WINNER: Hull Clinical Commissioning Group – The Jean Bishop Integrated Care Centre

This centre provides a community frailty pathway with GPs, advanced nurse practitioners, social workers, pharmacists and other specialists working together as a single system.

Since it opened in May 2018, it has led to a 10 per cent reduction in both emergency department attendance and emergency admissions, and a saving of £72 a year per patient on drug costs.

For those reviewed in their own homes, the reduction in emergency admissions has been 29 per cent and for those reviewed in care homes 24.3 per cent.

The team has proactively intervened with 3,100 patients identified as being at risk of severe frailty with more than half of them having a comprehensive geriatric assessment.   

Read a detailed case study on this project on HSJ Solutions.


Wellbeing Enterprises Community Interest Company and North West Boroughs Healthcare Foundation Trust – Community Wellbeing Services, St Helens


  • Betsi Cadwaladr University Health Board – Health and Wellbeing Service at Her Majesty’s Prison Berwyn, North Wales
  • Bury CCG, Bury and Rochdale Care Organisation, Northern Care Alliance and the North West Paediatric Allergy and Infection Network – Empowering families and healthcare in milk allergy
  • Manchester University Foundation Trust – Manchester Community Response – Acute Atraumatic Low Back Pain Service
  • Mansfield and Ashfield CCG – Collaborative working delivering dermatology transformation 
  • Midlands Partnership Foundation Trust – Staying Well pathway – supporting frail patients to live and age well
  • Northumbria Healthcare Foundation Trust – Swallow Screening in Care Homes
  • South Tyneside and Sunderland Foundation Trust, Pennine MSK Partnership and Newcastle University – Paediatric Musculoskeletal Triage in the Community – RightPath: A Pilot Study
  • Turning Point – Leicester, Leicestershire and Rutland Substance Misuse Services