Acute care in the community

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

Key resources

NHS England – Integrated primary and acute care systems vanguard sites announced March 2015 (with links to the home project pages)

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.

Monitor 

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

Kings Fund – follow updates to the Library database using the subject term search on “service relocation”or “care closer to home“.


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.

Care closer to home: Narrative report, RCP 2012 – Literature review on ‘Care closer to home’ conducted on studies between 2000 and 2009

Evidence Submission: Care Closer to Home (Lancet UK Policy Matters 2011) The Department of Health funded Care Closer to Home demonstration sites, together with a national evaluation, conducted by a team at the University of Manchester The report concluded that the policy should not be rolled out more widely without consideration of implementation, costs, quality and training.

Specialist outreach clinics in primary care and rural hospital settings. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD003798. DOI: 10.1002/14651858.CD003798.pub2.


Searching the literature

Much of the literature around moving care closer to home is in the grey literature rather than journals.

Search terms

  • (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

Audiology

Transferring ENT/audiology services into a community setting – (Health Foundation SHINE project)

Cancer

Ambulatory Cancer haematological service (Health Foundation SHINE project)

Frail elderly 

Interface Geriatrics 

Interface Geriatricians – Leeds

Other case studies: 

Dermatology

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.

Diabetes

Work on Diabetes Integrated care is ongoing as part of the RCP Future Hospitals programme.

Take a look at Diabetes UK Integrated carehttps://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

Mental health

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.

Ophthalmology/Vision

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)

Respiratory

Integrated respiratory services: Hospitals without walls


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