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Community-Oriented Integrated Care

 

Blog headlines

  • Structuring a PCN Social Prescribing Service for the post COVID world
    25 February 2021

    This week we have a blog by Nick Sharples.

  • Community-Oriented Integrated Care
    18 February 2021

    The blog this week is a short extract from a paper considering an approach primary care networks could use to move towards community-oriented integrated care.

  • Strategy Unit releases opensource model for planning vaccine centre capacity
    11 February 2021

    This week's blog is from The Strategy Unit who are sharing an opensource model to help with vaccine centre capacity planning.

  • Time to talk day
    4 February 2021

    A small conversation about mental health has the power to make a big difference.

  • Supporting Staff: the emergence of ‘long-covid’
    28 January 2021

    As we are now well into a second, or is it now the third, wave of Covid-19 it is becoming apparent that Covid is something we have not experienced before and it has unique implications for staff management. It is not just the possibility that staff may become acutely ill with the virus, but that for some they may go on to develop persistent debilitating symptoms that will affect their ability to go back to work. This article looks at the implications of long-covid for HR and service managers when looking to support health care professionals (HCPs) return to work.

  • Link of the week: Clinically-Led workforce and Activity Redesign (CLEAR)
    21 January 2021

    This week we are sharing a link to the Clinically-Led workforce and Activity Redesign (CLEAR) site that is funded by Health Education England.

  • So much more than an extra pair of hands
    14 January 2021

    The introduction of the additional roles reimbursement scheme for primary care networks has started to grow capacity in general practice to address the unsustainably high workload that has put so much pressure on GPs.

  • Primary Care Networks – how did we get here?
    7 January 2021

    This week we are sharing a blog by PCC’s chairman David Colin-Thomé.

  • A year like no other
    17 December 2020

    On 5 July 1948 the NHS was born, over the last 72 years challenges and changes have been remarkable but the service has probably never been tested as much as in the last nine months. There have previously been numerous re-organisations, multiple changes to hospitals, mental health services and a shift from the family doctor towards more integrated primary care services delivered by a range of professionals. However, rapid transformation of services to embrace digital technologies, and a shift change to work differently has been forced upon all areas of the health service this year.

  • Guest blog: David Hotchin
    11 December 2020

    This week we have a guest blog that was submitted to us by David Hotchin, written by a retired friend....obviously, he's used a little poetic licence.

  • What now for commissioning?
    3 December 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

  • What White people don’t see
    26 November 2020

    This year’s Black History Month (BHM) has, unfortunately, in its shadow another example of why campaigns like this exist.

  • Primary Care: Why don’t we talk about Racism?
    20 November 2020

    Rita Symons is an ex NHS leader who is now a leadership consultant, coach and facilitator. Her work is mainly in the NHS and she is an associate for PCC offering facilitation, coaching, strategy development and team development activities. She is a concerned but hopeful world citizen and combines work in the NHS with a board role in a non for profit organisation and an interest in writing.

  • Primary Care and the Health of the Public
    12 November 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

  • What now for primary care
    4 November 2020

    By Professor David Colin-Thomé, OBE, chair of PCC and formerly a GP for 36 years, the National Clinical Director of Primary, Dept of Health England 2001- 10 and visiting Professor Manchester and Durham Universities.

  • Boosting your resilience
    30 October 2020

    The last year has been a difficult one, who would have imagined last Christmas that we would have been in lockdown, with the NHS seriously tested by a global pandemic. So much change has happened and the resilience of people working in and with health and care services has been seriously tested. Resilience is our ability to deal with, find strengths in and/or recover from difficult situations. Its sometimes referred to as “bounceabiliy” – but bouncing in what way?

  • Link of the week: National Cholesterol Month
    23 October 2020

    Every month or week of the year seems to be an awareness week, October has more than its fair share.

  • New redeployment service offers talent pool of motivated, work-ready individuals
    15 October 2020

    People 1st International have shared some of the work they are doing to support people displaced from industries due to the Covid-19 pandemic. There is an opportunity for health and care services to benefit from this workforce.

