I want to tell you about the learning emerging from Productive Community Services, which the NHS Institute will launch later this year.
Community services are NHS services provided in local care settings but not by GPs or other independent practitioners. They represent a significant proportion of NHS patient care: around 9 per cent of spending and 25 per cent of staff numbers.
We have spent a year designing Productive Community Services and testing it intensively with our 12 local primary care trust development partners. It focuses on field based services provided in patients’ homes, which represent about 70 per cent of all the activity in community services.
The indications are that this programme will be as successful as Productive Ward. However, it is more complex and challenging than any of our previous Productive programmes. Community staff often work alone in people’s homes dealing with vulnerable people in sometimes distressing circumstances. They are the real front line of NHS care delivery.
“Teams can waste up to 15 hours a week due to sub-optimal travel patterns”
The first observation we made is just how much variation there is in community services. Some PCTs spend twice as much per head as others on community services. Within district nursing, for instance, the cost per contact for face to face visits varies by 143 per cent between PCTs and there is wide variation in the number of visits per team member per day. This variation also typically applies to the day to day work of clinical teams. There is huge potential for local teams to learn from good practice.
Time with patients
A recent PCT study indicated that frontline community staff spend less than 40 per cent of their time directly with patients. Our own observations, with a smaller sample, suggest about 30 per cent. The potential to release time to care is significant. For instance, rework on incomplete referrals can take a team of eight up to eight hours a week, while sub-optimal travel patterns can waste 15 hours a week.
We estimate that if all the improvement ideas from Productive Community Services were adopted, the proportion of time spent with patients could increase by 50 per cent.
We are working with our PCT partners to translate the improvement ideas into a series of modules that any community team can use. As with other Productive programmes, the “big ideas” are not rocket science but practical solutions to energise and mobilise staff. This includes:
- basic planning and scheduling to match demand and capacity;
- co-ordinating with other care partners such as GPs;
- preparation for patient visits;
- reducing paperwork;
- managing performance as a team.
Measurement is critical. The teams are testing a range of metrics to gauge improvements in patient experience, use of resources, staff wellbeing, and safety and reliability of care.
Our 12 local testing partners are making a tremendous contribution. If the calibre of leadership they display is representative of other PCT providers, then the future of community services is very bright indeed.