that they will receive high quality care which supports them to stay well and manage their needs at home.
Find out about further visits here.
Register for our New Care Models: What we can learn and the journey to accountable care event in Birmingham on 31 January 2018.