Surrey County Council: enhancing care in care homes

In 2014 East Surrey CCG embarked on a project to improve the medical care of residents of nursing and residential homes. This example of a local initiative forms part of our managing transfers of care resource.


Within care homes, out-of-hours support would routinely send individuals to hospital, often with a lack of available information with regards to a plan of care. The key aim was enhancing the level of care to all residents of care homes based on a proactive and preventative approach to care, using personal planning and reducing the variation in care experienced across care homes.

Phase 1:

  • nurse advisors for care homes – First Community Health and Care (Community Provider)
  • redesign of the locally commissioned service to facilitate work of GPs in care homes
  • improving links with pharmacy
  • developing a new ambulance pathway.

Phase 2 (current) aims to

  • introduce anticipatory care records secondary care, ambulatory care, frailty unit, integrated reablement unit and emergency department.
  • increase pharmacy support to regularly review more care home patients – 1,800 patients – with average length of stay of approximately 20 months
  • promote access to community services, ambulatory care and frailty unit
  • appoint a dietician to complement the provision of medicine management.

Evaluation

Quality of care:

  • patient centeredness – one GP seeing all patients in one home was viewed by care home staff as providing good patient care
  • polypharmacy – 592 residents were reviewed leading to 861 medicines stopped, contributing to a reduction in waste.

Acute activity

The project has led to a fall in acute activity:

  • latest data shows average reduction of 51 per cent for both A&E admissions and A&E attendances equating to £253,417 saving compared with 2016/17
  • emergency admissions to hospital of patients from all care homes fell by 7.3 per cent in 2016/17 (949) compared to 2015/16 (1,024)
  • by having care plans in place, ambulance crews have reduced the number of patients being transferred to A&E as an emergency; they now ‘see and treat’.

Contact

Andre Lotz

Project Manager, Health & Care Integration

Surrey County Council

[email protected]