NHS East Riding of Yorkshire has piloted a model of Neighbourhood Care Teams. These are extended community teams which aim to provide multi-disciplinary, integrated and streamlined care closer to a patient’s home. They offer a comprehensive and pro-active case management service up until 11pm on weekdays and over extended hours during the weekend. The aim of the pilot is to reduce emergency admissions, support earlier discharge, increase rehabilitation provision and enabe patients to manage their conditions in their own homes.
How it works
The pilots are based on work carried out by the PCT in response to the Department of Health’s 2006 white paper Our Health, Our Care, Our Say, and its Community Services Strategy promoting care closer to home.
Reducing pressure on acute services by providing support in the community is a central feature of the PCT’s Commissioning Strategy for Community Services, Health strategy and QIPP plan. Under the pilots, additional investment has been made to provide extended community nursing teams and therapy support. Two pilots have been running - one since December 2008 in Bridlington and the second in Goole, Howdenshire and West Wolds since July 2009.
Led by community matrons and therapy staff, the teams focus on patients with long term conditions, providing an enhanced level of care up until 11pm on weekdays and for extended hours at weekends.
The teams have close links with local authority social services and share boundaries with social services care management teams, enabling them to provide joined up care. The teams are also aligned to local GP practices and work closely with primary care. They are also supported by more specialist teams who work across the patch such as the respiratory team and specialist therapists.
They help people needing assistance outside normal working hours to avoid being admitted to hospital by providing a rapid response and pro-active case management service.
In the past, community nurses would have offered core services between 9am and 5pm, along with a more restricted evening crisis management service.
The teams also provide rehabilitation services, enabling patients to be discharged from hospital earlier. Setting up the teams has enabled the PCT to boost capacity in rehabilitation services beyond that which it was able to offer in its community hospitals.
What the pilot has achieved
An analysis of the Bridlington pilot carried out over a period of 8 months resulted in a reduction of 256 acute spells, 159 GP appointments, and 247 accident and emergency attendances. This generated a saving of £589,000.
NHS East Riding of Yorkshire is now in the process of rolling out Neighbourhood Care Teams across its patch.
Further information
If you would like further information on this case study, please contact Elizabeth Wade, Head of Commissioning Policy and Membership at elizabeth.wade@nhsconfed.org.