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Care in the right place

Ensuring care is delivered in the right place with the particular focus on primary healthcare and community services

Transformed health and social care services of the future will deliver the right care for patients, in the right place and at the right time. To achieve this transformation across all care settings, the workforce in each will require the necessary skills and capabilities to deliver appropriate care that meets patients’ needs. The combined impact upon primary health care and community services, of existing local, regional and national transformation programmes is significant. Many of the proposed changes across London require primary health care and community services to operate in a different way, to ensure patients are at the centre of care. Without fundamental changes to primary health care, or appropriate development and support of the workforce, the benefits of moving care away from hospitals and into the community will not be realised. Therefore, a particular focus on the primary health care services’ workforce is needed.

Supporting resources

To support the delivery of local solutions, here are links to existing resources, case studies and organisations with expertise to support the delivered of care at the right time in the right place,  with the particular focus on primary healthcare and community services.

The Nuffield Trust – Reshaping the workforce to deliver the care patients need: The Nuffield Trust was commissioned by NHS Employers to examine how best NHS staffing can be reorganised to support new ways of delivering care to patients. In the published paper, authors offer practical guidance on implementation to those wishing to reshape their workforce, and identify opportunities to ‘grow’ the workforce.

Ensuring the right people, with the right skills, are in the right place at the right time: A report, developed by the Chief Nursing Officer for England in collaboration with the National Quality Board, sets out guidance on how to get nursing, midwifery, and care staffing right so that staff can deliver high quality and safe care.

Common insights

Where the existing medical workforce does not have capacity to meet the growing demand for primary and community care services, this burden could be reduced by sharing clinical responsibilities with other health professions, for example by empowering practice, district and community nurses to manage a greater proportion of general practice workload.

As a consequence of existing vacancies and an ageing workforce, there is an increasing need to make careers in primary and community care more attractive, to encourage more medical and health professionals to want to work in these settings.

New ways of working in networks between primary and community providers should be encouraged, to enable professionals to share knowledge, expertise and resources across organisational boundaries, and improve their general skills base.

A planned shift in patient care away from hospital settings will require a shift in the provision of staff training into the community.

Given that shifting patient care into the community is a key part of the planned services transformation in London, it is vital to understand the combined impact of all transformation programmes on the primary and community care infrastructure and workforce, in order to enable the successful transition of care services.

More training placements should be offered in primary and community care, so more trainee health and care professionals can experience the benefits of working in these settings and see their attraction.

Given the important role of the workforce in system transformation, funding for training needs to be more closely aligned to primary health care and community services.

Building greater capacity and expertise in the workforce is necessary to achieve the health and social care transformation ambitions for children and young people, mental health, cancer, and urgent and emergency care.

In delivering greater patient interventions in primary health care and community services, it will be equally important to consider the impact on secondary care service providers.

It is recognised that a fundamental shift away from ‘paternalistic’ to ‘personalised’ models of care is needed, and this requires a workforce equipped with the right skills, behaviours, knowledge and attitudes to engage patients in managing their own health, in decision-making, administering and even commissioning their own solutions.

Case studies

Specialists in out-of-hospital settings: The King’s Fund visited six services where consultants are delivering or facilitating care outside hospital and describes the benefits and challenges to this way of working.

Pharmacist in general practice: A description of how a team of 48 experienced Pharmacists support GP Practices across London to deliver their new models of care.

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