Two leading clinicians offer an insight into the work of the care homes vanguards

The national new care models programme brings together local health and care systems as vanguards to radically redesign care for the local populations they serve. As part of this work, NHS England has set out details of the framework – what good looks like – for enhanced health in care homes. A lead nurse and a GP from the Gateshead Care Home Project vanguard provide an insight into their work and the role they play in this new model of care.

Dr Dan Cowie – GP

I am delighted to be part of the Gateshead care home vanguard – it is an absolute pleasure to work directly with people who are so passionate about improving care for older people, and to make real progress in redesigning services for the future.

Throughout my career as a doctor, and particularly over the last seven years, I have strived for improvement in older people’s care. I started working with colleagues on improving care in our local care homes in 2009, recognising the need to change care delivery from a ‘reactive’ health model to a holistic care one.

As a clinician, supporting residents living in care homes can be hugely challenging, but at the same time, this can be extremely rewarding. Trying to manage the complexity of health and care needs, in a way that delivers personalised care, requires a fundamental shift in the way the NHS and social care systems are currently shaped.

As a result of this new model of care, I have been able to work closely with my peers in health and social care in the vanguard – as part of a multi-disciplinary set up. This has given me the crucial insight and capability required to care for the residents.

I have been working in care homes as part of our enhanced primary care offer, as well as working closely with practitioners who have skills in nutrition and hydration, medicine management, end-of-life-care and dementia.  These are all core components of the new national enhanced health in care homes framework and essential to improving outcomes for care home residents.

As a GP, delivering best practice without dedicated time and resource for our care home population is challenging. Often for many GPs, other practice commitments supersede our efforts to achieve ‘optimum care’. I find this frustrating and disappointing, especially when ever-changing demographics of our local communities highlight the reasons why this work is so important and should be a major part of general practice life.

I celebrate the new national framework for enhanced health in care homes. This publication recognises the complexity of the core components of care delivery and addresses the key enabling foundations that are essential to making this work successful. For me, putting ‘health’ back into care homes is long overdue – if we can get it right for care homes, we can get it right for all older people.

Providing the very best of care for a growing, highly vulnerable group of people is a major challenge – but that, and the sheer potential for transformation and improvement, is what makes it such an exciting and rewarding area of work.

Lesley Bainbridge – Lead Nurse

I was recently asked what made me want to do the job I do and now that I’ve collected my thoughts I can tell you.  First, I am passionate about the care of older people, especially those most frail and vulnerable and I believe that in this post I can positively influence how we support them.  Second, I wanted to do it for my profession, to showcase the clinical knowledge and leadership skills nurses have in an inter-agency and multidisciplinary world and third, I wanted to work for the person who is now my boss.

The best thing is leading a group of outstanding and dedicated professionals who are experts in the care of older people living with frailty. The learning is endless; not just for me but for all of us.

From nine organisations representing eight disciplines we meet every Wednesday morning as a pathway of care team and our remit is focussed upon seven elements of care specific to the care of older people living with frailty [responsive care, enhanced primary care, technology enabled care solutions, dementia, palliative and end of life care, nutrition and hydration and medicines management] and we have associated metrics for which to measure our improvements.

We are holders of evidence, explorers of practice, testers of new care models and the best thing of all is; we are confident enough to have very loud voices about the care those living in care homes should receive.

Despite our loud voices, the most challenging thing about my job is feeling that the need for us to be heard isn’t met.  Some days I think that ignoring and questioning these experts equates with me going to the finance team and advising them their spreadsheet is wrong.  In the same way that the orthopaedic surgeon accepts the gynaecologist knows best how to manage the hysterectomy situation, experts in older people’s care know best about older people’s care and there is now a good evidence base for sharing.

Traditionally all this expertise would have sat in secondary care in specialist teams and departments but today’s ageing population means however that it is time for all that expertise to spill out into other teams and services.

One way to improve this would be through the use of the enhanced health in care homes model framework and the pathway of care team will take this very seriously and look forward to leading its introduction in their respective organisations and beyond.

Our approach to care delivery already includes a structured medicines management approach, employing the principles of medicines reconciliation to improve the health and wellbeing of older people living with frailty in care homes.

Also, our delivery of comprehensive assessment, problem identification and care planning as well as the building of inter-agency and multi-disciplinary teams are all reflected throughout the framework and our work to date gives us an excellent base from which to improve them further.

Being a vanguard has not only allowed us to raise the profile of older people and their health needs living in care homes, but has also provided us with a great base to continue from  in terms of the whole over 65 year old population.

Dr Dan Cowie

Dr Dan Cowie, Clinical Director Transformation, Newcastle Gateshead Clinical Commissioning Group.

Dan graduated in 1999 from Newcastle University and qualified as GP in 2004. Over the last 10 years he has worked as a GP in varies roles with a particular focus on elderly care. Dan has also been a part time clinical author of clinical knowledge summaries and writing guidelines for primary care.

He took up a GP partnership at Crowhall Medical Group in 2012 and also started his work within Gateshead Clinical Commissioning (CCG) Group as the Community Services and Urgent Care lead. Recently, Dan has been leading transformation work within the CCG and has particular interest in service redesign.

Lesley Bainbridge

Lesley Bainbridge is Lead Nurse at Newcastle Gateshead Clinical Commissioning Group.

Lesley trained as a nurse and midwife in Gateshead in an apprentice style training that she loved. She says she laughed through all the student years while making lifelong friends and importantly being privileged to work alongside, and learn from, nurses and midwives she still regards to be among the best in the business. Since then she has complimented her training with graduations from Northumbria University.

Professionally there are two things that get Lesley out of bed every morning and they are nursing in its fullest sense and the care of older people. She is very much looking forward therefore to progressing all of the clinical components of the Care Home Vanguard programme so as to make a positive contribution towards improving not only the lives of older people and their families; but the working lives of the staff providing the services also.

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