The system-wide, GP-led multidisciplinary team (MDT) works with professionals from across primary care, community care and the voluntary sector with a single vision and purpose of meeting the needs of the person in their care. The approach is holistic and proactive, focused on quality of life. Point-of-care testing is available to inform the delivery of clinically appropriate interventions, including intravenous fluids and antibiotics. The team operates in one of the most deprived areas of southeast England, with the fourth lowest GP-to-patient ratio. Infrastructure includes co-location of the Acute Response team, as well as an integrated IT system.

The Acute Response team has led to improved experience for people and their carers, increased interprofessional support and reduced hospital deaths. The success has been due to the strong cross-organisational working of the partners; team members collectively focus on the best outcomes for people rather than organisational boundaries.

Key learnings

• A shared vision has been developed through engagement with stakeholders, including general practices, community providers, voluntary services and the district and county councils. Ensuring engagement included the appropriate seniority to foster ongoing commitment was important.
• Regular engagement with patient groups informs continuous learning and improvement.
• The development and design team has strong support from senior clinical and managerial leaders across the system, which included chairs, chief executive officers and medical directors from the then clinical commissioning group, the community trust and acute trust. There is a clear mandate; reporting is agreed and enables constant review of performance.
• Creative use of available resource enabled the Acute Response team’s development, with existing resources from providers moved into 1 team, supplemented with a GP. This work was led by Thanet Health Community Interest Company, the local GP federation.
• Shared care records and an IT system that allows live access to general practice patient records, as well as community, hospice, hospital and mental health records, provides the team with a broad and detailed understanding of the individual, enabling clinical risk management.
• Palliative care and end-of-life care are everyone’s responsibility. As such, this neighbourhood way of working engages, embeds and enhances this for all professionals regardless of roles or settings.

Impact

Thanet acute response team reports:

• the number of hospital deaths per population in East Kent has decreased by 16% in the past 3 years, compared to an average decrease of 6% for the southeast
• the East Kent population currently has the second lowest emergency medical overnight admission rate per standardised population in the southeast for people over 75
• the standardised admission rate has been continuously decreasing for 3 years and currently stands at 8.62 admissions per 100,000 people per month
• provision of education, training and support at multidisciplinary meetings has improved shared learning and reduced workforce distress and burnout
• between 2018 and 2024, emergency department attendance for people aged 85 and above decreased by 0.9% in Thanet compared to a 108% increase in the rest of Kent and Medway and a 72% increase in the southeast
• feedback from people and their carers has also been positive, for example:

Publication reference: PRN01756_ii