The new NHS: a model for integrated, out-of-hospital care

28 May 2018

As the NHS approaches its 70th anniversary there is an increasing sense of urgency around the need for transformation. Financial pressures, workforce numbers, low morale, fragmentation of services and a social care in crisis indicate that we have a duty to transform and shape a modern NHS to be the best system in the world.

Four years ago, the Five Year Forward View – a visionary document setting out the challenge, but skilfully avoiding a top-down approach to solutions – marked the start of a transformation journey for many of us. In Dorset, we took an inclusive, clinically-led approach to a whole system clinical services review across acute, community and primary care. This, with the inclusion of the local authority and public health bodies, underpinned the Sustainability and Transformation Plan as we moved into the formation of a new Integrated Care System.

Before we can think about reducing the flows into acute care, and better support overstretched hospitals, we need to fundamentally transform community care and develop an integrated support offer. This should maintain and grow high quality, safe, responsive care by collaborative multidisciplinary teams of community and primary care across physical and mental health who understand the needs of their local populations. This means agreement as a system to support a resource flow into the community and primary sector. It also means developing new relationships with the local authorities and a renewed approach to preventative care.

General practice is the bedrock of the NHS. Without it the NHS fails. This foundation needs strengthening with investment and security, allowing an agile and innovative response to develop alongside community teams.

Bringing together health and care to work to common goals and outcomes requires a sustained approach to organisational development, development of trusting relationships and motivating the workforce to develop new skills within these new teams. Continuity of care should be maintained as a core feature.

Population health analytics, enabling both a strategic view on health cost and outcomes and a view on specific population needs at practice level, is a key enabler to identifying where resources are needed and where transformation can take place and be measured.

Technology advances can accelerate joined-up care. Digital reform is core and central to change, and should not be regarded as an “add-on.” An integrated care record is fundamental for each system.

Out-of-hospital care can be transformed at pace by giving teams permission to help shape services locally. This will enable them to find the right solutions for local communities with the Primary Care Home model, which should be the fundamental building block upon which the rest of the system can be built.

One size doesn’t fit all, and a fundamental change to allowing an organic bottom-up approach reaps rewards for the system and the local area.

Where we see the best examples, the workforce stabilises, the outcomes improve for patients and the joy of work comes back into the lives of the amazing staff who sustain the NHS.

Dr Karen Kirkham, NHS GP and Assistant Clinical Chair, Dorset Clinical Commissioning Group

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