New, joined up models of care being developed by the NHS risk overlooking the full potential of community health services which are vital for their success, according to a discussion paper launched today by the NHS Confederation Community Health Services Forum.
Community health covers a broad range of ‘cradle to grave’ services including community and district nursing, health visiting, speech and language therapy, public health and school nursing. These services are essential if the NHS is to care well for the millions of people who have long-term conditions, the paper highlights.
Overall, community services provide at least 100 million patient contacts each year – more than four times the number of A&E attendances – and accounts for £9.75 billion of the NHS’s £102 billion budget. Much of this care is provided in people’s homes, by nurses and allied health professionals who build trust with patients and work with many other professionals to join up their care.
The paper The art of the possible – what role for community health services in reshaping care? states that community services’ focus on whole person care makes them “ideally placed” to help lead and deliver new care models. Based on the views of community services leaders, it contains practical suggestions on the role community services can play in new care models.
Suggestions in the 15-page paper include:
* Community services and primary care working even more closely, for example:
*Community health staff taking on more care planning for people with long term conditions rather than GPs being expected to do it all.
*Developing new arrangements for patients to have access to a wider range of professionals and specialist services through GP practices.
* Community services partnering with new GP federations and networks to enable them to work across much larger populations more quickly. For example, this might include putting in place processes for consistent clinical governance and accountability across a much larger and more complex set of services than those in a single GP practice, and sharing management and administrative functions such as finance, HR and IT.
* Community providers and GP practices combining their knowledge of local community and voluntary sector organisations and networks to develop new approaches to local health and wellbeing issues.
* Joint initiatives between community services and care homes, for example offering ‘intermediate care’ within a care home so that residents suffering an acute episode of illness can avoid hospital admission.
* Using community services to their full potential to ensure health and care systems, and smaller hospitals, are viable – including delivering more care in community settings and rotating more staff across acute and community settings.
The paper concludes by highlighting two key risks that may prevent community services’ potential from being realised. Firstly, knowledge and understanding of community health services’ potential remains variable. Secondly, longstanding policy barriers have yet to be resolved. These include a need for better ways to measure and pay for community services and a strategy to overcome workforce shortages.
NHS Confederation Community Health Services Forum Chair Matthew Winn said: “We need truly joined-up, community-based models of care if we are to meet the demands of a 21st century health and care service.
“Community services and primary care are natural partners. We could create a stronger and more sustainable community-based offer for patients if we build on the strengths that each possess. Bringing together the two parts of the NHS that see and support the entire population at different points of people’s lives would be incredibly powerful.
“Everyone involved in developing new care models – commissioners and providers – will need to take a strategic approach to maximising the expertise, innovation and resources in community health services and release the possibilities of working in an integrated way with general practice.
“To create new care models we must not start with organisational structures but instead use the views and insights of patients and the public, and engage community health care and general practice staff, to design a new future.”