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At the vanguard of improving care in care homes

Nottingham City, one of six areas in the country selected by NHS England as a ‘vanguard’ site to develop a new model of enhanced healthcare in care homes, describes its ambitious vision for an outcomes-based model which is fit for the future.

The Vanguard sites were announced following publication of the NHS Five Year Forward View (October 2014) which sets out a series of new ways of providing care. It is intended that the Vanguards act as the blueprints for the future NHS, inspiring the rest of the health and care system.

The Nottingham City approach, being developed over the next 12 months, will offer older people better, joined-up health care and rehabilitation services.

Care home residents have complex medical needs. The average resident has six diagnoses and takes eight medications. Currently, care homes residents are 0.5 per cent of the city’s population but account for 5 per cent of all admissions to hospital. Many older people are cared for in hospital but best practice evidence indicates that care is most effective when provided at home or in the community.


The Vanguard initiative seeks to build on progress to date. Since 2010 the local NHS and partners have been working on a whole systems approach to improving care in care homes. Activities have included:

  • Enhanced primary care support to care homes service – building more constructive relationships between care homes and GPs by contractually aligning Nottingham City residential and nursing homes with a named GP practice. There are currently 1,200 care home residents who are registered with 23 GP practices providing this service. Since the service went live, there has been a 5 per cent reduction in emergency admissions from care homes to hospitals
  • Care homes nursing team - providing a dedicated nursing service to Nottingham City registered patients in residential care homes with a view to improving relationships, communication and clinical care
  • Specialist nurse practitioners to care homes – aiming to achieve individualised, assessment driven, multi-disciplinary healthcare for residents newly admitted to care homes
  • Care home clinical pharmacist (pilot) – looking at the added value and efficiencies associated with having a clinical pharmacist role in the skill mix of GPs, advanced nurse practitioners, community geriatricians and other health and social care professionals involved in the care of residents  
  • Dementia outreach team – improving quality of care for people with dementia through specialist input, support and training in care homes
  • Resident representative service – engaging with people resident in a Nottingham City residential or nursing care home to support the strategic development of proactive and preventative health-related service models to care homes
  • Community geriatricians.

Vanguard vision

The Vanguard vision will enable residents living in a care home to be healthier, have a better quality of life and to be treated with dignity and respect, focusing on residents’ capabilities rather than their dependencies. It hopes for all residents and their families to have a positive experience of care. This will be achieved by the care home sector, commissioners and providers working together to transform the model of support provided to care homes.

The Vanguard programme in Nottingham City is set to move more older people’s care from hospital to the community, introduce greater use of healthcare assistive technology and IT in care homes (such as video consultations), improve medicines management, and build partnerships of support across professions and organisations in improving patient/citizen care. Feedback mechanisms will be put in place so lessons can be learnt and services continually adapted and improved.

Russell Pitchford, commissioning manager for community services and integration with Nottingham City Clinical Commissioning Group (CCG), said: “We believe we have the basic building blocks in place forming a solid foundation to work from at pace. Our aim is to remove organisational barriers and ensure that care home staff have support from specialist health services to identify, understand, manage and respond to the everyday impact of providing essential care. Residents will receive co-ordinated input from generalists and specialists of multiple disciplines in partnership with social care professionals and care home staff. These partnerships are essential, built on shared goals, reliable communication and mutual trust.”

The programme will be overseen by a steering group which includes GPs, nurses, pharmacists and community geriatricians. Organisations and networks involved in the Nottingham City CCG-led programme include Nottingham City Council, Nottingham CityCare Partnership, Nottingham University Hospitals, Nottinghamshire Healthcare, Age UK, University of Nottingham and the Care Home Managers Forum.

The Vanguard work with care homes fits into the Integrated Care programme that is taking place within the city, bringing together health and social care services to provide joined-up, holistic care for citizens/patients. 

Vanguard objectives 

Over the next 12 months Nottingham City CCG will work with local partners to develop a new clinical model for care home residents based on the following objectives to:

  • Strengthen the culture of partnership, support, and engagement with the care home sector, local community services and voluntary sector, working together to develop an outcomes framework and improve the experience of residents
  • Review and re-design services commissioned to support care homes in order to improve outcomes for residents and deliver efficiencies through better use of resources
  • Support the roll-out of new technologies and telemedicine to provide fast and effective access to clinical and specialist input
  • Increase the provision of community beds to support people to return to independent living with appropriate support from community services
  • Develop an effective hospital discharge pathway and processes that support residents to return to care homes as early as possible, seven days a week
  • Ensure care home residents have agreed goals of care based on proactive, resident-centred multi-disciplinary review involving families
  • Develop and implement an effective urgent care pathway for care homes
  • Develop and implement an effective end-of-life pathway for care homes.

We hope to carry a progress report in a future issue of the BGS newsletter.

Russell Pitchford
Community Services and Integration
NHS Nottingham City Clinical Commissioning Group


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