Four improvement programmes offering a path to sustainable recovery

The five sites introduced a range of practical approaches to improving continuity of care. One project, run by the Valentine Health Partnership, used practice data to identify usually healthy patients who were experiencing new or changing symptoms, having seen many different doctors in a short space of time. They found that allocating one lead GP to those patients helped to reduce their use of A&E and urgent care. In another part of the programme, Morecambe Bay Primary Care Collaborative and One Care collaborated to produce the Continuity of Care Toolkit, an in-depth, practical guide to improving continuity which is now being shared by RCGP.  

General practice is facing big challenges around workforce and demand. Continuity of care isn’t the only solution to these problems, but the programme findings clearly indicate that it can play a role in supporting more efficient consultations, enabling patients to play a greater role in their own care and providing quality of access.  

A soon-to-be-published mixed-methods evaluation of the programme, commissioned by the Health Foundation, found that continuity of care can be achieved without detriment to patient access (only 15% of patients weren't willing to wait longer to see their preferred GP), and that implementing continuity of care interventions can lead to efficiency and quality gains. 

Mark Rickenbach worked on the programme on behalf of RCGP as a clinical champion across all the projects. He says: 

'The paradox is that as workload increases for our GPs, continuity of care tends to decrease. Instead we should actively focus on continuity of care as a solution – to help reduce costs, urgent care needs and workload. The work of the Continuity of Care programme shows this can be done without necessarily having to make huge changes, and that it leads to definite benefits, for patients, for staff and for the system overall. The toolkit provides a really useful resource. Anyone wanting to improve continuity of care can dip in and out of this to pick a few things to adapt to their local practice.'  

One year into the 3-year programme, the partnerships are already producing learning about the value of collaboration between the voluntary and community sector and the NHS in supporting recovery from the pandemic. For example, Common Ambition Brighton and Hove is showing how local voluntary and community sector organisations can support transitions between NHS services for homeless people. 

Health inequalities have widened during the pandemic and addressing this will be an important part of health and care system recovery. The partnerships are involving their communities to make sure service improvements focus on those with the greatest need, and those with the poorest outcomes and experiences.  

Common Ambition Bristol is working with local African and Caribbean heritage communities to increase the uptake of HIV testing and broader sexual health services, and to reduce late HIV diagnosis and stigma. The partnership is beginning to test a range of coproduced interventions, including a monthly dedicated sexual health clinic for African and Caribbean heritage communities and a community engagement programme with local barber shops.  

The Common Ambition programme is supporting health systems to align the goals of patients and clinicians, and generating a better understanding of how communities can contribute to service improvement. 

Inspired by our report on the role of the NHS as an anchor institution, and delivered by the Innovation Unit, the HALN has over 1,200 participants. The network aims to support health care organisations and systems to improve (or get started on) their anchor work through connecting people, sharing learning and developing practical tools and resources. 

‘Some excellent anchor action was already happening’, says Health Foundation Programme Manager Jenna Collins. ‘But the HALN has given a forum for participants to share learning and connect with others, enabling them to further progress their anchor ambitions and adopt new approaches in their own contexts. This is particularly important in the light of the challenges facing the health and care system in the recovery from the impact of the pandemic.’  

Our research into how anchor institutions responded during the pandemic demonstrated how COVID-19 galvanised the NHS into more purposeful action in its role as an anchor. Intentionally using its wider resources and influence on areas such as employment, procurement and environmental sustainability can help reduce local health inequalities and develop thriving communities during the COVID-19 recovery period and beyond.  

In March 2022, we awarded Test and Learn funding for six NHS organisations to test innovative anchor approaches and generate new and valuable learning for the HALN. For example, three projects are focusing on how the NHS can widen access to quality work for local people. Projects in Doncaster and Essex are specifically looking at supporting young people’s employment opportunities. A project in Kings Lynn is developing a shared local plan between health and care partners for enabling the most deprived local communities to access employment opportunities across the local workforce. 

The programme is at an early stage, with the newly established hubs still getting teams in place, formalising plans and prioritising which innovations to focus on locally. The aim is for the hubs to build knowledge, skills and confidence in their local systems, and to share wider learning of the conditions and enablers that need to be in place to better support the effective uptake of innovations.  

Health Foundation Programme Manager Gill Clayton says:  

‘This is a unique opportunity to create change to improve patient care. It comes at a time when the NHS needs to accelerate effective uptake of new ideas to meet the challenges it faces and in the context of pandemic recovery. 

‘All of the local systems are seeing their hub as an opportunity to better adopt innovation in order to address local challenges stemming from the pandemic. There are already some themes emerging through the set-up stage, including the need to contextualise plans within local systems, create a shared vision around innovation adoption and the importance of docking in with local Integrated Care System priorities.’