Author Topic: What actions can we take to improve integrated services? (Read 55 times)

Laxmikant Tyagi · « **on:** May 11, 2015, 02:35:55 pm »

Actions

Risk Stratification of patients in GP surgeries to proactively manage and co-ordinate care of the people at risk outside of hospital.
Closely aligned health, social care and community teams working with acute providers to ensure a seamless admission into hospital and discharge from inpatient stay.
Some admissions and length of stays will be avoidable with more appropriate non-hospital services and workable pathways.
Ensuring that all opportunities for joint commissioning of integrated services are exploited.
Exploring ways to appropriately address the rising admissions from residential homes where care is best provided in the community.
GPs improving quality of care and life for patients and to help them to avoid emergency admissions to hospitals where possible (Direct Enhanced Service).

Outcomes
Increased number patients referred to community care teams as an alternative to hospital admission from agreed baseline.
Agree integrated working model for health and social care teams across primary care, secondary care, social care and the voluntary sector.
Increase in the number of people living well in the community with long term conditions as a result of the enhanced service in primary care.

For further information: http://www.warwickshirenorthccg.nhs.uk/mf.ashx?ID=3234e3a0-ff3c-4e49-9db5-2bbe162b89ad
http://www.warwickshirenorthccg.nhs.uk/mf.ashx?ID=27aeec71-5834-43e4-b050-99fdd4c940c9

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