Aligning primary and community care: Bromley Healthcare

Background

Bromley Healthcare is a community interest company providing a wide range of community health care services to people in Bromley, Bexley, Greenwich and Lewisham.  This includes health visiting, district nursing and school nursing, as well as therapy services for adults and children including speech and language therapy, physiotherapy and occupational therapy. The care provided reaches hundreds of thousands of lives each year and spans an entire lifetime, empowering people to start well, live well, and age well. It was established in 2011 and employs approximately 1,300 members of staff.

Bromley Healthcare is a partner organisation within the South East London Integrated Care System (SEL ICS), and a member of the One Bromley Local Care Partnership. A key priority within the ICS is to focus on primary care and people with long-term conditions. Bromley Healthcare is working closely with primary care in Bromley to build and strengthen joined-up, integrated care, ensuring that people, including those with continuing health needs, can conveniently access high-quality primary and community care services.

Bromley Healthcare’s approach to primary and community integration

Seven years ago, Bromley Healthcare decided to switch to EMIS software to align its system with primary care, and therefore support data sharing between community and primary care partners. The aim was to create a joined-up view of the primary and community support an individual was receiving at any one time, and the costs associated with delivering these services.

To develop this further, Bromley Healthcare has now implemented a full data-sharing agreement with 42 GPs across Bromley. This agreement has been in place since 2018. Getting to this point has taken time and required open and honest conversations about some of the challenges, as well as the clear benefits of shared data between primary care and community partners.

At the same time, Bromley Healthcare set up a care coordination centre to bring together all administration for community services in the area into one physical location. The work of the care coordination centre is currently divided into approximately ten pods, covering a range of services:

• The urgent community response teams accept referrals from 111 and London Ambulance service directly, including rapid response, rapid access therapy team (RATT), falls pick up and GP out of hours. 
• The SPA (Single Point of Access) One Bromley collaboration, hosted by Bromley Healthcare, which provides supported discharge. Referrals are received from acute hospitals discharging patients into Bromley community health, social and third sector services.

One Bromley services are implementing further neighbourhood team working, to bring services together so they can work closely and focus on the needs of people living in very local areas.  This will enable the delivery of more coordinated and proactive services based on very local needs, to help people stay well, reduce demand on health and care services and help communities to become more resilient.  The aim is to re-organise the current pods to mirror and therefore support the neighbourhood team footprints.

Bromley Healthcare is also carrying out some early work with primary care networks in diabetes and podiatry services to look at patient need and identify any gaps in provision. This will inform who is best placed to provide these services to individuals to avoid the risk of duplication.

Key barriers and enablers

It is clear that developing trusted relationships is key to greater integration between community and primary care services. In the early days of developing the shared data agreement, Bromley Healthcare spent a lot of time working with GPs in the area who were supportive of data sharing. During this time, the medical director at Bromley Healthcare was a GP, therefore understood the sector and was well placed to collaborate with primary care colleagues to drive forward integration.

The One Bromley Local Care Partnership has a good track record of working collaboratively and delivering joined-up care.  Although Bromley Healthcare has worked hard to gain buy-in from community and primary care colleagues to enable greater integration, there remain a number of barriers to more joined-up working. For example, the big suppliers of NHS data and digital software cannot always be flexible to local needs. For Bromley Healthcare, the ambition is for neighbourhood teams to have a single (filterable ¹ ) version of EMIS with both community and primary data contained in one system. Currently, although there are data-sharing agreements to allow both organisations to view patient data, they still operate on separate systems. National support is therefore needed to encourage suppliers to explore ways to improve access to data-sharing systems.

Benefits for staff, patients and system flow

Bromley Healthcare has already seen some key benefits from greater integration with primary care and other system partners. One benefit being a 35 per cent reduction in calls regarding podiatry following the co-location of administrative services into one place as part of the care coordination centre. They realised that having a better, and more joined-up understanding of a person’s needs reduced the need for patients to call. The same members of staff talk about and to the same patients and families, supporting a holistic view of the patient and their care.

Looking to the future

Bromley Healthcare is keen to build a business case for community services and the opportunities they provide for staff and patients. It is currently providing the community element of the One Bromley Hospital at Home service for children and young people and wants to develop an evidence pack with data to support the impact these services are having.

While key strategic policies emphasise the importance of delivery at neighbourhood level, there needs to be a shift in the way services are funded to make this a reality. Community services must be further supported by national policy and funding to produce real-time data to raise the profile of the work they are doing and the positive impact it has on staff, patients, system flow and reducing pressure on other key services.

Ultimately, Bromley Healthcare, along with many other community providers, wants to get to a place where it can quantify the savings and benefits to patients being made by delivering community services in and integrated way with primary care. This requires a serious discussion and conscious decisions about where funding and resource is allocated in order to keep people healthy in the community.