Professor Andrew Walton, Executive Chair of Connect Health, looks at what lessons can be learned from community healthcare when implementing the NHS Long Term Plan ambitions to deliver more patient centred care.
“Bringing care closer to home” so that patients can access high quality services in their local communities has long been an objective of successive Governments. However too often when the NHS needs to make efficiencies, community health services are the first place to be hit – despite some of the most innovative, outcomes focussed, and cost-effective care being delivered in this sector.
As the NHS embarks on implementing its long-term plan, it would therefore be wise to learn some lessons from community healthcare which could benefit the wider healthcare system.
At Connect Health, the largest independent provider of Integrated community MSK (musculoskeletal) services (including orthopaedics, pain and rheumatology) in the UK, serving over 300k NHS patients every year, the basis of our approach is to simply start by asking what the problem is, and from there we can start developing solutions and look how the services should be delivered, rather than simply trying to shoehorn patients into an existing model of care.
Data is key to this. Working with CCGs, RightCare is a key enabler, helping identify local areas which have a high proportion of activity being directed to the orthopaedic departments (research has shown that in some cases around 30% of people who go to see an orthopaedic surgeon, do not actually end up having surgery). It is then possible to analyse this data to look at both high and low performing areas and whether there are any links between their community MSK provision performance upstream.
And putting this theory into practice has significant results – working with Nottingham West and Nottingham North & East CCG for example, in the first year of Connect delivery of their MSK services, we saw a 22% reduction in elective trauma and orthopaedics referrals to secondary care with surgical conversion rates improved from 30-40% to 70%. Waiting times also significantly improved year on year from 84 days to 13 days for physio face to face appointment – something which not only saves money but also saves patients’ time.
Delivering more patient centred care also means being creative and looking outside the traditional medical model, with a core part of Connect’s work taking place, for example, in local authority-run gyms. For people with MSK conditions, we’ve found this helps reduce the medicalisation of simple problems, empowers patients to successfully self-manage and increases the uptake of gym use/membership. It improves patients’ confidence and wellbeing by breaking down the barriers for people to exercise by providing a fun, energetic environment where we can offer bespoke rehabilitation in a fully equipped gym setting – a far cry from the MSK clinics of old which were often in a small cubicle with little or no equipment.
Once we know where the best place for patients to be treated are, you then need to look at how your workforce can support them. Workforce is undoubtedly the biggest challenge the NHS faces with major shortages in key areas. However, whilst recruitment and retention are obviously vital, it’s also important to look at whether health services are utilising the staff in the most effective way. Doctors are expensive and a medical model approach is not always fit for purpose in MSK services, but too often allied health professionals (AHPs) and nurses are underutilised in terms of filling the gap. First Contact Physiotherapists can play a vital role in primary care if they are well trained, well supervised, the culture is right, and it is part of an organisation that is responsible for the community pathway – playing a key role in in responding quickly to the majority of MSK patients who simply need advice and signposting to self-management resources.
Given the challenges facing the health service, with rising demand and an ageing population, we understand the need to make spreading innovative healthcare solutions the norm. From being the first to offer self-referral in the NHS in 1999, by Easter 2019 Connect will cover a population of c5 million patients across multiple regions of England. And this expansion is no mean feat when different services are host to different working cultures and behaviours. Taking a data driven approach is therefore key. Our data warehouse now feeds back a variety of data sets to clinicians including diagnosis made, treatments and patient-rated health outcomes. This allows clinicians to benchmark against their peers with good practice disseminated throughout the organisation, helping develop a culture of consistent improvement with a relentless focus on patient outcomes.
So while the additional £20bn investment in the NHS should be welcomed, money alone is not going to transform the health service. What is clear from our experience at Connect is that you can only succeed if you start by looking the patient’s needs and build a service around them – something that is not only key in community services but should be the core principle across the health system. Delivering the right care, at the right time, in the right place is the number one priority and that can only be achieved where community, primary and acute sectors work together to deliver the most effective and seamless care.