Supporting an NHS fit for the future: shift from hospital to community & from analogue to digital in the East of England
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Introduction
The aim of the project was to collect and present quantitative and qualitative (we collected both) about advanced practice in community services and settings in the East of England and the impact it has had on keeping patients closer to home or within their community.
Impact data was provided directly by advanced practitioners or from their employing organisations, across 14 services. Data about numbers of advanced practitioners and numbers of specialties amongst trainees was sourced from the Faculty’s trainee monitoring data and regional organisational ESR data.
Snapshot of findings
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Number of practitioners in the community
A combined number of 141 trainee and qualified advanced practitioners:
- 36 NHS England funded active advanced practice trainees working within community services
- 105 advanced practitioners working in community organisations, based on job role coding in ESR records*
*This number does not include advanced practitioners working in community organisations that do not use ESR
Range of specialism in the community
NHS England funded active advanced practice trainees work across 8 specialities:
- MSK
- Hospital at home
- Frailty
- Paediatrics
- Rehabilitation
- Palliative care
- Long term conditions
- Intermediate care
- Prison healthcare
Patient contacts in the community
Across 9 projects, on average 1,092 patients had contact* with advanced practice services in the community monthly:
- Bedfordshire Hospital NHS Foundation Trust, Frailty Virtual Ward – 302
- North West NHS Foundation Trust, Haematology – 40
- East Suffolk and North East Essex NHS Foundation Trust (ESNEFT), Rapid Assessment Unit – 121
- ESNSEFT, Outpatient Parenteral Antimicrobial Therapy – 25
- West Suffolk NHS Foundation Trust, Virtual Ward – 126
- Norfolk and Norwich University NHS Foundation Trust, Musculoskeletal (MSK) – 375
- ESNEFT, Learning Disabilities and Autism – 61
- East of England NHS Ambulance Trust, Palliative Care – 12
- Hertfordshire and West Essex, Stroke Rehabilitation – 30
*Contact includes virtual as well as face-to-face
Improvement in patient outcomes
Across 3 services, the combined average number of patients who had the most appropriate outcome from monthly contact was 86%:
- Bedfordshire Hospital NHS Foundation Trust, Acute Frailty Services – 76%
- Mid South Essex, Integrated Neighbourhood Team – 90%
- East Suffolk and North East Essex NHS Foundation Trust, Frailty Rapid Assessment Unit – 92%
Increase in service capacity
Four services examined increases in capacity, 3 of which measured quantitively and averaged a 52% increase:
- Norfolk and Norwich University NHS Foundation Trust, Musculoskeletal (MSK) – 21% increase
- West Hertfordshire Teaching Hospital, Frailty – 64% increase
- East Suffolk and North East Essex NHS Foundation Trust, Outpatient Parenteral Antimicrobial Therapy – 70% increase
- North West Anglia NHS Foundation Trust, Haematology – advanced practitioners leading clinics increases medic colleague capacity
Increase in appropriate referrals
East Suffolk and North East Essex NHS Foundation Trust’s Virtual Respiratory Ward found the number of clinically appropriate referrals increased from 14 to 46 over a 4-month period, which is a 228% change.
Increase in bed capacity
East Suffolk and North East Essex NHS Foundation Trust’s Outpatient Parenteral Antimicrobial Therapy service saved between 200-400 hospital beds monthly, measured over 8 months.
280 beds were saved on average monthly.
Improvement in quality of patient care
Two services examined how their service improved quality of patient care:
- East of England NHS Ambulance Trust, Palliative Care. Advanced practice paramedics delivering to provide better end of life care
- Mid South Essex, Diabetes Service – facilitating high quality diabetes care processes across GP practices
Supporting shift from analogue to digital
Four services provided or supported virtual wards. One service utilised a computerised platform for data collection aligned with indicators QOF (Quality & Outcome Framework)
- East Suffolk and North East Essex NHS Foundation Trust, Virtual Respiratory Ward. Virtual bed utilisation increased from 40% to 76% within 3 months of starting
- Mid South Essex, Diabetes Service. Utilised computerised platform for QOF
- East Suffolk and North East Essex NHS Foundation Trust, Rapid Assessment Unit, supports Virtual Ward
- Bedfordshire Hospital NHS Foundation Trust, Frailty Virtual Ward
- West Suffolk NHS Foundation Trust, Virtual Ward
Evidence
Impact data provide by advanced practitioners or their employers was collated in standardised templates. A link to each template is available by clicking the plus symbol below. To access the links, you must have an account with Learning Hub – Home