As part of its Five year Forward View, NHS England are investing in a number of New Care Models through Vanguard sites. One of these models is integrated primary and acute care systems, joining up GP, hospital, community and mental health services.
This page brings together some of the key resources, evidence and case studies around taking acute care into the community.
See foot of page for Interface Geriatrics
- See also the Hot Topic Integrated Services page
NHS England – Integrated primary and acute care systems vanguard sites announced March 2015 (with links to the home project pages)
- Wirral Health Partners
- Mid Nottinghamshire Better Together
- South Somerset Symphony Programme
- Northumberland Accountable Care Organisation
- Salford Together
- Better Care Together (Morecambe Bay Health Community)
- North East Hampshire and Farnham
- Harrogate and Rural District Clinical Commissioning Group
- My Life a Full Life (Isle of Wight) – see presentation to NHS England Board meeting May 2015
Watch the presentation videos.
London Association of Directors of Adult Social Care (ADASS)
Resources on delayed transfers of care – Webpage with a focus on delayed transfers of care (DToCs) including key resources, such as events, important documents and examples of best practice related to DToCs.
Moving healthcare closer to home – guidance based on an examination of cases where provision of non-elective care has been moved from an acute hospital to the community. (Sept 2015)
- Literature review of clinical impacts
- Financial impacts
- Implementation considerations
- Case studies
Royal College of Physicians
Future Hospitals Programme – to implement the findings of the Future Hospitals Commission which set out the commission’s vision for hospital services structured around the needs of patients, now and in the future.
Teams without Walls – The value of medical innovation and leadership (2008)
An integrated model of care, where professionals from primary and secondary care work together in teams, across traditional health boundaries, to manage patients using care pathways designed by local clinicians. The intention of this document is to inform professions, policy makers and commissioners about the options available for moving care ‘closer to home’ and to develop the concept of ‘Teams without Walls’.
Department of Health
Transforming Services for Acute Care Closer to Home (part of Transforming Community Services). Best Practice Guidance, 2009
Keep up to date
Reviews of the evidence (by date of publication)
Outpatient services and primary care: scoping review, substudies and international comparisons. Health Serv Deliv Res 2016;4(15)
This study updates a 2006 literature review on ways of improving the effectiveness and efficiency of hospital outpatient services. A review of the current literature found that substantial areas of care traditionally given in hospitals can be transferred to primary care. For example, relocating specialists to work in the community is popular with patients, and joint working between specialists and general practitioners (GPs) can be of substantial educational value. A series of substudies investigated five areas: referral management centres, in-house review of referrals by GPs, financial incentives to reduce referrals, consultants contracted to community organisations and, last, international experiences of moving care from hospital into the community. They conclude that high-quality care in the community can be provided for many conditions and is popular with patients, but may not always be cheaper.
Integrated care for the frail and elderly: a review of the evidence by Susan Smith and John Gale (JET Library, Mid-Cheshire NHS Foundation Trust) – Evidence, case studies from acute trusts, policy background and academic research. A very comprehensive report included with permission from John Gale.
Moving healthcare closer to home – Literature review of clinical impacts from Monitor (Sept 2015)
Older People in acute settings : Benchmarking report (NHS Benchmarking Network, April 2015)
Report of the first phase of a national benchmarking project looking at older people in acute settings involving 47 trusts and health boards. Findings of the project across the four areas of the pathway : admission avoidance in A&E, assessment units, inpatient care and supported discharge. Within each area of the pathway the service models, activity, workforce and finance data is explored.
Improving Adult Rehabilitation Service in England: Sharing best practice in acute and community care (NHS IQ July 2014)
Examples of good practice in rehabilitation services and to highlight the common elements that have contributed to improved patient outcomes. It supports NHS England’s understanding of the role rehabilitation has within local and national priorities (see Appendix B), which will strengthen the alignment and positioning of rehabilitation within the whole system of transformational improvement work.
Searching the literature
Much of the literature around moving care closer to home is in the grey literature rather than journals.
- (care or healthcare) adj “closer to home”
- “integrated care” or “integrated services” possibly in conjunction with community or acute care.
Case studies by Clinical Specialty
Transferring ENT/audiology services into a community setting – (Health Foundation SHINE project)
Ambulatory Cancer haematological service (Health Foundation SHINE project)
- ECIST conference report 2012
- The role of the interface geriatrician: Medical Crises in Older people discussion paper
Interface Geriatricians – Leeds
- Leeds interface geriatrician service – Kings Fund October 2014
- A new kind of geriatrician – introducing interface geriatricians – British of Geriatric Society 2013
- Liaison Services for Older People at the “Front Door” – Leeds Teaching Hospital
Other case studies:
- Bhowmick Model – implemented in parts of Wales by Professor Bim Bhowmick, Now being trialled in Warrington
- NHS Lanarkshire
- Age Specialist Services Emergency Team
- Hospital at Home
- Hospital at home services in Scotland – links to several different services, includes tools, documents, presentations and other media
- Kent Community Health NHS Foundation Trust- Enhanced Rapid Response Service
- Guys and St Thomas’s @Home
- Cambridgeshire and Peterborough CCG – admission avoidance
- Croydon Acute Care of the Elderly Service
- Southern Trust Acute Care at Home Team
- NHS Improving Quality – Older people case studies
- Oxford Health NHS Foundation Trust
- Dartford and Gravesham NHS Trust – Hospital at home
- North London – Emergency response service brings hospital care to older people’s homes
- Whittington Health Integrated Community Ageing Team
- Scotland – Community Geriatrician
- NHS Elect – Acute frailty network
Dermatology Specialist Outreach Clinics from BAD – guidance to providers, Commissioners and Local Health Authorities on the provision of outreach clinics for dermatology services.
The British Association of Dermatologists (BAD) has produced guidance on commissioning integrated dermatology services across primary and secondary care.
Work on Diabetes Integrated care is ongoing as part of the RCP Future Hospitals programme.
Take a look at Diabetes UK Integrated care – https://www.diabetes.org.uk/Professionals/Service-improvement/Integrated-diabetes-care/
Taking diabetes services out of hospital into the community. Neha Unadkat et al. London Journal of Primary Care 2013;5:65–9
Consultation liaison in primary care for people with mental disorders (Cochrane Systematic Review September 2015) – Consultation liaison is a model of mental health care where the primary care provider maintains the central role in the delivery of mental health care with a mental health specialist providing consultative support. The review found evidence that consultation liaison improves mental health for up to three months; and satisfaction and adherence for up to 12 months in people with mental disorders, particularly those who are depressed.
Case studies about ophthalmology in primary care setting (enhanced services) from the Local Optical Committee Support Unit (LOCSU).
A commmunity-based, consultant-led one-stop-shop for carpal tunnel syndrome patients (Health Foundation SHINE project)