On the Connecting Care partnership covering Bristol, South Gloucestershire and North Somerset and the Manchester Care Record.
GPs hold overviews of their patients’ healthcare, while hospitals and mental health providers have detailed information on specific treatment. But community healthcare, which helps to join up primary and secondary care, often suffers from lacking access to information from other parts of the NHS.
Health boards in Wales and Scotland provide all NHS services in their areas, and Cardiff and Vale NHS health board has issued its community healthcare staff with laptops, allowing them to access patient records. But in England, care is split between clinical commissioning groups for primary care, trusts for acute care and a range of trusts and social enterprises for community care, all with separate records.
A few areas have responded by setting up shared record systems linking all NHS and social care providers in an area. While this helps all health and social care professionals, it has particular benefits for community healthcare.
The Connecting Care partnership covering Bristol, south Gloucestershire and north Somerset links up three acute trusts, two mental health trusts, three clinical commissioning groups (CCGs) and more than 100 GP practices, the out-of-hours provider, three local authorities and three community healthcare providers, all of which are community interest companies.
Planning for Connecting Care started in 2011, with work by the provider Orion Health starting in March 2013 and the system going live that December for urgent and unplanned emergency care. It allows professionals to see, but not change, elements of the data held by the other organisations.
Sue Romain, a heart failure specialist nurse at Bristol Community Health, says the system is particularly useful to her during home visits to those who have received hospital cardiology care. Through a tablet computer, she can see their blood tests and recent GP and hospital appointments as well as outpatient and inpatient information for both of Bristol’s acute hospitals. “What I haven’t got yet, because I always want more, is access to their discharge letters,” she says. The Connecting Care team is working to add this in 2016.
This access allows Romain to provide more coordinated care. For example, she is able to see if and when patients have a cardiology review booked and plan her treatment accordingly. However, the most valuable data is the ability to check blood results: “That helps me make decisions about what tablet changes I make for that patient, so it’s given me as much information as I need to make clinical decisions,” she says.
Access to blood test results also lets Romain see if any tests are still to be taken and, if so, take the required samples immediately. This data comes via GP systems, but a planned upgrade will provide Romain and colleagues with direct information from the pathology labs.
Andy Kinnear, Connecting Care’s programme director at NHS South West Commissioning Support, says other community care staff save time in triage and assessment and in calling GP surgeries for information. “There’s a real industry in the health service of people just making calls for information,” he told last year’s EHI Live conference, estimating that the system could save £155,000 a year if all of its planned 10,000 users made just one telephone call less a week.
The system also saves community care nurses from making unnecessary home visits, as they can see if a patient has been admitted to hospital. Based on the rate of saved visits in pilots, this could save NHS provider organisations £68,000 a year.
Other areas are working along similar lines, some with funding from NHS England. One area with a particular motivation to do so is Greater Manchester, which will gain control of its £6.2bn health and social care spending under the so-called Devo Manc project. It already has an information sharing system, the Manchester care record.
Ed Dyson, assistant chief officer for Central Manchester CCG, says the record is being used to focus on the 1.5% of the population who use 30% of emergency care provision. It shares summary records on GP, secondary care and social care activity, along with integrated care crisis plans and recently-added end-of-life plans.
Dyson told EHI Live that one 78-year-old man often attended a hospital’s emergency department with urinary tract infections. He cares for his wife who has dementia, and when he was in hospital she would often be admitted too. “We had two admissions due to a urinary tract infection,” he said. Now, information sharing has allowed his condition to be managed by community-based staff, with no emergency admissions since this started.
Another patient with cancer hoped to end her life at home. A community care nurse read the end-of-life plan and spoke to the patient’s hospital consultant, leading to her to go home. “It’s a good outcome by chance, by one person being an advocate,” says Dyson. End-of-life plans are being added to the Manchester Care Record so this happens more often.
Although the project only covers the city of Manchester at present, other Greater Manchester councils are working on similar projects, and Dyson says the hope is to join these up: “There’s huge enthusiasm within Greater Manchester to create shared care records. It’s one of the key things we want to do.”
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