Your latest news from encompass MCP.
Building future models of integrated health and social care, for better patient outcomes
View from our Chair – Dr John Ribchester
“Our Encompass MCP Vanguard has now been in existence for 2 years. A lot of that time has been spent developing the various initiatives which are beginning to improve clinical and social care for our population. I’d like to tell you about two significant steps which have been taken recently, and will increase the pace of change.
Firstly, the Encompass core partners have unanimously and collectively taken the decision to form the Encompass Alliance. This means that the GP practices, Canterbury and Coastal CCG, EKHUFT, KCHFT, KMPT and KCC have agreed to work collaboratively on our new care model for community health and care. An Encompass Strategic Alliance Leadership Team and Operational Management Team have been set up.
Secondly, the Encompass GP practices have voted unanimously to form a GP Partnership. The purpose of this is to sustain and develop our GP practices, working together at scale in newly developed local care systems to improve clinical quality and outcomes for our patients.
Thus Encompass is moving from a time of development to one of more rapid delivery. There is much change ahead of us. The real test will be how this feels different for our population, and our colleagues.
I feel optimistic that these two exciting developments will make this difference.”
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Community Hub operating Centres (CHOCs) save nearly 200 acute admissions so far
All five of our of Community Hub Operating Centres (CHOCs) are now up and running and regular meetings are taking place in each area:
Canterbury South – Bridge/ NDR / University Medical Practice
Ash and Sandwich
Canterbury North – Canterbury Health Centre/Northgate Medical Practice/Sturry (went live 21 March 2017)
We are now seeing over 700 patients through the CHOCs and this is increasing each week. So far this approach has resulted in 188 planned hospital admissions avoided and over 2017/2018 we expect to save £1.125m from fewer admissions.
We created a short film to explain the multi-disciplinary team process. We focus on Valerie a 92 year old lady who had stopped leaving the house and was confused about the care she was receiving. Watch it here
We are now planning the next steps of CHOC development which is to look at bringing them into physical locations rather than being virtual teams.
Aligning our work with the wider transformation in health and social care
The Kent and Medway sustainability and transformation plan (STP) sets out how local health and care organisations want to work better together to:
help people lead healthier and longer lives
address variation in the quality of care and how easily people can access services
and ensure the NHS makes better use of the money available.
The care model piloted by Encompass over the past two years continues to inform the broader Local Care strand of the STP, through initiatives such as; integrated and multi-disciplinary teams, social prescribing, prevention, and Home First. Over the coming few months, we will work with partner organisations and stakeholders to identify the detailed specifications for the physical locations from which we will deliver our multi-disciplinary model of care.
Sharing information and creating one patient record
One of the key projects for Encompass and for the health and care system across East Kent is the ability to share data. Sharing data helps reduce duplication for all parties and gives a better patient experience. Patient confidentiality and data security remains an absolute priority.
The MIG (Medical Interoperability Gateway) is currently being implemented across East Kent, with providers such as EKHUFT, KCHFT, KMPT, Pilgrims Hospices and Out of Hours already viewing the GP Record as well as viewing care plans. Currently testing is underway to provide the ability for GPs to view EKHUFT data with plans to extend this to other providers.
This wider access to the patient record will reduce duplication and save time for the patient.
GPs with special interests (GPwSIs)
Encompass continues to grow out of hospital (OOH) care by supporting GPs to specialise in services that would otherwise often take place in an acute setting. Following the success of the current Ear Nose and Throat (ENT) service (in which GPs were trained to offer services previously only available in hospital), there is an extension in 2017/18.
Progress is being made on the development of more GPs with Special Interests (GPwSIs), with twelve GPs coming forward for training in dermatology, dementia, ear nose and throat (ENT), neurology, ophthalmology, respiratory, cardiology and rheumatology.
We anticipate that GPs with special interests (GPswSI) would undertake training during 2017/18 with a view to implementing the new community services in 2018/19.
Social prescribing update
Red Zebra have been attending many CHOC meetings to continue to share social prescribing knowledge.
Jenny from Red Zebra gave us her thoughts on working in the Encompass model:
“The Social Prescribing Co-ordinators have attended the CHOCs where relevant for nine months. The CHOCs are an excellent model for multidisciplinary working relationships, bringing together primary and secondary health care professionals with the charity sector, sharing information on patients who have needs that span across more than one specialism or sector.
Our role within the CHOCs is to be the voice of the voluntary sector, and it’s the co-ordinators job to know what support and services are available in the areas we work in. We feel it’s important to be ‘seen’ in these meetings as a partner in facilitating services and care to patients who are brought to the meetings. Positive social impact will have positive health outcomes.”
One lady, recently referred to Red Zebra via the CHOC meeting was Mrs S.
Mrs S has been known to a number of agencies for some time, has various long term conditions and is becoming forgetful. She recently moved into sheltered accommodation and doesn’t feel that she is coping. She is lonely and would like to get out and about more socially and make a permanent move to a care home.
Whitstable Age UK for benefits check
Faversham Age UK for Advocacy Service
Age UK Herne Bay for Day Centre Services
Red Zebra Transport service re. attending medical appointments and transport to and from Day Centre
Back to GP surgery re. continence service
Social Services re. potential move to a care home
Integrated Community Equipment Service re. a perch stool
Although Mrs S is happy with the service she has received, she may need further assistance in the future and Red Zebra, alongside the other members of themulti-disciplinary team will continue to support her to avoid her going into hospital.
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