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1 – 10 of 330A new model of multidisciplinary team working with health and social care is being developed in Exeter. This article describes how inclusion of a domiciliary pharmacist in the…
Abstract
A new model of multidisciplinary team working with health and social care is being developed in Exeter. This article describes how inclusion of a domiciliary pharmacist in the team has improved medicines management for patients with long‐term conditions and for adult patients identified as needing support with their medicines. Initial results are discussed, case studies are described and future developments for the service are outlined.
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Steven Wyatt, Robin Miller, Peter Spilsbury and Mohammed Amin Mohammed
In 2011, community nursing services were reorganised in England in response to a national policy initiative, but little is known about the impact of these changes. A total of…
Abstract
Purpose
In 2011, community nursing services were reorganised in England in response to a national policy initiative, but little is known about the impact of these changes. A total of three dominant approaches emerged: (1) integration of community nursing services with an acute hospital provider, (2) integration with a mental health provider and (3) the establishment of a stand-alone organisation, i.e. without structural integration. The authors explored how these approaches influenced the trends in emergency hospital admissions and bed day use for older people.
Design/methodology/approach
The methodology was a longitudinal ecological study using panel data over a ten-year period from April 2006 to March 2016. This study’s outcome measures were (1) emergency hospital admissions and (2) emergency hospital bed use, for people aged 65+ years in 140 primary care trusts (PCTs) in England.
Findings
The authors found no statistically significant difference in the post-intervention trend in emergency hospital admissions between those PCTS that integrated community nursing services with an acute care provider and those integrated with a mental health provider (IRR 0.999, 95% CI 0.986–1.013) or those that did not structurally integrate services (IRR 0.996, 95% CI 0.982–1.010). The authors similarly found no difference in the trends for emergency hospital bed use.
Research limitations/implications
PCTs were abolished in 2011 and replaced by clinical commissioning groups in 2013, but the functions remain.
Practical implications
The authors found no evidence that any one structural approach to the integration of community nursing services was superior in terms of reducing emergency hospital use in older people.
Originality/value
As far as the authors are aware, previous studies have not examined the impact of alternative approaches to integrating community nursing services on healthcare use.
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This article demonstrates how the role of the community matron has developed in Cornwall over the past three years, and how this role can be understood as the lynchpin of an…
Abstract
This article demonstrates how the role of the community matron has developed in Cornwall over the past three years, and how this role can be understood as the lynchpin of an integrated approach to the care and management of patients with complex needs and multiple long‐term conditions. In recent years there has been growing recognition that current models of care delivery would be likely to struggle to meet the future demands of an ageing population. Cornwall's approach is to build on the introduction of the community matron service, and to support a new model of care delivery which will encompass use of assistive technology as an additional tool to support those with long‐term conditions. The article will demonstrate the current effectiveness of the service in terms of savings for the health and social care community, and presents a case study to show how integrated working can be used to facilitate improved outcomes for patients.
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Juliana Thompson, Sue Tiplady, Phil Hodgson and Carole Proud
This study aims to scope the profile and application of an advanced clinical practitioner (ACP) roles in primary care in the North of England and how these roles meet the…
Abstract
Purpose
This study aims to scope the profile and application of an advanced clinical practitioner (ACP) roles in primary care in the North of England and how these roles meet the requirements of Health Education England's (HEE’s) ACP workforce capability framework.
Design/methodology/approach
A two-stage design was used. Stage 1 analysed health and social care workforce intelligence reports to inform scoping of numbers of ACPs working in primary care. Stage 2 used two surveys. Survey 1 targeted ACP leads and collected strategic-level data about ACP application. Survey 2 targeted staff who perceived themselves to be working as ACPs. Survey 2 was in three parts. Part 1 collected demographic data. Part 2 required participants to record their perceived competence against each of the HEE ACP framework capability criteria. Part 3 required respondents to identify facilitators and barriers to ACP practice.
Findings
Despite the introduction of HEE's ACP capability framework, there is inconsistency and confusion about the ACP role. The results indicated a need for standardisation of role definition and educational and practice requirements. The results also suggested that some ACPs are not working to their full potential, while some staff who are employed as “gap-fillers” to provide routine clinical services perceive themselves as ACPs despite not working at the ACP level.
Originality/value
Although previous research has explored the application of ACP practice in primary care, few studies have considered ACP application in the light of the introduction of workforce capability frameworks aimed at standardising ACP practice.
