Ealing’s integrated care journey: learning from international models | Dr Serena Foo

Hands writing

As part of NHS England's new care models programme, vanguards and integrated care pioneers have been working with international care model experts to share and adapt good practice. 

Dr Serena Foo, GP partner and member of Ealing CCG governing body, reflects on what they have learnt from the Alzira model in Spain and how they shared this with colleagues at the Adapting International Care Models Conference earlier this month.

Sometimes when one is on a journey where the path is not straight, paved with challenges, and obscured with various obstacles, it helps to look back at how far we have come and what difficulties we have already overcome, as well as to keep looking forward with an eye on the destination. It also helps to be encouraged by those who have walked a similar path and seen success.

Ealing’s integrated care model is on such a journey. During the last year, we have had the opportunity to learn from the successes of care models outside the UK. In particular, Ribera Salud and the Alzira model have shown us what is possible and inspired us to face similar challenges.  

In 2012, Neha Unadkat, now deputy managing director, led the development of the Integrated Care Programme. I was privileged to be one of the first multidisciplinary group (MDG) chairs trying to galvanise a group of GPs and allied health professionals to work with each other and see the value in doing so.

Four years later, the MDGs want to meet, consultants and GPs are discussing cases by phone and on email and avoiding unnecessary referrals, and we have a set of ‘out-of-hospital services’ provided by primary care, which allows different practices to refer to each other. 

We also have Home Ward, a consortium led by West London Mental Health Trust, providing intermediate care for physical health problems, to treat people at home, avoid unnecessary hospital attendances and admissions, as well supported discharges for all adult patients who may benefit. They are showing how different providers are able to work under the same umbrella to achieve a common outcome.

Over the years, we have seen providers in Ealing embrace the opportunity to work in networks, share knowledge, skills, and now even resources. While both Neha and I have taken on additional roles within the CCG, we are still passionate about progressing towards a truly integrated model of care in Ealing.

We were inspired by the success of Ribera Salud and, as part of the new care models leadership support programme, have developed a strong relationship with them. After 16 years, they have an integrated model that provides care that is seamless, has good patient outcomes, and satisfied staff with good morale. 

A key enabler is an IT system that encompasses all providers, and even offers a portal for patients to take charge of some aspects of their own healthcare. It provides real-time data for admissions, discharges, and risk stratification. 

Furthermore, they seem to understand how to bring all the key components of a healthcare system together and did not focus on one at the expense of another. They ensure that attention is paid to clinical management, people management and a fully integrated information technology system. They focus on clinical outcomes and incentivise the teams to achieve them.

Over the last six months, we have been sharing our reflections and learning with colleagues in Ealing. The Adapting International Care Models Conference held on 12 May gave us an opportunity to share them with a wider audience, and also to hear about what other CCGs were doing around the country, as well as other European models. 

Now we need to keep taking steps forward. However, we continue to struggle with the challenges of culture change, developing incentives to work differently, a complicated funding system and multiple IT systems.

Following their attendance at the conference, we were fortunate enough to host Alberto de Rosa, chief executive, and Santiago Delgado, deputy chief executive from Ribera Salud, who visited Ealing to help us explore these challenges. 

On 13 May, Ealing CCG held a workshop with our Spanish guests and invited key strategic personnel from local providers. The aim was to use the expertise in the room to see whether we could find a way over the obstacles we saw, in particular those around culture change. 

First our guests learnt about Ealing’s integrated care journey, including the challenges and successes. This was followed by discussions about the new road ahead.

It was useful to have an outside viewpoint. We were encouraged about our evolving model and the steps the IT team is making to integrate the various systems. 

The following were key take-home messages:

  • Remember that this is about people.
  • Active listening is important – find consensus and agreement.
  • Define a plan.
  • Develop leadership.
  • Allow new changes to embed.
Ealing CCG will now continue on its journey of integrated care with its partners. While I think some debris has been cleared away and we can see the path ahead, the culture change cannot be forced. We need to encourage those who share our vision to work together and inspire others to come with us. 

We are grateful to the new care models programme for their ongoing support with this work and for providing forums where we can continue to learn from each other. We also thank Ribera Salud for their input and we look forward to other opportunities to learn from them.

Ealing CCG is part of the North West London Integrated Care Pioneer. Follow them on Twitter @NWL_integration

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