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Finding new ways of doing things differently

Dr Chris Leggett, GP lead for Down Integrated Care Partnership
Dr Chris Leggett, GP lead for Down Integrated Care Partnership

Despite the current headlines about the pressures on GPs, one Co Down doctor is enthusiastic about his job and the vital role he can play in making a difference to patients’ lives.

Castlewellan-based Dr Chris Leggett is the chair and GP lead of Down Integrated Care Partnership, (ICP), one of 17 ICPs throughout Northern Ireland charged with designing and co-ordinating local health and social care services.

With over 30 years’ experience, Dr Leggett has been involved with collaborative working in the past – he was Chair of the Donard Commissioning pilot between 1991 and 2002 – and is keen to encourage other health professionals to get involved in ICPs.

Dr Leggett is passionate about a number of ICP initiatives which have already proven to make a difference to patients’ lives. Among them is a new coordinated service for people who have fallen at home and have been attended to by the Northern Ireland Ambulance Service (NIAS).

“Falls are very common in the elderly and a serious cause of distress among patients and their families. In addition, a fear of falls can have a devastating impact, leading to reduced activity, and social isolation,” he said.

“Paramedics attending a call out to an elderly patient who has fallen in their home can now make a referral to a falls assessor who will visit within 24 hours. They provide support and advice, identifying and addressing risks that could lead to further falls and co-ordinate any referrals to other medical services.

“In addition, strength and balance programmes have been proven to have a very significant effect on reducing further falls.  Held in the community, they’ve been shown to help reduce falls by 50 per cent and participants are also positive about them, helping to boost confidence and improve socialisation,” he said.

Another initiative, which frees up people from hospital admission, is the Enhanced Care at Home model, providing older people with expert medical and social care in their own home.

The patient is cared for at home with the support of a Consultant Geriatrician and the patient’s own GP. The team also includes specialist nurses, social care and Allied Health Professionals, such as physiotherapists.

“It not only frees up beds for more serious cases , but ensures patients are cared for in the comfort of their own home instead of a distressing hospital admission to unfamiliar surroundings, and the adverse health outcomes that can result, such as loss of confidence and independence, ” explained Dr Leggett.

Provided within Ards and North Down, there are now plans to roll it out across the South Eastern Local Commissioning Group area.

“These may not be cutting edge projects, but they can make a real difference. It’s these sorts of projects which can make a huge difference to patients and their families,” he said.

The North Down and Lisburn ICPs currently have a vacancy for a GP lead, so why would GPs want to get involved?

“As GPs we are perfectly placed; we know the system, we know the needs of patients and whether we appreciate it or not, we are experts in the community. I think we can use that experience and knowledge to work with others to make a difference, “said Dr Leggett.

Given the current well documented state of health and social care service in Northern Ireland, how does he remain positive and optimistic about the role of ICPs?

“I suppose it’s the motivation of finding new ways of doing something. It’s an opportunity to make a difference and address the things which frustrate you and help improve the system for patients. And it’s about educating other colleagues, encouraging GPs and district nurses and relatives to refer to these new services.

“It’s all about helping developing communications between different organisations and facilitating good relationships with the community and voluntary groups, hospitals and GPs. We have made some good progress on the ground.

“I think it would ideally suit a part-time GP, who could dedicate one day per week to ICP work, and they will get paid per session to ensure locum cover during that time.

“There is an opportunity to make a difference and address the things that frustrate you and improve the system for patients,” he said.
An ICP Interim Impact Report was published in November 2016, highlighting new ways of working and of delivering services which have impacted on patients, carers and health care staff.

Some of the projects include:
Enhanced Foot Care Pathway in the Northern area, a pilot scheme trying to bring the number of amputations down. Patients can see their podiatrist, dietician and nurse under one roof all within 24 hours, if required. As a result, the number of minor amputations carried out on patients in the Causeway and Mid Ulster ICP areas has reduced by 90 per cent.

Nursing Home In Reach in the Northern area
This initiative focuses on very frail older people living in nursing homes, who commonly experience a high level of attendance at Emergency Departments. Staff working in nursing homes in the Antrim and Ballymena area receive specialist education to enable them to provide more care for their residents in the home, rather than hospital.

To date there’s been a 25 per cent reduction in the number of visits from Marie Curie staff out of hours and a 48 per cent reduction in the number of calls to the hospital diversion team relating to feeding tubes.

Community Respiratory Teams in the Western area
The community respiratory team complement the existing respiratory service in the West, with patients and carers receiving an improved standard of co-ordinated care; are better informed and educated about self-management and early intervention; and have enhanced access to other services, including community pulmonary rehabilitation programmes. One of the major impacts has been a reduction in waiting times for oxygen assessment 13 months to 3 months.

Established in 2013, Integrated Care Partnerships (ICPs) are a novel way of working for the health and social care service in Northern Ireland to transform how care is delivered.

A total of 17 collaborative networks across Northern Ireland, they are based around natural geographies of approximately 100,000 people. They consist of healthcare professionals, working alongside voluntary and community groups, service users and carers, to keep people well and make sure they get the care they need, when they need it, closer to home, and help avoid unnecessary hospital visits.

Commissioned and funded by Local Commissioning Groups, the ICPs focus on diabetes, respiratory, stroke and services for frail older people.
Over the past three years £12,747,000 has been invested in services designed and implemented by ICPs, focusing on preventing illness where possible, delivering more care in the community, reducing demand on hospital services and improving patient and carer experience.