Working together: creating a new model of community-centred care in care homes

An increasing number of older people will spend their lives in residential care, but over half of older people in care homes do not have access to all the services and support they need from the NHS.

This project aimed to address these issues through a new model of ‘community-centred care’. The work brought together primary care teams, care home staff and volunteer ‘health champions’ to create extended care teams in three residential care settings in North Tyneside.

These volunteer health champions (people from the local community) gave their time to work alongside staff in the care homes to make life better for staff, families and residents. They offered a range of support including conversation, stimulating activities such as singing, reminiscing and games, and support for residents and staff at mealtimes.

The project team also developed prototypes around the practice’s prescribing system and the district nursing support. GPs have since noticed more streamlined connections between practice and care home staff in relation to the repeat prescription system, which results in fewer unnecessary visits to the care homes, and better outcomes for residents in relation to prescribing.

Upskilling of care home staff to undertake basic observations and wound care is helping to reduce the need for visits by GPs or nurses. Feedback from care home staff and residents’ family members has described how champions make a tangible difference to life in the homes.

The recruitment of an enthusiastic group of health champions has been key to the success of the project, as well as building and sustaining strong relationships between practice staff and care home managers and staff.

Other GP practices and pharmacies have shown an interested in the initiative, as well as another local authority commissioner.

Contact information

For more information about this project, please contact Helena Hughes, Head of Operations, Altogether Better.