• 10May

    Patient-centred care for older people with complex needs

    Patient-centred care for older people with complex needs: Evaluation of a new care model in outer east London

    This study evaluates a ‘one-stop’ primary care service within three London boroughs for older people with complex health care needs.

    Health 1000 was a new model of care dedicated to addressing the health and social care of patients with complex needs across the London boroughs of Barking and Dagenham, Havering and Redbridge (BHR). It aimed to improve quality of life through personalised care delivered by a clinically-led multidisciplinary team, focusing on prevention and early intervention and supported by contributions from the third sector.

    Individuals who were considered eligible for the service were contacted via their registered general practice, and invited to transfer from their current primary care practice to Health 1000. For those who consented, the patient de-registered with their current practice and re-registered with Health 1000.

    The Nuffield Trust was commissioned by the Redbridge Clinical Commissioning Groups (CCG) to evaluate this service. They used a mixed methods approach to understand who was using the service and its impact on the use of primary and secondary care services, and on staff and patient experiences.

    Key points

    • Health 1000 provided a ‘one-stop’ primary care service to older people within three London boroughs who had complex health care needs.
    • The service included a multidisciplinary team of health care professionals and specialists who provided proactive patient-centred care.
    • The original plans were for a service that catered for 1000 patients, but fewer than half that number were registered over two-and-a-half years.
    • Problems with recruitment were mainly due to difficulties engaging with local GPs and persuading them to de-register some of their patients, as well as persuading patients themselves to try out the new service.
    • Patients were generally very satisfied with the service, as were the staff.
    • Patients liked the friendly atmosphere, the attentiveness of clinical staff, the availability of GP appointments and the caring nature of the service.
    • There have been challenges with electronic prescribing, the distance doctors have to travel to see some patients and integrating with other services in the area.
    • Staff had reported reductions in unnecessary outpatient referrals and significant improvements to medicines management. They had also referred to the benefits of better care continuity, for example in enabling quicker discharges from hospital and avoiding duplication across the system.
    • However, there is no evidence that the service reduced use of hospital services – whether for all patients, those who satisfied the original eligibility criteria, or those at end of life. However, with the numbers of patients and the period of follow up, it may be too soon to detect any such change.

    Sherlaw-Johnson C, Crump H, Arora S, Holder H and Meaker R (2018) Patient-centred care for older people with complex needs: Evaluation of a new care model in outer east London. Research report, Nuffield Trust.

    Full article is available here: https://www.nuffieldtrust.org.uk/research/patient-centred-care-for-older-people-with-complex-needs