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All these demonstrate a far more tailored, person-centric and integrated approach

to delivering community-based care. Part of the concern about integrating care

in England hinges on the fixed approach to primary and community-based care.

Indeed, concerns about capacity in general pose a threat to integration. The

Nuffield Trust, for example, has suggested that: "significant reform is needed to

develop capacity in primary and community care."117

There are some promising examples of technology playing a role in English

hospitals to increase flexibility. For example, Airedale General Hospital in

Yorkshire which serves a rural population rolled out a telemedicine service. This

provides patients with instant access to medical tests and advice 24 hours a

day, plus a ground-breaking videoconferencing service which allows nurses

to monitor their patients remotely through webcams installed in their homes. A

study of 17 nursing and residential care homes linked to Airedale's telemedicine

service compared the 12-month periods before and after the introduction of

telemedicine. The study found that the use of telemedicine had resulted in a 60

per cent reduction in the total use of bed days, 69 per cent reduction in A & E

visits and a 45 per cent reduction in hospital admissions.118

Technology can also facilitate increasing access to GP services and primary care.

For example, a single GP 'super-practice' with 13 different locations around the

West Midlands - the Vitality Partnership - is piloting an online healthcare service

with a digital healthcare company. Supported by the Prime Minister's Challenge

Fund - created to pilot innovative ways of increasing access to primary care -

the online service makes it possible for 60,000 patients (regardless of whether

they are registered with one of the group practices) same day access to their

local GPs or nurses via instant messaging, telephone or Skype both within and

outside normal practice hours. So far up to 70 per cent of appointments to the

GP practices have been dealt with via a telephone or Skype consultation and

more than 1,000 patients a day access the clinical contact centre which provides

information on out-of-hours services and location.119 Another pilot scheme

supported by the Prime Minister's Challenge Fund aims to provide 43,000

patients across England with 24/7 telephone access to GP practices which has

seen a reduction in unscheduled registered patient use of walk-in services.120

But it doesn't even have to rely on technology. Just applying resources in the right

place can help the system to work better together. For example, GPs are working

within Royal Free Hospital in North London to intercept avoidable A&E patients

by treating minor injuries, doing blood tests and X-rays and dealing with those

who are drunk. They have had particular success with those who have never

registered with a GP.121

Despite promising examples, what remains clear is that primary and community

care reform is not complete and that relevant local bodies must work together to

come up with new solutions. As Norman Lamb put it: "There is, in my view, a

pent up energy in the system to work innovatively and to work collaboratively".122

CCG, council and community services - all three need to be signed up as a

tripartite - perhaps as a joint delivery vehicle for primary care reform. With the

NHS Forward View talking about "Multispecialty Community Providers" - hinting

at the future potential to "employ hospital consultants…or take delegated control

of the NHS budget," it looks like health leaders acknowledge the opportunity,

and local areas should make the case for it.

Recommendation: Ensure that primary care best practice (for

example, Airedale Hospital, the Vitality Group, and Royal Free 117 The King's Fund, Nuffield Trust,

A report to the Department of

Health and the NHS Future

Forum (January 2012)

118 Airedale NHS Foundation Trust,

"Sharing success at global

event" Telehealth Talk (Winter


119 NHS England, PM Challenge

Fund, Health United Birmingham

Pilot (Accessed January 2015)

120 NHS England, PM Challenge

Fund, Care UK Pilot (Accessed

January 2015)

121 Camilla Cavendish, "Making the

grazed knees and twisted ankles

wait longer will help heal A&E",

The Sunday Times (11 January


122 Peters, D, "Lamb roars against

'ridiculous' health and social

care divide" The MJ (31 October


Chapter 4 - What Are Our Proposed Solutions?



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