Implementation of Proactive Care Frameworks, alongside other targeted interventions, led to a reduction of more than 45,000 patient interactions, helping tackle COVID-19 backlog lists
Around 15 million people in England have a long term condition, and pre COVID-19 approximately 55% of people with long term conditions accounted for half of GP appointments, 64% of all outpatient appointments and over 70% inpatient bed days (Department of Health).
The Proactive Care @home programme responds to these challenges by supporting primary care teams to implement and deliver the Proactive Care Frameworks created by UCLPartners (the AHSN for the North east and North-central London). This is a great example of AHSN to AHSN importing of innovation to address local needs.
The pandemic dramatically disrupted pathways of care with the withdrawal of face-to-face appointments, cancelled referrals, and limited access to diagnostic and monitoring tests.
The frameworks help restore routine long-term condition care post COVID-19 by enabling practices to prioritise clinical activity for patients at highest risk, and support patients to undertake increased self-care and have more control of their conditions.
During the year we progressed two trailblazer projects – working with the Lakeside Healthcare Group (which covers Primary Care Networks within Northamptonshire and Lincolnshire) and with the Leicester, Leicestershire and Rutland Integrated Care System (LLR ICS). The experiences from these two East Midlands sites have contributed to important learning, both within the region and nationally.
