Harrogate and Rural District Clinical Commissioning Group “What Matters to Us” vanguard is one of the 9 Integrated and Primary Acute Systems across the country. Harrogate aims to transform the way care is provided locally with GPs, community services, hospitals, mental health and social care staff working together to support people to remain independent, safe and well at home. In this blog Kiri Quinn a senior mental health practitioner and Charlotte Jackson an occupational therapist talk about their experiences of working in the new care models programme and the changes that have been made through working in a newly formed multi-disciplinary team.
Kiri Quinn (KQ): Initially I feel like I fell into the programme. I was originally applying for a fellowship, where I was required to develop a proposal about linking better with GPs with the aim of getting them to work more closely with mental health trusts. My line manager then informed me of the New Care Models programme and how it was a great initiative bringing everyone together. Meeting people face to face from various organisations instead of speaking over the phone was really refreshing.
Charlotte Jackson (CJ): I was new to the programme and the county when I joined. I am a local authority occupational therapist with 10 years of experience. I was looking for a new challenge and experience, and joining the New Care Models programme ticked both of those boxes. The integrated care of the vanguard really appealed to me as it makes sense as the future of the NHS. In some previous role my teams tapped into other professionals’ knowledge where we needed to, but there was not enough joint working unlike the vanguard where there is a very high level of integration.
What has changed for you since joining the programme?
KQ: Since joining the programme I have continued to build relationships by working closely with people, going on joint visits and doing things collaboratively that we would not otherwise do. It is easy to say that’s not my job and to not support different people in the system but actually that’s a person and we’ll try and to support them as much as we can. We now feel the freedom to work from a caring nature and not let organisational boundaries get in the way of the patients best interests: these are exactly the kind of changes that we want. It is also more rewarding to be in a role where you’re learning things. Previously you never would have had the opportunity to learn from other clinical specialists, for example I had never done leg dressing before despite being a qualified nurse Having learned the skill from community nursing colleagues; when I see a patient who needs a dressing, I do not need to make a call and have them wait for a few hours as I can do it for them. This reassures the patient and gives them a better service and it is a really positive element of the programme.
The main thing I was hoping for from the programme was better and faster patient care and patients feeling more confident in the service. Things would be more streamlined and more time efficient, which allows more time to see patients. We also want to upskill district nurses and social services on mental health so that they are more confident with patients and able to give them better care. While we are not 100% there yet in the programme we are well on our way.
CJ: There has been a huge learning curve working as part of the programme. I have had a lot of new skills to learn and I have needed to tap into the right people in order to gain those skills. There are some great links with my health colleagues within the vanguard. While there are some links with my social care colleagues, the social care aspect of my role will require further integration. It is difficult to nurture both relationships and link both to the vanguard. However the links we do have in the vanguard are fantastic. Before, if you needed some information from another team you would have to call a faceless customer service line, now we have built relationships and are able to speak to someone we know directly and are a friendly accountable face. It’s great to see the level of friendly support within the vanguard. Overall the programme has been a very positive experience and I would like to see more transformation and more social care colleagues linking in a releasing the benefits as well.
What would be your highlights over the past year?
KQ: My highlight from the programme has been the feedback from the patients. We have had great response from them and it is rewarding hearing about how much better people are doing in the Multi-disciplinary team (MDT). Staff also feel more confident to ask questions and talk to a person which has led to a joint upskilling.
One example is a patient who was in a place where she was unable to do anything and had nurses visiting her every day. But after support she was able to improve and no longer needs to see the nurses anymore. She is now able to support herself, going from not being able to get out of bed to being able to drive herself to the practice.
Similarly, I once went to see a carer whose husband had dementia and he was struggling to support her. With carers support from the MDT she was able to return to work and this also avoided a hospital admission. From examples like these, we’ve found that where people have a high risk of admission we have been able to avoid them being sent to hospital.
CJ: My highs for the programme without going into individual cases would be working with people like Kiri, chatting locally with colleagues and linking with mental health and physio, which I have been able to refer patients to within a fortnight. It is satisfying to see the outcomes and how much we can achieve when everyone works together. I do not believe this would have been possible without the New Care Models programme. Before the programme trying to get people physio support would have taken much longer and they would have just been placed onto a waiting list. Also linking in with mental health would have been a faceless referral and we would have received no feedback. Now you can go to the MDT the following week and get an update on the referrals you made. Professionally to get the reward to really help patients is very satisfying and the programme has helped achieve this.
I would also say that the pharmacist and clinical educator on our MDT are invaluable and the work they provide is very transformative. We would love to have more pharmacists supporting us as their work has been proven.
To me New Care Models just makes sense and MDT working is how the whole NHS should be. A lot of these concepts are driven into us at university and training but are not adhered to in practice, however the programme is achieving this. I have worked in a number of MDTs and the one in the vanguard is the first one that feels like it is working. None of these concepts are new but the vanguard is making them a reality.
What would be your advice to colleagues in health and care services?
KQ: My advice to other people about to undertake transformation would be to just do it. Now that I am part of the programme it feels really obvious. Patients do not fit into boxes so why is our system designed like that? One of the best thing about the MDT, are the staff from different backgrounds that meet together to discuss various complex patient needs. The MDT also uses different perspectives and experiences to solve a patient’s issues. You are also able to go back to the MDT for feedback on how the patient is doing.
CJ: My advice to others is this is how we should be working and if you can go ahead and change the way you work, you should as it provides a better service to patients. I also advise people to integrate with the new care models programme.
What are your hopes for the future and do you have any key messages for NHS policy makers?
KQ: As the programme spreads I hope that time and staffing are improved. District nurses are very busy and with more time we would be able to learn more from each other and improve our skills to support patients further.
A key message I would give to the policy makers in the NHS would be to report on the positive stories and case studies emerging from the vanguards, as they are so important and are showing some real change.
We need to make sure the benefits coming out of this programme last and we do not go back to working how we did before as it seems backwards. New care models are now the norm and should be across the country
CJ: I hope that what will change as the programme spreads is an equal partnership between social care and the NHS and less siloed working. For the future I believe we need to make sure that more teams in the council and across local authorities in general are further integrated into the programme.
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Kiri Quinn is a Senior Mental Health Practitioner in the Knaresborough, Boroughbridge and Green Hammerton Community Care Team. She is employed by Tees, Esk and Wear Valleys NHS Foundation trust |
| Charlotte Jackson is a Occupational Therapist working in the Knaresborough and Boroughbridge and Green Hammerton Community Care Team. She is directly employed by North Yorkshire County Council
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