Devon, beautiful one day, misty and cute the next. The magical natural surrounds have been the catalyst for creating Britain’s worst demographic nightmare. Nearly 8% of the population is over 85! They are where the UK will be in forty years in terms of population spread. With such a challenging patient profile, Devon is the ideal place for radical healthcare innovation.
Like the Adirondack region in the United States, an equally beautiful and hilly region, tough patients and a drastic shortage of clinicians has led to remarkable collaboration across the health and social sectors. In Devon, the council provides all of its social funding to the NHS and jointly commissions activity. This goes a long way to overcoming the divide between health and social care, so fundamental in keeping the aged and those with mental health issues functioning in the community. In addition, the hospital trust is merging with the primary care and community trust to provide one stop planning and resource allocation across the spectrum of need.
Devon’s virtual medical ward model is best of breed. It is proactive in identifying patients at risk of deterioration as well as catching those who fall. The model, initially targeted at frail aged, is now being applied to a range of other groups whose frequency of hospital admission is adding to the rapidly rising costs of care in the region. The trust and relationships developed through the multi-disciplinary approach has been the trigger for more ambitious collaboration.
The virtual medical ward, in every configuration, is led by GPs. Hospital consultants are active contributors as are all manner of clinical and social welfare providers. This combination of effective targeting, shared access to patient history and care planning for those at risk and multi-disciplinary team meetings are at the core of the model. More recent applications have led to the voluntary sector being engaged in case support, further spreading limited resources and creating social engagement for both recipients and volunteers.
Just as impressive as the algorithms for identifying patients are the care guidelines developed by local clinical groups. These address multi-morbidity, poly pharmacy and rational use of therapy in the last year of life. All are evidence based and have been embraced by both specialty and generalist medicos. They provide consistent guidance so that sound decision making occurs, whether by the ambulance service or the GP on call to support the non-urgent medical phone line or the registrar doing admissions to the medical ward at 2am.
Nobody needs much of an excuse to visit Devon. However, with their track record of innovation it could be easy to justify a return visit to see how their next raft of initiatives go…as they are too early in implementation to evaluate this month! That would also provide opportunity to check out the data on road accidents occurring on the narrow country lanes which are part and parcel of the region and how they treat the road carnage.
Tracey Johnson, General Manager, Inala Primary Care