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The vanguard of primary care

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Community nurses in Birmingham Community nurses in Birmingham are better able to signpost patients to services under the MCP model

When NHS England's Five Year Forward View was released in October 2014, many of the recommendations put primary care nurses at the centre of the NHS overhaul. In particular, the Five Year Forward View outlined three recommended models of primary care:

  • Multispeciality community providers (MCPs).
  • Integrated primary and acute care systems (PACs).
  • New specialist care models.

Of these three models, the MCPs focused on developing the role of primary care nurses and suggested employing senior nurses as consultants or partners working alongside community nurses and other healthcare professionals. It combines core primary and medical care services with wider community-based NHS services and, potentially, social care. The MCPs will serve a minimum population of at least 30,000-50,000 registered patients but could be larger.

The PACs are single organisations which provide NHS list-based GP and hospital services, together with mental health and community care services. The specialist care models rework certain services in the NHS such as urgent and emergency care and maternity care.

NHS England encouraged trusts and practices to send applications highlighting their interest in setting up one of the three models.

Simon Stevens, chief executive of NHS England, says that they have received 268 applications to become 'vanguard' sites for all three of the new care models. NHS England has a £200m transformation fund to be allocated to the chosen sites. Of these 268, 50 have been selected to proceed to the second-round application process.

A few sites across the country are already considering implementing the MCP model, including a CCG and community trust in Birmingham, a community trust in Liverpool and three practices in Kent.

Better access to services
NHS Birmingham South Central CCG, its GP partners and Birmingham Community Healthcare Trust have agreed in principle to work together to develop an MCP. The agreement means that the two organisations will work jointly to develop and deliver services for the 286,000 people covered by Birmingham South Central GPs. The model will cover all community-based health and social care services to reduce the need for patients to attend hospital.

Dr Andrew Coward, chair of Birmingham South Central CCG, says: 'The Five Year Forward View sets out how the health service needs to change to meet the challenges of the future. The publication argues for a more engaged relationship with patients, carers and citizens so that we can promote wellbeing and prevent ill health. For the people of south and central Birmingham we believe that this will be best served by joint working between our two organisations in the form of a community-based multispeciality provider.'

One of the key benefits of the MCP for the community nurses is the heightened access to all services that are available in the community for patients.

Birmingham Community Healthcare NHS Trust chief executive Tracy Taylor, says: 'Our district nurses have said that it opens them up to loads of new resources that they previously did not even know existed. Nurses feel like they can signpost to more services.'

Heather O'Sullivan, a community staff nurse at Birmingham Community Healthcare NHS Trust, agrees. 'I have found that it has enhanced communication with GPs and all the other services that we work with.

'I used to think that I knew of all the services available to my patients. It's actually brought that learning curve back to us as it's opened us up to so many new services that are both healthcare and social care related.'

Ms O'Sullivan also thinks that the new model has freed up time for the nurses to deliver more targeted care. 'Before we used to receive phone calls from people for quite small things and when we would arrive there it would be clear that it wasn't something that required a district nurse.
'Now we have a team of people who phone patients once a month and discuss their conditions, their mood and things like that to identify any problems,' she says.

Although it is still early days (the Trust is currently evaluating the model) Ms Taylor says that even if the Trust and the CCG are not successful in becoming a 'vanguard' practice they will still continue to operate in this way as it's 'the right thing to do for our local population'.
'Our intent is that we develop it regardless and hopefully as the Five Year Forward View looks at what the vanguards are doing, this type of approach will be emerging and bubbling up around the country anyway,' she adds.

Federating three practices
The Whitstable Medical Practice along with Northgate Practice and Saddleton Road and Seasalter practice in Kent have submitted an application to become an MCP. Together the practices employ 35 GPs, 18 practice nurses, seven healthcare assistants and have over 53,000 patients.

Dr John Ribchester, GP and senior executive partner of Whistable Medical Practice, says: 'From the point of view of the practice and community nurses, it means that there will be greater learning opportunities across the three locations and the chance to share expertise and share education.'
He says that they are already holding meetings where the nurses share working practices to improve patient care.

It also means that each patient will have a single electronic patient record which can be accessed by the nurse or doctor and will encourage integration between the community and practice nursing teams.

He hopes that the implementation of the MCP will bring better 'internal career progression for the nurses and enable the practice and community nursing teams to work as a single entity rather than separately.'

He echoes Ms Taylor's opinion that even if they are not successful in their application, the practices will continue to implement the MCP model.

'There are going to a number of MCP forerunners and we would like to be one of them as that will attract some management resources. However, if we don't succeed we will still try and move this model forward,' he says.

Increasing community nurse numbers
Another trust considering the MCP model is the Liverpool Community Healthcare Trust. This would make it one of the first Trusts in the North West to pilot one of the models outlined in the Five Year Forward View, if they decide to take it forward.

Since last year the Trust has recruited almost 60 extra district nurses and health visitors and aims to recruit 34 more by April.
The approach is all part of an overarching plan to ensure nurses, doctors, therapists and other health professionals work together as joined-up teams across Liverpool and Sefton, and to ensure that more care is carried out in the community.

Dr Craig Gradden, Liverpool Community Health NHS Trust's medical director, says: 'One option included in the [Five Year Forward View] permits GPs to combine with nurses, other community health services and hospital specialists to create integrated out-of-hospital care.'
Amanda Pye, interim director of nursing at Liverpool Community Health NHS Trust, says: 'The challenge for the future is to make sure district nursing, health visiting and other community health services continue to move forward and are sustainable for the long-term.

'Between now and the summer, we will work with our commissioners and other partners to explore this and other options. From the summer onwards, we will then take forward one of these options together, which we'll look to implement no earlier than April 2016.'

Within six months, primary care has begun to take forward the recommendations laid out in the Five Year Forward View. Enhancing relationships between nurses and other services means that patients will receive more holistic care at home, which has been a driving force of the government for the past few years. Time will reveal whether they are successful and whether these models can sustain the NHS in the long term.

1. Five Year Forward View. NHS England: October 2014.

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