3. South Bristol Primary Care
Six practices in a deprived part of Bristol have come together with the city’s community health services provider, Bristol Community Health, to develop new services to improve the health of the population. The area is one of the most deprived in the country, with high levels of health inequalities and disease.
The practices were concerned that on their own they would no longer be sustainable and wanted to collaborate to deliver primary care differently. Becoming a primary care home gave them an opportunity to move away from struggling on their own and do things differently – together and with new partners. The vision is to create a multi-specialist team providing primary care services for their population, where the patient gets the right treatment at the right time. The primary care home is run by an executive committee with a memorandum of understanding between the six practices and Bristol Community Health. It has close links with the Bristol Clinical Commissioning Group and the public health department of Bristol City Council.
How things are changing
The collaborative has developed teams of nurses and paramedics who provide a rapid response to urgent calls for home visits from the frail elderly. Previously, GPs could only make home visits in the afternoon when it was often too late to intervene usefully with new medication, care arrangements or assessment at hospital. Now the teams attend quickly, early in the day, and make new arrangements for prescriptions, nursing, social support or hospital assessment. This means people who are frail, housebound and acutely unwell get appropriate care sooner. Doctors brief the practitioners before the visit and there is a debrief with a doctor afterwards. The practitioners (two nurses and two paramedics), employed by Bristol Community Health, are funded by the Better Care Fund and the clinical commissioning group but their clinical workload is allocated by the practices, crossing cultural and organisational boundaries.
Integrated community dressing clinics have also been developed. Instead of patients going to see a GP or nurse for a wound dressing, or requiring a home visit from a district nurse, an offsite wound dressing clinic has been set up, once a week, in a local community centre, in a semi-social setting. Bristol Ageing Better provides transport. This means people have a social as well as clinical experience, which reduces their isolation and improves their mental wellbeing. There is a large and active patient participation group with a patient champion who are engaged and helping to define the development of new services.
Lessons learnt have included the time it takes to build trust and relationships and the need to challenge a culture of ‘silos’ where people naturally focus on their own businesses. Challenges continue to be limited funding.
Bristol Clinical Commissioning Group (CCG), Bristol City Council (BCC) and the Better Care Bristol Vision Governance Structure, Brisdoc (the GP out of hours service,) University Hospitals Bristol NHS Foundation Trust.