Three new teams of NHS healthcare staff and council social workers are pioneering an innovative way of helping people who have the most complex health and care needs.
The pilot High Impact Primary Care teams, being led by Manchester Local Care Organisation, are intended to help find ways of transforming the way people use NHS and care services.
Emma Gilbey, programme manager from MLCO, explained: “The team builds a relationship of trust so we become people’s service of choice and then we support them to manage their health in a different way.
“They will have other issues than their health – maybe debt, housing problems, family difficulties. What we are able to give them is time and flexibility. If they need an hour’s appointment to talk through all their issues then we can do that together with different professionals.
“We will identify what is important to them and what will make the difference. It is not about fixing illness, it is about long-term interventions.”
The service is targeted at the two per cent of people who are estimated to be the highest users of NHS and care services. They are identified by GPs in the neighbourhood and referred to the team.
Emma said: “The people we are working with are those for whom the existing primary and
community services don’t work. They are heavy users of hospital services, turning up at A&E for example.
“It is very early days for the teams, but they are loving the new way of working and the trust they develop. It’s the way primary care should be.”
High Impact Primary Care teams have been set up in three neighbourhoods: Cheetham Hill and Crumpsall, Gorton and Levenshulme, and Wythenshawe and Baguley.
The team in the north of the city has been supporting people since November from its base at
Cheetham Hill Health Centre, while the teams in the central and south areas have begun their work during February.
The service is commissioned by Manchester Health and Care Commissioning (MHCC) through the city’s GP federations. The federations employ the GP, nurse and a service manager who helps to ensure the programme meets its objectives. The team also includes a pharmacist, a social worker and a health coach - all coming together around the needs of the patient.
Carol Rutter, of North Manchester GP federation, said: “The team comes together to wrap care
around the patient. By being commissioned through the federations we can ensure that a consistently high standard of service is provided to patients, regardless of which practice they are registered with.”
Dr Sohail Munshi, clinical lead for the service and chief medical officer from MCLO, added: “I want to thank everyone involved for all their hard work so far. This is a great example of what can be achieved through organisations working together, putting the person at the centre of their care."