Home Visiting Service covering South Eastern Hampshire and Fareham and Gosport population only

Following the placement of the PIN, Hampshire, Southampton and Isle of Wight CCG, Covering South Eastern Hampshire and Fareham and Gosport population only award of contract to Badgerswood Surgery, Swan Medical Group, Vine Medical Group, Oaks Healthcare, The Elms Practice, Highlands Practice, Centre Practice, Stubbington Medical Practice and Willow Group for the provision of Hove Visiting Service. For a period of 3 years with optional 2 year extension period.

Service Description

The service will provide access to a home visiting service on weekdays during core hours (08.00am - 18.30pm).

This service will be delivered at scale across the agreed grouping of practices which has been agreed locally based on geography and patient needs.

Where possible the service provider will deploy a multi-professional work force, which includes new and emerging Primary Care Network roles, to ensure a skill mix which would include GPs, Nurses, Paramedics, Health Care Assistants and other professionals appropriate to meet the needs of the patient population in line with core GMS. It is expected this will include an appropriately qualified clinical team led by doctors. Patients will be treated by the clinician best equipped to meet their needs (especially at periods of peak demand). The service model should be integrated with the patients registered practice to provide wrap around care where required.

The aims of the service are to provide visits to patients earlier in the day than General practice is otherwise able to do. This is to prevent avoidable hospital admissions due to patients feeling unable to wait, and where patients do require a hospital admission; as a result this should happen earlier in the day and prevent the patient having to stay in overnight unnecessarily. The service should also provide sustainability to general practice.

Please see attached service specification for full details of the service requirements.

• This delivery of this service is most suitably delivered by the Badgerswood Surgery, Swan Medical Group, Vine Medical Group, Oaks Healthcare, The Elms Practice, Highlands Practice, Centre Practice, Stubbington Medical Practice and Willow Group providers for the following reasons:

Patient Needs and quality:

• To ensure full access to patient notes and records is available ensuring the best and safest care can be provided to patients
• To provide continuity of care by working as part of the patients usual GP practice and the wider PCN workforce
• Patients already contact their practice for their primary care needs, so this ensues no further step is required from the patient to access a home visit
• Ability to utilise the PCN workforce is critical to the proactive care to be provided to patients.
• Improve public confidence in general practice availability,
• A skill mix of staff should decrease GP time required for Home Visiting and release them back into practice
• Contracting for the whole population so that unwarranted variations in care are minimised
• Contracting for the whole population so that scale efficiencies can be delivered
• Workforce flexibilities through scale with practices working across PCNs
• Building on the current general practice workforce to ensure local knowledge and relationship benefits are maximised and investment can support the sustainability of general practice as the bedrock of local community services
• Patients visited earlier in the day will be less likely to be admitted and if admitted will be less likely to have an overnight stay

Efficiency:

As home visits are required within the core GMS contract this service provides 'top up funding' to meet over and above GMS home visiting requirements. This prevents it from being separated out and funded as a standalone service from a separate provider.

This service has been piloted by General Practice working primarily at PCN level with local nuances based on Geography, since 1st July 2018. This has been thoroughly evaluated at two points since then, and it has been concluded that the successful embedding of this service, as well as the ability of the providers to meet the outcomes as outlined in the specification is owed to the fact it is provided by the practices that patients already receive their primary care needs from, and the access to the wider workforce that gives them. Some key points on this are provided below:

• Workforce has been diversified with HVSs making use of a range of staff including GPs, paramedics, physician associates, nurses, community matrons, pharmacists and health care assistants
• Patients are being seen earlier in the day and either treated or referred to ED earlier, reducing the length of stay in hospital
• All HVSs reported, as a result of the introduction of their HVS, GPs' time was better used.
• Most GPs are reporting that they only spend 0-30 minutes per day on home visits now, in comparison to +120 minutes prior to the scheme
• Up skilling and better job satisfaction for all staff involved. Community nurses were reported to have benefited from HVS expertise and GPs were reported to be happier.
• There had been a 18% decrease in the total GP referred ED attendances when comparing the same period prior to the service being in place, compared with during..

In addition the potential system benefits attributed to this service are as a result of the efficiencies realised through funding this via primary care.

The service has also had an extremely positive effect on practices, with 85% of Clinicians reporting that the service has reduced their stress levels and 86% reporting that the service has had a positive impact on the sustainability of their practice.

This service will be led and delivered by GP Practices to cover the Fareham and Gosport and South Eastern Hampshire CCG population.