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Patrick Keating, Angela Sealy, Linda Dempsey and Beverley Slater
Against a background of an ageing population, rising emergency admissions and a policy direction moving towards providing care in the least intensive setting, this paper presents…
Abstract
Against a background of an ageing population, rising emergency admissions and a policy direction moving towards providing care in the least intensive setting, this paper presents the dramatic results achieved in a 22‐week pilot of undivided health and social care replicating the Castlefields study and using Unique Care principles. In the context of practice‐based commissioning, where GP practices develop and commission services that represent the best model of care and use of resources for their patients, the potential for creating savings from this approach are discussed.
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Amy Blakemore and Clare Baguley
The current focus on psychological well‐being and the treatment of people experiencing common mental disorder in primary care is of interest to health professionals and economists…
Abstract
The current focus on psychological well‐being and the treatment of people experiencing common mental disorder in primary care is of interest to health professionals and economists alike (Centre for Economic Performance Mental Health Policy Group, 2006). This brings with it an important opportunity to consider how services for people living with long term medical conditions may benefit from developments in widening access to psychological therapies. The National Service Framework for Longterm Conditions (DoH, 2005a) aims to improve the quality of life for people living with chronic medical conditions. Further to this, NICE Guidelines for the Management of Chronic Obstructive Pulmonary Disease (COPD) (NICE, 2004a) specifically focuses attention on quality of life issues for COPD sufferers and the influence of co‐morbid mental disorder on the ability of individuals to optimise selfmanagement of their condition. By examining issues relating to co‐morbidity of common mental disorders within the long‐term condition of COPD this paper concerns itself with how the agenda for widening access to psychological therapies delivered through a stepped model of care and the introduction of new mental health workforce roles such as community matrons, case managers and primary care graduate mental health workers (PCGMHWs) provides an opportunity for primary care services to integrate mental health care into chronic disease management for COPD, which in turn may provide a model for the development of services for other long‐term medical conditions.
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Key to successfully addressing the ongoing transitions being experienced in the care home sector is a transformation of the workforce. This is required in order to respond…
Abstract
Key to successfully addressing the ongoing transitions being experienced in the care home sector is a transformation of the workforce. This is required in order to respond appropriately to the increasing dependency of older people moving into care homes. This article considers the policy framework surrounding the provision of care services in England and reviews the relevant research into the workforce and the changes needed if the sector is to meet the needs of vulnerable older people living in care homes. Building on present policy and practice, consideration is given to how this change could be achieved.
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David Lyon, Julia Miller and Kirsty Pine
This article presents and reviews the evidence from a pilot project in the North of England in which a social worker was based in a surgery and worked proactively with a district…
Abstract
This article presents and reviews the evidence from a pilot project in the North of England in which a social worker was based in a surgery and worked proactively with a district nurse to introduce an integrated case management approach for patients in the practice. Decision‐making was noticeably simplified and speeded up, with most assessments completed in a single day. The authors recommend that PCTs should consider the benefits of social care input to case management, especially when planning new services and new roles such as that of community matron.
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Sally Jacobs, Jane Hughes, David Challis, Karen Stewart and Kate Weiner
Care management has developed in a variety of forms. This diary study explores differences in the approach taken to care management in three distinct social service settings…
Abstract
Care management has developed in a variety of forms. This diary study explores differences in the approach taken to care management in three distinct social service settings: community‐based older people's teams, hospital social work teams also for older people and community‐based teams for adults with mental health problems. Conclusions are drawn both for social care and for health services developing case management for people with long‐term conditions.
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There is a strong tradition of integration in rural community hospitals which has been largely unrecognised in the past. The national strategy for health in England now gives…
Abstract
There is a strong tradition of integration in rural community hospitals which has been largely unrecognised in the past. The national strategy for health in England now gives community hospitals a central role in providing integrated health and social care, in a policy referred to as ‘care closer to home’. The evidence emerging from international and national studies is demonstrating the benefit of the community hospital model of care. Public support for community hospitals over their 100‐year history has been strong, with value being placed on accessibility, quality and continuity. There is, however, a tension between the national policy and the current financial pressures to close or reduce services in one in three community hospitals in England. Innovative ways of owning and managing these services are being put forward by communities who are actively seeking to maintain and develop their local hospitals. The challenge is to demonstrate that community hospital services are valued models of person‐centred integrated care, and to demonstrate their contribution to the health and well‐being of their communities.
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