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Gateshead Care Home Programme

Gateshead Care Home Programme. Marc Hopkinson. Quality of Care. Working together. Compassion. Improving Lives. Respect & Dignity. Everyone Counts. Our Mission & Vision. Mission: Working together to improve the health of Gateshead Vision: Care for people in a seamless way

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Gateshead Care Home Programme

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  1. Gateshead Care Home Programme Marc Hopkinson

  2. Quality of Care Working together Compassion Improving Lives Respect & Dignity Everyone Counts Our Mission & Vision Mission: Working together to improve the health of Gateshead Vision: • Care for people in a seamless way • Ensure commissioning is clinically led and driven by patients and carer involvement • Improve the quality of health services

  3. Needs increasing: scale Now • 191,000 population • 18% over 65 years • 3.7% over 85 years • 0.85% living in care homes • Median length of stay 20 months (23 in Nursing, 27 in Residential) 2030 • 203,000 population • Aged 65 + increase of 1/3 (34,000 – 45,000) • Over 85 years - 90% increase (3,900 to 7,500)

  4. Quality not right now Frailty is the issue • Care is reactive … we need specialist proactive • Variation e.g. multiple practices causes problems • Communication issues across settings - admission/discharge • Care planning inc advanced care(In and OOH)

  5. Specialist Care Homes (including Learning Disability, Promoting Independence Centres and Specialist Mental Health) Nursing Homes 15 homes (907 patients) Residential Care Homes 17 homes (596 patients) Older People supported to live at home aged 65+ (4273 patients) Older People (40, 000 aged 65 +)

  6. Aim: To improve the care of patients and families through more integrated proactive care

  7. Objectives: Improve each care setting and bring them into a ‘frailty team’ • Increasing skills and understanding in homes. • Changing reactive primary care delivery to a proactive model involving weekly visits by a lead GP from the care homes linked practice • Comprehensive care planning and MDT case management led by specialist nurses at the weekly ward rounds with ongoing support to homes

  8. Objectives (Cont) • Bringing specialists into a virtual team to support when needed and improving communication between • Reduce avoidable hospital admissions • To be cost saving

  9. Pilot Results • Investment of approx £50k • 98 patients case managed • 45.5% reduction in admission rates based on 2008/09 data - admission days 440 - admission costs £243,146 • Savings assuming same conditions/reasons for admission for total care home population in Gateshead: - 6763 bed days - £3,730,446 • ‘You gave me my father back’

  10. Inpatient Outpatient geriatrician Specialist input (OAP, SALT, Physio) Lead GP, Specialist Nurse Care home staff Patients, Carers and families

  11. Expanding this across Gateshead • Care homes trained • 28/34 Care homes linked to practices • 6 specialist nurses proving comprehensive reviews, care planning, liaising and reactive care • Medicines Management Team • GHFT Geriatrician • Laptops • Key partners- LA, OA Psychiatry

  12. Specialist Nurses Commissioned

  13. The Project Group • Dr Mark Dornan • Lesley Bainbridge • Lynne Shaw • Dr Daniel Cowie • Dr Louise Crabtree • Marc Hopkinson

  14. http://gatesheadccg.nhs.uk/about-us/case-studies/ Any Questions?

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