Can Community Integrated Teams (CIT) really lead us to an improved NHS?

How will Best Practice be judged and shared across Teams?

The NHS has identified significant variability in healthcare practices across different regions, which can be both warranted and unwarranted. Warranted variation is expected due to differences in patient needs and preferences, while unwarranted variation cannot be explained by these factors and is often due to differences in professional knowledge or organizational performance.

Measuring improvements and performance across regions is crucial for identifying best practices and ensuring that high-quality care is consistently delivered. We will look at this near the end of this article, firstly lets look at ‘why’ things are not better now. This should help provide some indication of the metrics required to drive collective improvements across the NHS.

Reasons for Variability

1. Professional Knowledge and Practice: Differences in how healthcare professionals are trained and the latest evidence they follow can lead to variability in care. For example, there is a 2.5-fold variation in the percentage of key antibiotics prescribed in primary care across Clinical Commissioning Groups (CCGs), ranging from 6.8% to 16.8%
2. Organizational Performance: Variations in the efficiency and effectiveness of healthcare organizations can also contribute to differences in care. This includes differences in funding, staffing, and resource allocation.
3. Patient Preferences and Demographics: Regional differences in patient demographics and preferences can influence the type and quality of care provided. However, this is generally considered warranted variation.
4. Data and Reporting: Inconsistent data collection and reporting methods can mask or exaggerate variability. Improving the quality of data collected about the activity of the direct patient care workforce is essential.

Solutions to Address Variability

1. Standardization of Care: Implementing standardized care pathways and guidelines can help reduce unwarranted variation. This includes adhering to National Institute for Health and Care Excellence (NICE) recommendations, such as the 8 recommended care processes for diabetes patients
2. Enhanced Training and Education: Continuous professional development and training for healthcare professionals can ensure they are up-to-date with the latest evidence and best practices.
3. Data Collection and Analysis: Improving the quality and consistency of data collection can help identify and address areas of unwarranted variation. The NHS Atlas of Variation is a tool that helps commissioners and service providers identify and tackle such variations
4. Public Engagement and Communication: Better communication with the public about the reasons for expanding the direct patient care workforce and the role of general practice in a reformed NHS can help build trust and understanding
5. Integrated Care Models: Moving towards more integrated care models, where different medical disciplines work together, can improve the coordination and quality of care. The leadership of general practice during the COVID-19 pandemic has shown the potential benefits of such collaboration .

By addressing these areas, the NHS can work towards reducing unwarranted variability and ensuring that all patients receive high-quality, consistent care regardless of their location.

Community integrated teams (CITs) are playing a crucial role in improving NHS services by enhancing coordination and collaboration across different healthcare settings. Here are some examples and benefits of these teams:

• Leeds Community Healthcare NHS Trust: This trust has developed neighborhood teams that act as a hub for service integration. These teams help reduce duplication, improve patient experiences, and provide more opportunities for staff to work and train in different care settings
• Central London Community Healthcare NHS Foundation Trust: They have implemented a joint case management service between primary care and community services. This initiative ensures that care is more integrated and person-centered, leading to better outcomes for patients
• Hampshire and Isle of Wight Healthcare NHS Foundation Trust: In collaboration with New Forest District Council, they embedded a mental health nurse within the council’s housing team. This partnership focuses on early intervention and support for tenants with mental health issues, improving both housing and health outcomes
• NHS Surrey Heartlands ICS: They have established networks that meet quarterly to foster collaboration among various partners, including the NHS, local authorities, voluntary sector organizations, community leaders, and more. These networks address local issues affecting community health and wellbeing and have led to initiatives such as improving GP access, community-led dance programs, and cookery classes to support healthy eating

Benefits of Community Integrated Teams

1. Reduced Duplication and Improved Efficiency: By working together, community integrated teams can reduce duplication of services, leading to more efficient use of resources and better patient outcomes
2. Enhanced Patient Experiences: Integrated care ensures that patients receive more coordinated and person-centered care, which can lead to improved satisfaction and better health outcomes
3. Holistic Care: Multi-disciplinary teams can address the holistic needs of patients, including physical, mental, and social aspects, leading to more comprehensive and effective care
4. Workforce Development: Integrated teams promote resilience and skill development among healthcare workers, allowing them to work across different settings and understand the benefits of community-based care
5. Preventive Care: By focusing on prevention and early intervention, community integrated teams can help reduce the need for more intensive and costly treatments later on
6. Community Engagement: Collaboration with community groups and local organizations can build local health-creating capacity and address the wider determinants of health, such as housing and social support

These examples and benefits demonstrate the significant impact that community integrated teams can have on improving NHS services and enhancing the overall health and wellbeing of local communities.

