Teams without Walls - working together will improve patient
care
23.04.08
The success of providing care closer to home lies in developing
‘teams without walls’, according to a working party of three
medical Royal Colleges.
‘Teams without Walls’ brings together
healthcare professionals from primary and secondary care to work
across traditional health boundaries to deliver care that puts the
patient first.
The working party, made up of representatives
from the Royal College of Physicians, the Royal College of
General Practitioners and the Royal College of Paediatrics and
Child Health, suggests that jointly commissioned
integrated health services should be provided by primary and
secondary care working together.
An integrated model of care, where
multi-professional teams work in a managed network across services
and manage patients on a care pathway designed by local clinicians
is the best model for the future.
The report stresses that clinical leadership
is required if this approach to commissioning is to be successful
and says that the incentives and disincentives of Payment by
Results need to be re-balanced to bring integrated specialist and
generalist care closer to the patient’s home.
The report suggests that the Department of
Health should explore the idea of payment by pathway for an episode
of care and annual payments by condition for long-term
conditions.
Patients with long-term conditions move
between primary and secondary care at different times of their
lives and as they get older or more unwell these moves become more
frequent and complex. However, despite the need for services and
healthcare professionals to work together, the current system based
on demand management creates barriers between generalist and
specialist practitioners.
Key features of successful integrated working
identified by the report are:
· Clinical
leadership and involvement
· High-quality
partnership between clinician and professional manager
· Primary and
secondary partnerships
· Committed
commissioners willing to innovate and fund flexibly
· Clear patient
focus for a defined group
· Clear governance
arrangements
· Agreed measures
and standards to improve the quality and quantity of work.
Elements that hinder integration are:
· Clear separation
of managerial and clinical aims
· No clinical
leadership
· Targets with
unintended negative consequences
· A culture of
competition rather than collaboration
· Financial flows
that encourage efficiency without considering effectiveness
· A ‘command and
control’ ethos that does not value learning.
Dr Rodney Burnham, Registrar
of the Royal College of Physicians, said: “ ‘Teams without
Walls’ celebrates medical innovation and leadership and
shows that generalists and consultants can work together
effectively in one team with other health care professionals. These
teams are not bounded by institutions or bricks and mortar. The
care provided is high quality, sensitive and accurate along an
agreed care pathway. We believe that the Department of Health and
commissioners should encourage such medical innovation and
leadership so that patients can benefit from the best clinically
integrated care.”
Professor Steve Field,
Chairman of the Royal College of General Practitioners (RCGP),
said: “ ‘The report endorses a collaborative approach with strong
clinical leadership, centering on the delivery of high quality,
patient-centred care.
"Developing closer working relationships
between primary and secondary care clinicians – as recommended in
the RCGP Roadmap to the Future of General Practice - will enable us
to set up smoother care pathways and provide a wider range of
integrated health services. This is particularly important for
patients who move frequently between primary and secondary care,
such as those with long-term conditions and the elderly.”
Dr Simon Lenton, Vice
President for Health Services, Royal College of Paediatrics and
Child Health (RCPCH), said:
“‘Teams without
Walls’ illustrates the power of clinical
collaboration to redesign and improve the patient experience and
outcome of services. The future challenge is to align
management structures, healthcare financing systems and
commissioning strategies to promote this type of
collaboration. Patient care needs to be delivered by teams
based on pathways within managed networks, unconstrained by
traditional or organisational boundaries."
The report provides a range of examples of
where integrated care has benefited patients, including:
Gastroenterology in
Barnsley
Patients with inflammatory bowel disease were
educated and empowered to manage their condition without hospital
attendance if they were stable. The results of blood test
monitoring and advice were sent by email or text. This freed
outpatient slots, saved an estimated £40,000 a year and allowed
rapid advice for patients suffering a relapse.
Shared scheme for patients with
psoriasis in Manchester
Engagement led by a consultant, GPs, nurse
specialist and patient group led to a randomised controlled trial
of management of psoriasis in primary care. This assessed the
effect of written guidelines and education on the appropriateness
of referral to secondary care. The trial was successful and
patients are now seen by the right person in the right place at the
right time. Patient feedback has been positive, as has an audit of
the quality of care provided.
Community children’s teams for
life-threatening conditions – Lifetime Service,
Bristol
Children with complex continuing healthcare
needs often have acute exacerbations of their conditions that can
be difficult to assess and manage in primary care due to their
multiple co-morbidities. Community children’s nursing teams run
from children’s departments, proactively plan for these problems,
give telephone advice, and at the end of life provide 24/7 nursing
care.
Cardiology rapid access clinic in
County Durham
A PCT and trust funded a rapid access one-stop
diagnostic clinic to assess patients with suspected heart failure
and breathlessness. The clinic was run from the hospital with GP
referrals, by a GP with Special Interest in Cardiology, supported
by PCT-funded specialist nurses with a consultant cardiologist
available for advice. Outcomes included reduced hospital admissions
and high uptake of evidence-based heart failure therapies.
Musculoskeletal pain service in
London
Collaboration between the PCT, local
practices, an independent provider specialising in pain
rehabilitation and a healthcare trust provides a patient-centred
approach to improve the journey of people with low back pain. This
includes a fast-track service for treatment or investigations as
well as a Pain Information Afternoon with 70% of patients rated as
excellent.
ends
Notes for editors
‘Teams without
walls - the value of medical innovation and leadership’ is the
report of a working party of the Royal College of Physicians, The
Royal College of General Practitioners and the Royal College of
Paediatrics and Child Health, endorsed by the NHS Alliance.
For further information please contact:
Lorna Fletcher, Press & PR Officer, 020
7344 3136 / press@rcgp.org.uk