Practices across Lancashire and South Cumbria are transforming the way they work to improve services for patients.
They are joining together as groups of practices working with community service providers and other health and care organisations – a partnership known on the Fylde Coast as ‘neighbourhoods’, but in some areas of the country, ‘primary care networks’.
The Fylde Coast CCGs were among the first in the country to develop neighbourhoods to improve the way practices work together at a local level to improve the services they offer to patients in the community.
The development of neighbourhoods was described in the NHS Long Term Plan, published last week, and is key to the transformation of primary care and community services.
Neighbourhoods plan and deliver services for populations of 30,000 to 50,000 people, which will enable them to focus on health and wellbeing priorities. They will build on the core services currently available from GP surgeries, offering more care closer to home in communities rather than in hospitals and supporting patients with long term conditions to better manage their own health.
By sharing resources, neighbourhoods will be able to employ a broader range of staff, including newer roles like clinical pharmacists and physician associates. In addition, they may be able to extend services that are currently only available in one practice within their group – such as physiotherapy – to all patients or offer new services such as ultrasound and mental health therapy.
NHS England (Lancashire & South Cumbria) is investing £1.75million to support the development of neighbourhoods. Every practice across the whole of Lancashire and South Cumbria is included or linked to one of the 41 primary care networks that have been established.
With an ageing population and growing number of people living with long term conditions like diabetes and heart disease, strengthening primary care services through the development of networks is seen as key to helping people to stay healthier for longer.
Jackie Forshaw, head of primary care at NHS England (Lancashire & South Cumbria), said: “We are pleased with the progress that has been made by all of the neighbourhoods across our region, though the networks are at different stages of their development, practices and community services have been keenly working together to be involved in this ground-up transformation.
“This will help primary care to be more sustainable and better able to continue to deliver high quality health services to the people they serve, now and for many years to come.”
Working in this way is not new for all practices, primary care networks have been growing in recent years. The funding boost is intended to support established networks and encourage new networks to form.
Dr Malcolm Ridgway, GP and Healthier Lancashire and South Cumbria’s senior responsible officer for primary care, said: “Working as a neighbourhood will offer practices the opportunity to care for the communities they serve in a more joined up way. They will be able to offer more services like physiotherapy, ultrasound and mental health support close to home.
“In Lancashire and South Cumbria we are already ahead of the curve with every practice now part of a primary care network and starting to plan improved services with community colleagues. The NHS Long Term Plan will help to accelerate and build on this new way of working, improving the health and wellbeing of our population whilst at the same time improve recruitment and retention of staff.”
Where emerging neighbourhoods are in place there are clear benefits for patients and clinicians. Practices are able to share workforce which gives the network back up to cover illness but also helps manage demand for services.
Fleetwood has a population of just under 30,000 residents, with significant health inequalities and traditionally poor health outcomes. It is also home to the National Association of Primary Care – Primary Care Network of the Year, Healthier Fleetwood.
The area has a number of health and care challenges with prevalence rates for all major long-term conditions significantly above the national average, especially mental health issues such as depression and anxiety as well as long term conditions associated with smoking, obesity, drug and alcohol misuse.
Over the past four years the three GP practices in Fleetwood have developed integrated care across the town, together with other health and care providers such as community pharmacy, the local dental practice, community nursing, Lancashire Care Foundation Trust, providing specialist mental health services, Blackpool Teaching Hospitals NHS Trust and Inspire, the local drug and alcohol service provider, to address the health needs of the town.
Together, Healthier Fleetwood has been looking to improve mental health services, services for people with long term medical conditions such as Chronic Respiratory Disease (COPD) and focussing on the health of the towns children. There is also a significant focus on empowering residents and on promoting wellness, along with a wide range of social prescribing initiatives. Social prescribing involves helping patients improve their health, wellbeing and social welfare by connecting them to community services which might be run by the council or a local charity. For example, signposting people who have been diagnosed with dementia to local dementia support groups.
The changes that have been put in place has not only led to a very positive health impact for numerous residents, but also to improving the recruitment of new GPs and nurses to the town, as well as significantly reducing the number of A&E attendances and emergency hospital admissions needed by Fleetwood residents.
The neighbourhood is also addressing childhood obesity by teaching children to cook through the Fleetwood Young Chef programme. Working with the Children and Families Division of Blackpool Teaching Hospitals they have are also working with 20 families in the town whose children are at highest risk of hospital admission. This integrated approach has received excellent feedback from the families involved and has also significantly reduced the need to hospital services, especially A&E.
Mental health services have been integrated across primary care, at a GP practice level and secondary care, in hospitals.
Dr Mark Spencer, GP at Mount View Practice, Fleetwood and Clinical Lead for Primary Care Transformation for Lancashire and South Cumbria said, “The most significant change that we have seen through Healthier Fleetwood is with residents genuinely taking control of their own care. They have designed and implemented their own social prescribing pathway with over 24 different activities now available, many of them resident led.
“This has led to real improvements and changes to residents’ lives. Attendance at A&E has fallen sharply with a 7% reduction in 2016-17, followed by a further 16.7% reduction in 2017-18. Acute hospital admissions have also fallen by 6.5%, against a backdrop of increasing hospital activity levels.”