Celebrating two years of Vanguards – a view from Dr John Ribchester

The future NHS – a time to innovate not stagnate


It won’t be news to you to hear the NHS is under pressure. In fact it’s facing some of its biggest challenges since its inception. There was no denying this when the Five Year Forward View delivery plan was published recently. What was also clear in that plan was the inextinguishable ambition to improve patient care, along with some very honest reflections on how the NHS needs to change to meet rising demand within constraints of available resources.


Here in East Kent, while we also feel that strain from the demands of our growing and ageing population, we are also full of ambition. When under pressure it’s not always easy to find time and space for innovation and testing new ideas. But as we’ve seen over the last two years, allowing that space is crucial.


Back in 2015, 13 GP practices across Faversham, Whitstable, Canterbury, Ash and Sandwich came together under the name Encompass, to look at how to improve local services, provide more care in the community and reduce the need to go to hospital.


We became a vanguard to test new care models and ever since, we have driven forward our movement to bring together GPs, district nurses, hospital clinicians, community services, mental health professionals, Pilgrims Hospices, paramedic practitioners, Kent Adult Social Services and the voluntary sector to work as one team – helping people avoid needing hospital care and have more services on their doorstep. Changing services in this way is making better use of NHS and social care resources and helps to secure the long-term future of the local NHS.


What has been so important about the work of vanguards and finding new ways of running services, is being allowed that all important time to innovate. And in doing so we have owned our mistakes and successes, learned from them and continuously refined our model. The result? We have saved others valuable resources as we pass on all of our learning – the good and the bad – and support them to spread a model that works.


Key to our progress to date has been the mammoth effort from all of our partners. We have seen frontline clinical and professional leaders working together across different care settings, and sharing expertise across organisational boundaries. We have also worked hard to make sure patients, carers and local communities, including organisations outside the NHS like the local authority and voluntary groups – contribute to what is a shared vision for better, joined-up health and care services.


More than anything, I’m pleased to see the difference this way of working is making to the lives of local people. Take Valerie, for example, a 92 year old lady who cares full time for her husband who has dementia. She had stopped carrying out normal day-to-day tasks and needed trips to hospital after falling at home, all of which was impacting on her mental wellbeing.


She didn’t understand all the different agencies visiting her and felt understandably confused by the system and complexity of visits from GPs, social workers and other professionals.


By bringing those professionals together around the table to develop a single care plan to meet Valerie’s goals, it has transformed her life. Her care plan focused on physical, mental and social needs now she feels more confident and able to cope at home. Hear more about Valerie in this short film.


That example is part of our wider pilot of integrated case management that has seen some fantastic results. Three CHOC (Community Hub Operating Centres) sites were identified, as were around 50 patients who would benefit from an integrated approach to enhance their lives at home and avoid hospital admission.
The pilot saw an integrated team of health, social care and voluntary services meet regularly to discuss a single patient care plan, to which they all contributed and the patient owned. Meeting in this way identified many gaps that previously may have gone undetected such as social isolation and bereavement.


We now have five CHOCs up and running and over 700 patients have been discussed and had shared cared plans developed.


A few other examples of our progress, include:


Wound and catheter clinics


We have been working in partnership with Kent Community Health NHS Foundation Trust, developing specialist wound medicine centres of excellence and integrated wound care processes and procedures between community and GP practices. Using advanced computer software they are able to scan wounds and track progress on healing rates and on the use of the most appropriate dressings to apply to the wound. The hand held devices mean that an image can be taken of the wound and in the presence of the patient, which can be sent to a specialist Tissue Viability Nurse, for a second opinion if necessary.


Catheter clinics started at Faversham from April 2016, Whitstable from May 2016 and Canterbury from July 2016 and continue to see patients with community setting for catheter related issues, who would otherwise go to A&E. So far the clinics have reduced hospital visits for catheter patients by over 30%.


Introducing new digital technology initiatives to improve patient care


Our WaitLess app has been used over 55,000 times since launching at the end of 2016. The smartphone app was designed with partners across east Kent to cut waiting times at local A&E departments. The first of its kind in the UK, the app combines current wait times at all urgent care centres with real time travel information – helping people to decide which urgent care centre to head to for faster treatment for minor injuries. Results from the first three months already show a 5% shift of attendances from A&E units to minor injury units


Social prescribing
We have continued to work with Red Zebra to identify community and voluntary groups and services which local people may benefit from. Two social prescribers have now been employed, with a third being recruited, to signpost people to the right services for them. A directory of services is available at www.connectwellkent.org.uk


Talking about these in significant projects in just a few words doesn’t reflect the level of hard work and commitment involved in delivering them. There is still a lot of work to do to expand these initiatives to spread the work we have started to reach more people.


I am looking forward to maintaining our momentum. For the first time ever we are seeing a shift in the contracting of health and care services that will allow us to build on these strong foundations and continue to give patients better care and make East Kent a fulfilling place to work in healthcare.


If you’d like to know more about Encompass and our work visit www.encompass-mcp.co.uk or follow us on Twitter @encompassmcp


Dr John Ribchester

Clinical Chair – Encompass Multispecialty Community Provider


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