Last month I visited the Fylde Coast in Lancashire, home to the well-known seaside town of Blackpool and the neighbouring, more rural districts of Fylde and Wyre.
Here, partners across the local healthcare system are testing out new ways to support patients with one or more long-term conditions by providing better coordinated care closer to home.
The aim is to produce better patient outcomes and to support the overall health and wellbeing of local people. These new models of care, including the work of the vanguards, will be key to the delivery of local sustainability and transformation plans.
During my visit I met representatives from vanguard partners including Blackpool CCG, Blackpool Council, Fylde and Wyre CCG and Lancashire County Council.
They are particularly concerned with improving outcomes for two key groups within their shared population: people living in Blackpool who face significant deprivation and very poor life expectancy, and older people living in the surrounding countryside, many of whom have multiple long-term conditions.
The Fylde Coast vision is to develop healthcare that ‘wraps around’ the patient, delivering more support closer to people’s homes and resulting in less time spent in hospital.
This includes a new ‘extensivist care’ service, creating a single point of access for older patients with multiple conditions, who typically see several different health professionals such as nurses, care coordinators, therapists and wellbeing support workers.
Extensivist care will be complemented by ‘enhanced primary care’ – neighbourhood care teams who work alongside local GPs to empower patients to self-care by learning more about their condition and how they can stay well for longer.
This new model has the potential to deliver a number of significant benefits for patients:
- Helping patients to feel more empowered with support to better manage their conditions and stay healthy
- Relieving pressure on the health system through better coordination and fewer unnecessary hospital admissions
- Improving patient experience as a result of coordinated, streamlined care through a single point of access and agreed shared electronic care records
Successes, learnings and challenges
I was encouraged to see how the partnership is approaching change with the emphasis on place, people and making neighbourhoods the building blocks of these new models to deliver care.
Importantly, different services and providers are planning, spending and acting together in the interests of improving health and wellbeing, where the default for care and support is home-based and not in hospital.
There have been challenges: the region bears significant levels of deprivation and an existing GP vacancy rate of as much as one in five, with a further 20% of the GP workforce due to retire in the next five years.
Yet despite this there are many successes to be proud of. The Extensivist care model is now being rolled out across the entire Fylde Coast, with every GP practice across the area able to refer eligible patients to this new support.
At first, fewer referrals were received than expected, with feedback from primary care colleagues that they found the referral criteria too rigid. As a result, these criteria are now more flexible.
Early indications of their figures already show a 13% reduction in A&E attendances, a 25% reduction in non-elective admissions and an 18% reduction in out-patient appointments.
Most notably though has been the 37% fall in planned visits to hospital among patients receiving support from extensive care, well exceeding expectations. The model has also recruited more than 80 full time-equivalent staff across a variety of roles.
The Fylde Coast new model of care should enable greater capacity for GPs to help them better manage and support patients with more complex needs, enable greater adherence to best practice and improve outcomes.
More than 12 months’ worth of impact data has been collected and this will help the partnership to target these new services more effectively, particularly as it now begins the phased roll out of the enhanced primary care service.
The partnership is committed to sharing learning from the development and implementation of this new model as they continue their journey, and I am sure this will prove useful to other areas looking to make changes to the way they provide care.
By working together across local government and the NHS we will move forward in delivering our shared vision for a sustainable future health service. This is public health in action.