7. The Healthy East Grinstead Partnership
The primary care home was established to improve the health of the population of East Grinstead and deliver a high quality local model of health and social care that is sustainable for future generations and works for children, families, people with increasing health needs and our older population. The town’s four GP practices had been struggling to recruit and cope with demand treating a population that was living longer with long-term conditions. They wanted to build on the strength of general practice. The PCH’s objectives are to enhance primary care, improve access and bring specialist care to the community.
How things are changing
The biggest initiative has been to merge the community nursing team and an existing multidisciplinary proactive care team (consisting of occupational therapists, physiotherapists, community psychiatric nurses, community matrons, and social workers) to create an enhanced primary care team to focus on patients at highest risk of admission to hospital and to provide care to stop unnecessary admissions. Patients are receiving more joined up care and are less likely to be admitted to hospital.
GPs are no longer involved in activities where they were adding no value, freeing them up for other work and improving access. These include the referral of pregnant women to midwife services (self-referral introduced), referral of people with musculoskeletal needs to a physiotherapist (self-referral introduced) and prescribing wound dressings (community nurses now order these online).
Care co-ordinators have been introduced at all four practices to signpost patients to non-clinical services they may need, ranging from food banks to social clubs. An additional urgent, on-the-day primary care service is being developed across all four and the PCH is working closely with the Fire Service to ensure housebound patients at risk of falls have their social and medical needs identified.
Lessons learnt include that the PCH needs a collaborative mindset from all organisations and a lot of one-to-one engagement. Buy-in comes from explaining specific changes and benefits to individuals and teams.
Four GP practices, Horsham and Mid-Sussex Clinical Commissioning Group, Queen Victoria Hospital NHS Foundation Trust, Sussex Community NHS Foundation Trust, Sussex Partnership NHS Foundation Trust, East Grinstead Town Council, West Sussex County Council, South East Coast Ambulance NHS Trust, Age UK East Grinstead and District, St Catherine’s Hospice, Horsham and Mid-Sussex Voluntary Action, West Sussex Fire and Rescue Service.