Measuring improvements and performance across regions is crucial for identifying best practices and ensuring that high-quality care is consistently delivered. Here are several methods and tools that can be used to measure and promote shared best practices:

1. Standardized Metrics and Benchmarks

• Key Performance Indicators (KPIs): Develop and use standardized KPIs to measure performance across different regions. These can include:
• Clinical Outcomes: Measures such as readmission rates, patient satisfaction scores, and treatment success rates.
• Operational Efficiency: Metrics like waiting times, appointment availability, and resource utilization.
• Patient Experience: Surveys and feedback mechanisms to gauge patient satisfaction and quality of care.
• Benchmarks: Establish national or regional benchmarks to compare performance and identify areas for improvement.

2. Data Collection and Analysis

• Centralized Data Systems: Implement centralized data systems to collect and analyze data from different regions. This ensures consistency and comparability.
• Data Quality: Ensure data quality through regular audits and validation processes to maintain accuracy and reliability.
• Advanced Analytics: Use data analytics and machine learning to identify trends, patterns, and areas of high performance.

3. Peer Reviews and Audits

• Peer Reviews: Conduct regular peer reviews where healthcare professionals and managers from different regions assess each other’s practices and provide feedback.
• External Audits: Engage independent auditors to evaluate performance and provide objective assessments.

4. Performance Dashboards

• Real-Time Dashboards: Develop real-time performance dashboards that provide visual representations of key metrics. These can be accessed by healthcare providers, managers, and policymakers.
• Accessible Reporting: Ensure that performance data is easily accessible and understandable to all stakeholders, including healthcare providers, patients, and the public.

5. Best Practice Sharing Platforms

• Collaborative Networks: Establish regional and national collaborative networks where healthcare providers can share best practices, challenges, and solutions.
• Online Platforms: Use online platforms and databases to document and disseminate best practices. Examples include:
• NHS Knowledge Hub
• National Institute for Health and Care Excellence (NICE) Guidelines
• Webinars and Workshops: Organize regular webinars, workshops, and conferences to facilitate knowledge sharing and professional development.

6. Patient and Public Involvement

• Patient Feedback: Actively seek and incorporate patient feedback through surveys, focus groups, and patient advisory boards.
• Public Reporting: Publish performance data and best practices in a transparent and accessible manner to engage the public and build trust.

7. Quality Improvement Initiatives

• Continuous Improvement Programs: Implement continuous quality improvement (CQI) programs that focus on ongoing monitoring and enhancement of care processes.
• Root Cause Analysis: Conduct root cause analysis for any identified issues to understand underlying causes and develop targeted solutions.

8. Research and Evaluation

• Research Projects: Fund research projects to evaluate the effectiveness of different practices and interventions.
• Pilot Programs: Implement pilot programs to test new approaches and evaluate their impact before scaling them up.

9. Policy and Governance

• National Policies: Develop and enforce national policies and guidelines to ensure consistency in care delivery.
• Governance Structures: Establish robust governance structures to oversee performance measurement and improvement initiatives.

10. Technology and Innovation

• Telehealth and Digital Health: Leverage telehealth and digital health solutions to improve access to care and enhance patient engagement.
• Electronic Health Records (EHRs): Implement EHRs to facilitate the sharing of patient information and improve care coordination.

References and Links

• NHS England and Improvement: “Performance Management and Improvement”
• Link: NHS Performance Management
• National Institute for Health and Care Excellence (NICE): “Guidance and Standards”
• Link: NICE Guidance
• NHS Digital: “Data and Information”
• Link: NHS Digital
• Health Foundation: “Improvement and Quality”
• Link: Health Foundation Improvement and Quality

By implementing these strategies, the NHS can effectively measure performance, identify best practices, and ensure that high-quality care is consistently delivered across regions.

Additional Information:

1. Data Collection and Reporting:

• NHS England and Improvement: “Workforce Data Quality and Reporting”
  • Link: NHS Workforce Data Quality and Reporting

1. Standardization of Care and NICE Guidelines:

• National Institute for Health and Care Excellence (NICE): “Guidance and Recommendations for Healthcare Professionals”
  • Link: NICE Guidance
• NHS Atlas of Variation: “Identifying and Tackling Unwarranted Variations in Healthcare”
  • Link: NHS Atlas of Variation

1. Enhanced Training and Education:

• Health Education England (HEE): “Continuous Professional Development (CPD) for Healthcare Professionals”
  • Link: HEE CPD

1. Public Engagement and Communication:

• NHS England and Improvement: “Public Engagement and Communication Strategies”
  • Link: NHS Public Engagement

1. Integrated Care Models:

• NHS England and Improvement: “Integrated Care Systems (ICS) and Primary Care Networks (PCNs)”
  • Link: NHS Integrated Care Systems
• NHS Confederation: “Case Studies and Best Practices in Integrated Care”
  • Link: NHS Confederation Integrated Care

1. Regional Variability in Healthcare:

• NHS Digital: “Statistical Analysis of Healthcare Variability Across Regions”
  • Link: NHS Digital Healthcare Statistics

1. Professional Knowledge and Practice:

• General Medical Council (GMC): “Good Medical Practice and Professional Standards”
  • Link: GMC Good Medical Practice

These resources provide detailed information and data that support the points discussed regarding the variability in NHS services and the strategies to address them.