  • Link of the week
    9 October 2020

    Article published in the BMJ looking at the ability of the health service to quickly bounce back to pre-Covid levels of activity and considers if it is desirable.

  • Virtual Consultations– the patient perspective
    2 October 2020

    This week Jessie Cunnett, director of health and social care at Transverse has shared this article.

 
 
Thursday, 18 February 2021

Community-Oriented Integrated Care

The blog this week is a short extract from a paper considering an approach primary care networks could use to move towards community-oriented integrated care.

Community-Oriented Integrated Care

Community-Oriented Integrated Care (COIC) provides a vision for society where people of all backgrounds contribute to the health of whole populations. We think of it as whole system integration for health and care where everything comes together through geographic areas of about 50,000 population - in the UK, this is primary care networks.

COIC concepts promote cycles of collaborative learning and coordinated change within and between areas, to facilitate organic emergence of innovation, social cohesion and systems-thinking. Across the community, policy ensures that different stories and cultures are valued; and positive, trusted relationships are built through deep listening, shared vision and broad participation in improvement projects. This is different to traditional hierarchical approaches to policy.

Policy for COIC is different from the usual stereotype of ‘top-down’ implementation of evidence-based solutions – that ‘tells people what to do’. Policy for COIC ‘helps people to think for themselves’. It facilitates creative interaction between people from different backgrounds that helps them to better see how individual and collective actions can affect ‘bigger pictures’. It establishes infrastructure that facilitates the emergence of innovation. It requires ‘village-size’ localities that are small enough to feel you belong and large enough to have political impact. It empowers more than controls people. It is a form of local participatory democracy.

Between 2007 and 2013 Ealing piloted and implemented policy for COIC, drawing on theories of organisational learning, generalists as sense-makers and fourth generation evaluation. Outcomes were good, as evaluated by routinely gathered data for diabetes care.

The work in Ealing shows that cycles of learning and change within geographic areas can bond and bridge. The 2011 video of the Southall Initiative for Integrated Care shows one of a sequence of meetings at which people of different backgrounds reviewed progress of four service improvement projects. You can see it at: https://www.youtube.com/watch?v=-u40x7-76iU&feature=player_detailpage. The video shows participation of lay people, primary, secondary and community care practitioners, policy makers and public health practitioners.

The acceptability of the approach is revealed in the comment by a voluntary sector participant:

“It’s not revolutionary; Yet it is revolutionary… If it is institutionalised, that would be incredible for our healthcare services”

The ability of the approach to energise people and help them to interact creatively across disciplinary boundaries is revealed in the comment by the dementia project lead:

“I’ve never had so much access and opportunity to talk across primary care and secondary care about mental health services…. and I find that the most exciting thing I have experienced in my professional life”

In 2012 learning was applied from this Initiative throughout Ealing. We:

  • developed localities within which stakeholders (generalist & specialist clinicians, public health & social care practitioners, and others) met monthly to develop care plans for frail patients, to learn, and to co-create innovations
  • aligned hospital-led diabetes clinics to these localities
  • targeted resources to reverse inequalities
  • supported a multidisciplinary team to co-design a new system for diabetes, including primary & community care practitioners, ‘expert patients’ and diabetes specialists
  • provided education courses for GPs to lead diabetes clinics within their practices
  • provided structured education for patients to contribute to their diabetes care

The COIC concept proposes policy in five areas to develop this approach

  • Build structures to support whole system learning and change
  • Facilitate local engagement in local developments
  • Develop case studies
  • Teach theory and practice of integration
  • Support multidisciplinary leadership teams.

The approach can be used, at scale, in different contexts and at different speeds. Primary Care Networks (PCNs) could use this approach and so move towards community-oriented integrated care.

This is an extract from an article by:

Paul Thomas, Raj Chandok, David Colin-Thomé and Laura Calamos.

The full article is available here.