Independent evaluation of the North East Hampshire and Farnham Vanguard Happy Healthy at Home: using the NPT framework to evaluate the Enhanced Integrated Care Teams [EICTs] in Farnborough, Aldershot and Fleet localities

Abstract

Background To achieve better patient centred care, greater efficiency, and improved outcomes, the findings of reviews of successful integrated care systems (Williams and Sullivan, 2010; Ham and Curry, 2011; and the Five Year Forward View (NHS England, 2014; GovUK, 2015) recommended greater partnership working and new integrated models of care. EICTs [Enhanced Integrated Care Teams] aim to give GPs and other healthcare professionals access to a team of experts to identify those at risks and develop a care plan that include making or supporting referrals to EICTs and other health and social care services before tracking progress of patients and keeping GPs informed in order to try and reduce attendance to A&E and unplanned admissions.

Aims and objectives The team evaluation sought to understand the experience of the staff involved in developing and delivering the implementation of the EICTs in three localities in Wessex [EICTs 1-3] overseen by Salus Medical Services, including enablers and barriers to embedding EICTs 1-3 in daily routine practice in a long term sustainable way.

Methods The conceptual framework was mixed methods (Plowright, 2015) informed by Normalisation Process Theory (May and Finch 2009), Force Field Analysis (Lewin, 1949; 1951) and Alexander (1985) team effectiveness. Data collection was by way of: non-participant observation of a regular multi-disciplinary team meeting [MDT] (n=38) [EICTs 1 n=15; EICTs 2 n=14; EICTs 3 n=10]; a structured focus group that took place directly following the MDT (n=23) [EICTs 1 n=6, EICTs 2 n=8, EICTs 3 n=9] and an anonymous survey (n=30) [EICTs 1 n=8, EICTs 2 n=12; EICTs 3 n=10]. Data were analysed using NPT (May and Finch, 2009) and thematic analysis (Braun and Clarke, 2006).

Results The highest overall score (n=29) was for Team members can see potential value of EICTs for their work [coherence] [8.7] [8.8; 9.0; 8.3] and Team members continue to support EICTs [cognitive engagement] [8.7] [8.6; 9.2; 8.2]. The lowest overall score [n=30) was for sufficient resources are available to support EICTs [collective action] [6.6] [6.7; 7.5 2; 5.6] and for team members can access information about E/ICTs and are aware of the effects of E/ICTs [reflexive monitoring] [6.8] [6.2; 7.5; 6.8]. The top barrier category was for staff shortages/competing demands on staff followed by ‘problems with IT (+IG)/phones’ and ‘unclear to outsiders/lack of awareness by those external to EICTs’. The top driver category was team/MDT/learning from MDT followed by patient outcomes and flexibility/autonomy/no traditional boundaries. Overall (n=29) team members agreed that they felt valued as team members and that EICTs had achieved its team goals [8.2] [8.1 for EICTs 1; 8.8 for EICTs 2; 7.7 for EICTs 3] which included identifying individuals at risks and developing a care plan entailing referrals to other services (e.g. social prescribing/voluntary sector), a cultural shift in organisational integration and shared learning by working with partner agencies. The relatively low score (less than 7) for the non-NPT question Those external to EICTs are aware of the range of services offered by EICTs [6.4] [6.4, 7.1 and 5.8] mirrored the results of the focus group in which ‘unclear to outsiders’ i.e. lack of awareness of what EICTs can offer was identified as a top key barrier.

Conclusion This pragmatic evaluation of EICTs 1-3 in a real life setting undertaken with limited resources found that they all are doing well in respect of all NPT domains, with EICTs 2 having the highest overall average scores and EICTs 3 the lowest (but still overall good average scores). EICTs are doing comparatively less well in relation to reflexive monitoring and collective action, especially EICTs 1 and EICTs 3 with a handful of questions rated below 7. Team members in all EICTs had a strong belief a belief in the value and benefit of EICTs. For historical reasons, in one locality GPs did not engage with the MDT and EICTs, but this had not stopped them achieving their goals, but the team was hopeful and making (slow) progress in getting the GPs engaged so they would take part in the weekly MDT as in the other 2 localities. EICTs planned for more staff to undertake proactive reviews and for the team to be more fully integrated.

Recommendations Improving IT and IT support and ensuring better integration across networks and patients’ records management systems as this would facilitate team work and help optimise patient outcomes. EICTs should be encouraged to make widely accessible all available information about what EICTs do and the impact of what they do. This would help those external to EICTs, including senior managers, to become more fully aware of the effectiveness and worthwhileness of EICTs. All three EICTs localities acknowledged that more progress had to be made and EICTs 3 planned to continue to work to get GPs more engaged and a more pro-active approach and wider organisational integration would be the ultimate aims.

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