Key points

  • The Improvement Analytics Unit (IAU) has evaluated the early impact of two complementary integrated care team initiatives developed in the Fylde Coast NHS vanguard, the Extensive Care Service (ECS) and Enhanced Primary Care (EPC), aimed at adults with complex chronic care needs.  

  • The analysis has found that ECS and EPC patients were admitted to hospital in an emergency respectively 27% and 42% more often compared with their matched control group. Similar trends have been also found across other measures of hospitalisation.   

  • However, due to observable differences remaining between these groups, the study could not conclude that this was a direct causal effect of the new initiatives.   

  • Our analysis suggests that at least in the short term emergency hospital use may increase. As more multidisciplinary teams are established across England, further research is needed to understand why they are not having the anticipated effect on emergency hospital use. 

In this briefing, the Improvement Analytics Unit – a partnership between the Health Foundation and NHS England and NHS Improvement – has found evidence that multidisciplinary teams (MDTs) may increase emergency hospital activity at least in the short term.    

The IAU has evaluated two integrated team initiatives developed in the Fylde Coast NHS vanguard: the Extensive Care Service (ECS) and Enhanced Primary Care (EPC). Both use risk stratification to help identify adults with complex chronic care needs who are at risk of hospitalisation. 

For each initiative, the IAU has carefully selected a matched control group that included individuals with similar characteristics in the local area who had not been referred for the service.  

The analysis has found that neither model of care reduced hospital activity during the period analysed, but it could not conclude that the higher levels of activity were a direct causal effect of ECS or EPC.

This study has limitations. Even after using robust statistical methods, observable differences remained between intervention and matched control groups. Importantly, matched control patients were slightly less ill than the intervention patients.   

The findings are consistent with previous studies and experience of integrated care teams in the UK and in other developed health care settings. Implementation of such services may require a longer time period to reduce population-wide admissions and attendances, as unmet medical need is initially identified and treated among high risk patients by MDT professionals.   

The IAU is currently undertaking new analysis to explore the effectiveness of community MDTs, particularly within specific patient groups and across intervention settings. To find out more, read this statistical analysis protocol

You can also read more detail about the methods used in this report in the accompanying statistical analysis protocol.

Cite this publication

Vestesson E, Shen J, Pariza P, Wolters A. The impact of Extensive Care Service and Enhanced Primary Care in Fylde Coast. 2020. (

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