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How our CCG reduced the rate of older people going to A&E by 60%

How our CCG reduced the rate of older people going to A&E by 60%

Medway Clinical Commissioning Group (CCG) saw an opportunity to reduce the number of older people going into Accident and Emergency (A&E) by doing more prevention and implementing a series of schemes.
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Medway Clinical Commissioning Group (CCG) saw an opportunity to reduce the number of older people going into Accident and Emergency (A&E) by doing more prevention and implementing a series of schemes.

The problem

The problem with the current hospital model is the longer patients are in hospital the less likely they are to go back home because they lose a lot of muscle function and end up going into care home or staying with their family.

This model is very expensive and it’s not what people want. They want to stay independent for as long as possible. We needed to find a way of changing services by intervening at a much earlier stage.

The solution

We agreed that if we wanted to find a solution, we had to work together.

With the acute, mental health and community trusts, local authorities and people from the voluntary sector, we developed the Medway model.

We got together a team, called the Medway and SwaleCentre for Organisation of Effectiveness (MSCOE), who helped us to think about how we could make changes and what patients we should target.

We decided to focus on frail people and tried to intervene before these individuals had an accident or became unwell, by using data and evidence.

Through the Proactive Assessment Clinics for the Elderly (PACE) model we identified 400 patients in 2016 and invited them to come to an assessment with a geriatrician. We’re able to look at their needs, including medication. Often, patients have medication that might not be right for them and can cause them to feel dizzy and fall over.

Sometimes we also find individuals that didn’t have all the health and social care services they needed.

We worked with the fire services, that often go and set people’s fire alarms.Now, when they go out, they’re also doing assessments of people’s homes about things that might hurt them or make them fall over, such as changing light bulbs.

We tasked a company to identify how long people stay in hospital to try to understand what’s not working well when they’re staying longer than they should.

We now have most of our GPs on the same EMIS web system, which records patients’ information. Patients can now see another GP in a different practice who will be able to look at their information, which allows more flexibility.

We implemented an app, six months ago, which reminds people of their GP appointment and allows them to cancel it if they don’t need it anymore.

We’ve now started employing key navigators who are individuals helping people find their way through the healthcare system.

As we found that many people come to practices as a result of social isolation, we started a new scheme called Involving Medway and created a programme called Medway Time Credits to encourage people volunteering in activities in their local communities.

The results

We’ve reduced the rate for highest-risk patients going into hospital by 60%, as well as saving time and money.

Thanks to our GP app, we got an extra 800 appointments a month in our system.

The challenges

As with any care systems, there are limits on the finances available.

We’re trying to shift money from the acute sector hospitals into prevention exercise classes or geriatric consultations. That’s a quite difficult thing to do because the hospital clearly starts to give people assessments of these activities and you have to make that change into more prevention.

Another challenge is that some of the care homes in Medway have a very high level of admitting people into the acute hospital. We’ve been doing some work with these on the reasons why those people are admitted and we recognised that there could be a change, if we provided more support for the people walking in care homes.

We also realised that if patients go into hospital from a care home, communication between the two isn’t always great. We have addressed that challenge by fitting in something from January 2018 called Red Bag Scheme.

The scheme means that when a person goes into hospital, they have a medication passport, which contains information about them and all their needs. So the hospital can clearly say what they’ve done and what is required for the patients.

Overall, access to general practice is difficult and there aren’t always available GPs.

The future

General practice is changing a lot. In the future, GPs will become more of consultants. They’ll see the most complex patients and act as a second opinion for other people in the practice. We’re using that precious GP’s expertise in a different way.

We’re looking at new apps for people with chronic obstructive pulmonary disease (COPD) and diabetes. There’s a lot of technology we can use and we need to roll that out and support people to feel comfortable using that new technology.

We need to find more innovative ways of reducing social isolation and improving prevention if we’re to help people maximise their health and reduce their needs to use care services.

Caroline Selkirk is the accountable officer of Medway CCG

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