Since its inception in March 2015, the Principia vanguard has worked towards ensuring there’s a joined up, integrated approach to delivering health and social care to a population of over 120,000 residents

A vision of improved service delivery

Our vision is to provide better quality care for the people of Rushcliffe through improving patient pathways across organisational boundaries, reducing duplications in the system and by doing this, improving both efficiency and patient care. We want to improve our community’s health outcomes and increase the satisfaction of staff and clinicians, as well as moderate costs.

As a multi-specialty community provider, Principia is a partnership between PartnersHealth (the organisation representing Rushcliffe GP Practices) and Nottinghamshire Healthcare NHS Foundation Trust working together with Rushcliffe Clinical Commissioning Group (CCG), and others. So it is not always easy to get us all around a table!

Working across so many organisations to deliver ambitious improvements requires a detailed workplan. Ours is made up of 47 different improvement projects across seven thematic areas. The projects include everything from improving medicines management, to health promotion, to better support for patients at risk of admission, including people with mental health conditions.

Reducing A&E attendance by providing better support in care homes

The Enhanced Support in Care Homes project was rolled out to 23 care homes in order to ensure residents received more consistent levels of support, and to enable residents to have greater involvement in decision making.

Our enhanced care package ensured all residents had regular visits from a named GP and, in the early phases, independent support from Age UK Nottingham and Nottinghamshire. We also ensured there was greater support for care home managers and community nurses, for example through a peer-to-peer network.

Setting up the project involved changes to ways of working – for example, we established a service specification with GPs to set out expectations and the allocated time they were to attend each home. Although there were initial challenges, the changes made to the service specification ensured all GPs were signed up to and were compensated for their additional responsibilities. More recently we have also put in place an electronic medicines management system, which has reduced wastage and improved safety by reducing the incidence of missed doses.

An evaluation of our Enhanced Care in Care Homes project was conducted by the Improvement Analytics Unit (IAU) – an innovative partnership between the Health Foundation and NHS England – and published earlier this year. The evaluation found that Principia care home residents attended A&E 29% less frequently than similar care home residents in other parts of the country. They were also admitted to hospital as an emergency 23% less often. The report concluded that these results were most likely the result of higher quality care for the Rushcliffe residents.

These results were very positive, and a testimony to a lot of hard work, but we still need to do more work to understand what the active ingredient was and to continue improvement further. Understanding what is at the core of a successful initiative is important for pinpointing what works and how this can be replicated elsewhere.

Following the evaluation, the IAU did further work with us to understand better the causes of potentially avoidable admissions from care homes. Subsequently, we’ve put in place new ways to improve the health and care of residents, including approaches to improve diagnosis of urinary infections and boost nutrition.

Where next?

As NHS England’s new care models programme comes to an end, we plan to evaluate all the projects we’ve undertaken as part of the vanguard and to build on our learning as we develop as part of the Greater Nottinghamshire Transformation Partnership and the Nottingham and Nottinghamshire Accountable Care System.

Our approach has been to look beyond the normal CCG commissioning model to make the most of the resources available across pathways. We’ve built up strong relationships with our partners and we’ve worked hard to understand our patient pathways and to identify any gaps that can be addressed by others in the partnership.

Going forward, our biggest challenge and opportunity will be to build on the successes of the vanguard so far. We want to identify what has worked well within the vanguard programme and to build and grow our relationships with new and existing partners.

Together we’ll be working to develop new ways to commission and deliver high quality care for people in Rushcliffe.

Nicole Bacon (@BaconNicole) is Development Manager and Programme Lead at the Principia vanguard

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