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]