What does shifting care ‘out of hospital’ mean for market access?

As the NHS heads towards implementing Integrated Care Systems across England, we are now starting to see this kind of pathway redesign happening.

While ‘out of hospital’ care is easy to explain, it is often much harder to deliver as it requires an integrated approach to be taken across the local providers within a health economy, and this can often be challenging to achieve.

Having said that, I have several clients working in this way where the CCG either directly commissions the services or the hospital subcontracts the work – the latter being more the norm.

To deliver out of hospital care successfully, four factors need addressing:

  1. The skills of the workforce need to be enhanced
  2. The workforce needs to be redesigned
  3. The work needs to be revised
  4. Consideration of the population’s health

What does good ‘out of hospital’ care look like in practice?

My best example of this in action comes from a GP federation that holds a number of subcontracts with the local hospital for the provision of care.  These include elements of cardiology diagnostics, aspects of community gynaecology and the front door to accident and emergency. Having delivered excellent outcomes in those services, the hospital approached them about the possibility of taking on the provision of follow-up appointments for non-mediated IgE paediatric allergy. This required all four factors listed above to be addressed in order to deliver that redesign.

This redesign has delivered all of the following:

  1. Consultants delivering care in different locations – they are now based out in General Practice
  2. No single model of care – this was designed specifically to meet local needs. It was built upon an understanding that patient volume doubles every three years and designed with that in mind to ensure it can expand as required
  3. Services differ in their scale, development and delivery – they started by covering part of the city and have expanded to cover the whole city. Further expansion to areas beyond the city is now being considered
  4. Enhancing the skills – two GPs fully trained and accredited to provide the service, with additional qualification
  5. Redesigning the workforce – this moved from hospital consultant and dietician service to now also include GPs, who took an additional qualification and were accredited by the hospital to provide the service
  6. Redesigning the work – the consultant sees the first outpatient appointment, GPs see the follow up appointment and the dietician sees all patients. Previously this service was simply consultant and dietician
  7. Population health – the service covers all patients in the city and now beyond. The service has been established with the doubling of work every three years in mind and has been designed to cope with that. In short: built for what they know they should have rather than just what they have now

This is a great example of an integrated service; hospital consultants and GPs working alongside each other and ensuring no patient need ever be called back. Any problems in the GP appointments can be resolved by the consultant immediately. It also alleviates workload pressure, as the hospital can now manage the volume on the basis that they have included the GPs.

There are many other examples within my work. Some include the pharmaceutical industry providing support by inputting to the training and education of the NHS teams, for example in atrial fibrillation, diabetes, gynaecology, DVT, sexual health, prostate cancer, mental health and many more. The key to success is that the companies all understood the process and spotted the opportunity to engage.

What would that redesign look like in your work? 

This will be different for each company as it will depend on disease areas within which you work. The key is keeping in mind that this will be happening more and more. For you, the opportunity will come when you get in front of the right customer. This is likely to be a business-ready Primary Care Network, GP federation or Super Practice that is working with its local hospital or foundation trust.

If you take the time to understand this process and find a way to engage in it, you can watch your opportunity come to life.

Scott McKenzie helps pharmaceutical, medical technology and device firms increase revenue by getting their products and services in front of the right NHS decision-makers. If you want to get your products fully embedded into treatment pathways we can help you. Scott has doubled revenue for his clients and can share these processes with you too. Download your free guide: here. 

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