Comment: Managing the evolution of NHS care into the community

The shift to community-led care will provide clear opportunities to improve the support and management of critical and chronic conditions such as diabetes, high blood pressure and obesity. With early intervention and the right preventative care, the NHS can reduce the acute incidents that require hospitalisation, improving patient quality of care and reducing costs. This is, however, a new and rapidly-evolving model. So, what is the best way to ensure secure mobile access to patient information while still delivering a joined-up care model and encouraging patients to take control over their own disease management? In this article JOHN SANDERSON, director of Hicom, outlines the opportunities for mobile data, apps and portals to both enable community-based care and empower patients to pro-actively manage conditions

There are clear opportunities for patients to take a more pro-active role in managing day-to-day conditions – from mobile apps that provide reminders and advice to the use of apps or portals to upload daily test or meter reading results

With the responsibility for commissioning now passing into the hands of GPs, the shift from hospital-based provision of services to a growing reliance on smaller community centres and home visits looks set to accelerate.

The emphasis is also on improving disease prevention. Encouraging patients to take greater responsibility for managing conditions and providing a raft of tools, services and information resources can enable individuals to both recognise early signs of deterioration and achieve the early interventions that are proven to reduce critical incidents and minimise the secondary care burden.

This forms a key part of the strategy that must address a predicted funding shortfall of up to £29billion a year by 2020, according to figures from the Nuffield Trust.

A recent research report by the trust commissioned by the National Association of Primary Care (NAPC) identified that recent NHS reforms present opportunities for a more pro-active approach to prevention and population health.

Report author, Ruth Thorlby, a senior fellow at the Nuffield Trust, said: “There was real enthusiasm for change among staff from these general practices, who feel that much more could be done to reach out to their local communities and prevent chronic conditions at the same time as taking better care of those with long-term conditions. Achieving this vision will require support to help practices make better use of their staff and data, and form strong working partnerships with other practices and providers.”

Information model

Indeed, while the evolution of joined-up care into the community makes sense for GPs, welfare providers and patients alike, the delivery of this care and the provision of the right information and services at the right time continue to challenge budget holders. What is the best way to provide the clinician – from community nurse, to specialist diabetes or dementia care provider to doctor – with access to critical patient information when working in the community? How can this information remain secure? And how can clinicians gain access to multiple information resources to ensure complete management of patients suffering more than one chronic condition?

Achieving this vision will require support to help practices make better use of their staff and data, and form strong working partnerships with other practices and providers

For this model to work it is essential to avoid paper-based recording of information to be updated later. In addition to adding time and cost to the process, manual rekeying of information is always prone to error. Such an approach would also risk creating multiple, duplicate patient records and risk a delay in clinicians spotting and taking action to remedy key indicators of disease escalation.

There are a number of approaches being discussed to facilitate effective community-based care, but the key requirement flagged by most teams is the need for tablet/mobile device access to the existing systems used within hospital departments. Extending the diabetes care system, for example, into the community by providing mobile access to information via the secure NHS Internet ensures the clinician has access to the complete patient history at all times, as well as new information on pathology tests that may need to be discussed with the patient.

With this mobile information resource, clinicians can also immediately record critical tests – from blood, glucose and blood pressure to weight and urine analysis – in the main system, rather than relying on updating information at a later date. Critically, this model can leverage the workflow processes already within a proven solution to ensure potential issues are flagged, additional tests immediately booked and consultants made aware of potential problems early.

Patient empowerment

There are also clear opportunities for patients to take a more pro-active role in managing day-to-day conditions – from mobile apps that provide reminders and advice to the use of apps or portals to upload daily test or meter reading results. The key is to combine ease of use for the patient with a solution that is tightly integrated with the core application to provide a seamless information resource. Combining effective technology with education will ensure patients understand the real benefits of taking control over their conditions and improving preventative care.

This approach provides an opportunity not only to improve the patient’s understanding of disease management, but also to transform the depth and quality of patient information collected, improving both short-term outcomes and longer-term understanding of factors that may cause an acute incident. By flagging trends in behaviour that are undermining patient wellbeing, the system can enable a pro-active response from the community care team to educate and, hopefully, change behaviour to further improve overall health.

Critically, in an NHS that is based on, and funded by, targets associated with chronic disease management, the ability to combine patient portals/apps with community-led care will be an increasingly important component of care provision. Combining the essential factors of improved local care and disease prevention with real time reporting, the mobile model will enable the NHS to extend services that have previously been only available in an expensive secondary care environment into primary care.

Realising the vision

Extending this model to the community has clear potential to improve patient care and enable local groups to meet targets for the management of chronic conditions and achieve the cost-savings required

Making community care work is going to be the biggest challenge for the next decade: the figures for reducing NHS costs and improving patient care will not add up unless more services are successfully delivered in the community and hospital admissions are reduced. Today, the funding for community-based care services remains somewhat confused as the transition to GP commissioning groups continues. Yet there remains no doubt that secondary care providers are actively seeking to extend the use of mobile devices to drive improvements in day-to-day management of chronic health conditions, from Parkinsons to heart disease and diabetes, within hospital and outpatient departments.

Extending this model to the community has clear potential to improve patient care and enable local groups to meet targets for the management of chronic conditions and achieve the cost-savings required. And it is only once this is in place that the NHS can look more closely at opportunities for community-based collaboration with other involved institutions, to achieve the whole life care that will undoubtedly be the model for future service provision.