• Harrogate PACS admits it had to change its model because its first version was not working
  • Vanguard claims staff “had no capacity” to test their original model due to pressures of their “day jobs”
  • New model covers a smaller population over just three GPs practices

A national vanguard site has told HSJ that it has started “afresh” with its new care model after the version used in the first two years “didn’t work”.

The Harrogate integrated primary and acute care system said from April 2017 it started “afresh” with its new care model after a recognising that its original model was not working and “had no impact on admissions or attendances.”

Cath Dorman, programme director for the vanguard, said the key problem with its initial model was that staff “had no capacity to think differently to test new ways or working because they were working flat out doing the day job”.

The PACS received £4.2m of national funding across 2015-16 and 2016-17.

Ms Dorman said: “In 2016-17, we implemented a model of integrated community care teams across the district, following a small pilot in the east of our patch. The model did not succeed and had no impact on admissions or attendances, engagement with mental health and social care was very limited, and engagement with practices was pretty non-existent – and so therefore we brought it to a close.”

As a result, the vanguard had to implement its “plan B”.

As part of the new model, the vanguard has created an “integrated response team”, which supports just three GP practices covering a population of 45,000. This is a significant downsizing from the original model, which covered 17 practices.

Harrogate has received £1.5m for 2017-18, which it Ms Dorman said allows it to run the new model “almost in a parallel world, away from the intense demands on community nursing services and social care in particular”.

The model relies on a new quality improvement system, based on Toyota production systems and the Virginia Mason Institute, and as part of this the integrated response team has a daily meeting and daily reporting of outcome metrics.

Ms Dorman said: “The premise of this team, that is different to what has gone before, is the attempt to identify people approaching crisis rather than at crisis, to stabilise their situation, optimise their care and prevent unplanned admissions/emergency department attendances.”

Ms Dorman’s comments were in response to questions from HSJ about a predicted negative return on investment by 2021, made in a financial template submitted to NHS England earlier this year.

She said NHS England’s financial template “assumes that we were building on what worked from previous years of the programme, however our model didn’t work. The template included/brought forward the sunk costs from last years and therefore have a negative return on investment.

“Our model starting afresh from 1 April 2017 actually gives a healthy ROI.”

The organisations working on the original vanguard model were:

  • Harrogate and District Foundation Trust;
  • Harrogate and Rural District Clinical Commissioning Group;
  • North Yorkshire county council;
  • Tees, Esk and Wear Valley FT;
  • Harrogate borough council; and
  • Yorkshire Health Network (representing 17 general practices in the district)