The development sites teams at East Lancashire and North-west Surrey explain the importance of building good working relationships in sustainable service improvement projects.
Improving care for frail, elderly patients
The team at East Lancashire Hospitals NHS Trust aims to deliver better quality and more effective services for frail and older patients. The solution to that aim is the Integrated Neighbourhood Teams (INTs).
The INTs identify high-risk frail and elderly patients who require more support. The team then tailors a plan for that person which will prevent that person spending longer in hospital than is needed.
Good working relationships with community services are essential for the success of this work and the team is making great progress to this end. Most recently the project has focused on the frailest of the frail – improving care for people in the last 12 months of life – and preventative medicine.
East Lancashire: key learning
The East Lancashire team have been working with the Future Hospital Programme for nearly 2 years. In that time they have learned a great deal:
- Creating the right environment for patients is a priority.
- Good communication across care settings is fundamental to good advanced care planning.
- Building relationships across the community is complicated, it takes time and involves a lot of people.
- It is important to embed common language/tools for consistency across the services.
- Be pragmatic and have the resilience to keep going.
- This work is part of a trust-wide ‘Together a healthier future’ programme, therefore part of the normal business of working with other organisations and linking with other projects.
- When measuring patient experience, it’s important to get a narrative rather than just a score, as this is where you can learn about the detail (especially when things are not as good as they could be).
- Getting responses from the carer rather than patient, where appropriate, is something the team is still working towards.
Joined-up, person centred services
In North-west Surry, the Bedser Hub team is establishing a general practice (GP)-led, fully integrated, person-centred service for frail, older patients. All locality general practices and their services are operating in a network supported by diagnostics, pharmacy and transport.
Due to delays with capital funding, only one hub is up and running so far: The Bedser Hub. The Hub is situated within a community hospital in Woking, and supports older people to stay well at home for as long as possible. Clinically-led by a GP (the medical director), it uses integrated IT systems and allows multidisciplinary teams of professionals to be co-located.
Working with primary care
To develop the hub model, the team established three Locality Network Boards with representatives from all 42 GP practices in the area, and admin and programme management support from the CCG. Each board has its own chair, a key role as an ambassador for the project.
Initially there was cynicism from some GPs who felt that the funding should go directly to their practices instead. They questioned whether the hub could offer any improvement to what they were already offering locally. The chair worked closely with the medical director and this proved to be an important factor for getting positive messages out to grassroots GPs.
North-west Surrey: key learning
Hub GPs work on a sessional basis, delivering care and building up relationships with the home GP and operating the hub. Key learning so far includes:
- The importance of good leadership skills in the GP medical directors.
- Good communication is necessary for success.
- Getting understanding and buy-in from local GPs takes time, but in North West Surrey over 90% of GPs asked now think it is a great service.
- Patients like this model of care – their feedback has been great.
- GP involvement at every level has helped with engagement. Involving practice managers has helped too.
- Shared IT records can help get people involved (the Bedser Hub is not completely integrated yet – they can see GP records on screen but can’t yet add to them).
This blog series is inspired by the presentations/conversations captured at a meeting of all eight development site teams in September 2016.