Urgent care forum

Collaborative care teams and ambulatory care in Airedale

06 / 03 / 2014

Overview

Airedale’s collaborative care team (CCT) initiative was launched in 2008 to establish an integrated care team tasked with preventing unnecessary admissions and facilitating efficient hospital discharge. At the heart of the CCT approach lies the principle that patients should only be in hospital when this is of clear benefit to them.

What the area did and why

Board sign up was secured early on, with partner organisations demonstrating integration can be delivered without the need for a single organisation. The strong relationships between providers and commissioners in Airedale helped to address many of the common challenges inherently associated with developing a CCT model, such as organisational structures and line management.

Results and benefits

One of the key drivers for local authority engagement was to minimise the number of people requiring long-term care, particularly in the current financial climate. There has been a downward trend in long-term care cases since 2008 as a result of the CCT. 

Feedback from patients, carers and relatives has been extremely positive, with 100 per cent of patients for Airedale CCT and 98 per cent for Craven CCT reporting that the quality of services is “excellent” or “good” in the most recent patient satisfaction surveys. Moreover, patients report that they prefer the services offered to hospital care.

Challenges and lessons learned

It was clear from the start that the CCT programme needed to be scaled at pace and that it offered patients clear alternatives to previous forms of care. Stakeholder involvement from the beginning was essential, as well as establishing appropriate financial mechanisms to ensure resources could be effectively moved around the system. Supporting the teams most impacted by changes in working through the transition was also a key challenge.

Ambulatory care: overview

A new ambulatory care model was introduced in February 2013 in response to a difficult winter, and built upon the foundations of the CCT. There was acknowledgement of the need for improved communication between GPs and acute clinicians. Existing ambulatory pathways were enhanced, fronted by doctors and with rapid diagnostics.

Results and benefits

In the first half of 2013/14, the ambulatory care unit (ACU) played an integral role in helping almost a third of cases to avoid admission to hospital. A significant cultural shift has also been achieved; acute consultants no longer contend an increase in inpatient beds is the answer to anxieties about capacity, regarding ambulatory care to be more effective. Feedback from primary care teams has been extremely positive and hospital patients also benefit from increased ward resources.

Challenges and lessons learned

Ensuring the appropriate location of the ACU within the pathway and investing in sufficient numbers of advanced nurse practitioners and additional acute physicians are among the main challenges. Airedale is now aiming to co-locate the ACU with their ED and clinical decisions unit within the next two years to enable further progress.

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