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How a notional patient in Sweden is making a tangible difference in Somerset | Dr Ian Wyer

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As part of NHS England's new care models programme, South Somerset has been working with care model experts in Sweden to share and adapt good practice. Dr Ian Wyer, complex care lead for the South Somerset Symphony Programme, one of the country’s 50 vanguards, explains how Somerset is developing new models of care after hearing about the success of Jönköping’s Esther model.

Sharing best practice with international partners 

Earlier this year, as part of the new care models leadership support programme, I was given the opportunity to visit the town of Jönköping in Sweden, where healthcare practitioners are implementing a different approach to integrated care. 

Last week, our Swedish colleagues – ward manager, Linda Jansson and medical officer nurse, Anna Carlbom – were in the UK for the Adapting International Care Models Conference and visited South Somerset to see how the Symphony Programme is developing its own new models of care.

What’s best for Esther?

The Jönköping model is based on the creation of ‘Esther’ – a notional patient with a number of complex health needs. Staff take a new approach by asking “what’s best for Esther?” and asking “what could be done better?” at every stage of her care, involving all care providers from day one.

The Esther Network was created in 1997 and has two main goals:

  • smoother and safer care pathways for Esther
  • better use of the provider’s resources.
The story of Esther, a fictitious person based on a typical patient, mirrors much of the work taking place within the Symphony Programme and the vision of providing a patient-led, integrated care approach which results in the ‘right care’ at the ‘right time.’ 

The Esther model is less about structural changes and more about ingraining a culture of quality improvement with a seamless network of care around the patient. Consistent, clear communication between primary and secondary care organisations is crucial, as well as an understanding of the importance that each stage of healthcare can play. 

Esther cafes

Continuous review and improvement is a large part of the Esther approach, bringing the system to Esther and asking real ‘Esthers’ to talk about their experiences of care at cafe-table-style events. Tables have a mix of hospital, primary care and community care teams, so that lessons can be learned about what went well and what could be improved for future patients.

All teams involved in the model drive a culture of improvement by continually looking at what’s ‘best for Esther’. Understanding what’s best impresses the need to think as part of a network and not as standalone healthcare organisations.

Adopting lessons in Somerset

As programme lead for complex care within the Symphony Programme, I fully believe that we are already leading the way in developing new models of integrated care and bringing together primary and secondary care.

The development of our Enhanced Primary Care Programme enables patients to access a greater range of specialist healthcare at an earlier stage and in the community, away from the hospital environment. Health coaches support patients – proactively contacting them, helping them better manage their own health, and helping to coordinate services around them.

In our complex care hubs, specialist healthcare teams, including keyworkers and ‘extensivist’ doctors work closely with patients to help them better understand their health conditions, treatment options and next steps.

Ongoing training for both teams will enable them to develop skills in supporting patients, building close relationships of trust and help them to better understand and cope with their health conditions. 

In June we will hold our first ‘Esther Cafe’ and will look at how our new models are working so far for our patients, asking our own ‘Esthers’ what we can do better.

Dr Ian Wyer is the lead for complex care for the South Somerset Symphony Vanguard Programme board, a GP and programme director for the Dorset GP Vocational Training Scheme. Follow the South Somerset Symphony Programme on Twitter @symphonyproj

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