Integrated Care: Its clinicians that make the difference

As clinicians we want to work in the health service to provide better care for our patients.  The only way we can do this is by being part of a team. The same is true for our social care colleagues. The relationships we have with other clinicians, managers and health and social care partners are absolutely vital if a community is going to meet the difficult financial challenges ahead and yet deliver the highest possible quality of care.

In Northamptonshire we formed our Integrated Care Partnership (NICP) in 2009.  We invited senior clinicians and front line workers from all major providers (including the LMC as the provider arm of primary care), as well as patients, carers, social care and the voluntary sector to come together with the aim of providing better integrated care to our mutual patients.  Our ambition was to use this partnership to break down and resolve all organisational barriers and interface issues.  We identified a series of quick wins that quickly established the value of the partnership, which still commands the attendance of all organisations 31 monthly meetings later!

We agreed a set of shared markers of success: decrease in emergency admissions and readmissions, decrease in length of stay, decrease in admissions to care homes, and ensure that we are able to honour the wishes of more patients in terms of their preferred place of death. Who could argue or put organisational barriers in the way of these markers?   We agreed that we would use the partnership to ensure that the right clinical leaders come together in the right meetings at the right time to make all of the important decisions.

We have already seen a 17% (440 patients) reduction in deaths in hospitals compared to last year following the introduction of new end of life service.  However, the most successful and ambitious scheme has been our £3 million Community Elderly Care Service. This all started when a Consultant Geriatrician asked me for 20 minutes on one of our agendas to present the concept. We quickly harnessed the collective enthusiasm around the table and ensured that doors of organisations on which we previously had to pound on heavily to find a solution were flung open due to the collaborative bottom up approach. The business case was quickly developed, piloted and approved. 

We are never going to agree on everything.  What we have developed over time are strong personal, as well as organisational, relationships that enable us to tackle differences of opinion in an open and constructive manner. For example, we continue to reconcile our ideological differences of the most appropriate place of care for patients by working our way through our Consultant to Consultant referral policy to agree exactly which patients should be seen where.  Because we have the right senior clinical leaders in place we can openly discuss and resolve all issues within the NICP.  We do not need to escalate to any higher authority, and in fact we would see this as a failure of our partnership.

Once we agree a collective course of action, each clinical leader takes this back to their organisations and ensures the appropriate changes are made. Where change is not delivered and there are further obstacles to be overcome we bring this back to the partnership and work together to resolve them.  The hearts and minds battle is so much more easily won when clinicians are leading and driving the change.