Working with the North West Clinical Leaders Network made redesigning local services on the Wirral less of a struggle, as David Rowlands explains

For the NHS to work best, patients needs to be seen at the appropriate time, in the appropriate place, by the appropriate person.

This supports the drive towards delivering care closer to home, within primary care. It also supports some patients being seen by secondary care clinicians in a primary care setting or by primary care clinicians in a secondary care setting.

This way, long-term conditions can be better managed and public health priorities can be addressed.

Service modernisation

On the Wirral, this shared ethos has led to the development of a Wirral-wide gynaecology modernisation group, which has now developed into a women's services modernisation group to encompass all aspects of gynaecology and obstetrics.

With the support of secondary care, an intermediate gynaecology service was established, which is audited through the modernisation group. Several years down the line, this service is seeing the appropriate women and has a very low onward referral rate to secondary care.

This arrangement has allowed more women to be given next-day outpatient appointments, avoiding non-urgent admissions. It has also made it possible to provide more complex gynaecological surgery, such as laparoscopic hysterectomy and excision of severe endometriosis through a minimal access. Inpatient length of stay has fallen to 24 hours or less because of shorter recovery times.

Working together

One of the major challenges for healthcare has been to adapt to central policies such as patient choice, choose and book and the 18-week referral to treatment target.

Being part of the Clinical Leaders Network has allowed service planners on the Wirral to have a dialogue with senior policy leaders in the Department of Health, which has helped us to see where the DH is coming from and to inform the DH of the practicalities of what is proposed.

The DH is committed to reducing the length of time people wait and it is here that service redesign has immense potential - not only in terms of months and weeks, but in terms of days, hours and even minutes.

Service redesign and integration of care between primary and secondary care (and ideally social services) makes the best use of limited resource.