The story of the Durham Dales Health Federation
From starting out with 1 employee and no offices to a dynamic, diverse organisation providing a range of primary health care services, the story of the Durham Dales Health Federation is one of delivery, growth and innovation.
The sections below chart our journey and showcase our successes, in the words of the people who made it happen.
In 2014, the NHS launched it’s 5 Year Forward View. This was a plan to address the building pressures on NHS services and to respond to the changing needs of patients.While the NHS had improved in the previous 15 years with waiting times down and patient satisfaction on the rise, the quality of care varied from one area to another and preventable illnesses were still widespread.
A ‘one size fits all’ model wouldn’t meet the differing needs of each community, so there was a need for new ideas and local leadership. The NHS plan made it easier for groups of GP practices to work together as networks or federations.
It was against this backdrop that the 12 Durham Dales GP practices met to discuss their options and decide what they should do.
Fledgling federations had appeared across the region, and joining an existing grouping was a distinct option.
After careful and detailed discussion about the specific needs of patients, a strong history of cooperation and a distinct collective identity across the Dales, it was decided to go it alone.
The Durham Dales Health Federation was born, with a GP or manager from each of the 12 member Practices forming our Board.
Our first piece of contracted work was to deliver a service that ensured the most vulnerable 2% of adults in the area were looked after.
Typically frail and elderly people with advanced or very specific needs, it was decided a standalone service would be best placed to serve their needs, freeing up considerable amounts of GP practices’ time.
All 12 practices pooled funding to support what has become known as VAWAS - our Vulnerable Adults Wrap Around Service.
This first service started with just one nurse building to a team of 4 by the start of 2016.
The team worked with vulnerable adults - primarily aged over 75 - to create personalised care plans.
This proactive approach took a holistic look at patient care, with the aim of reducing avoidable hospital admissions, and keeping people safe and well in their homes.
In the years that have followed, the service has developed into a nurse-led, multidisciplinary Community Wellness Team that has created over 2,500 individual patient plans, reducing admissions by 20%.It has also led the way in creating new teams and new services to fulfil unmet needs that have been identified along the way.
A case in point is the development of Health Care Coordinators - a team of non-clinical staff who would care for the social needs of patients, allowing the medical team to concentrate solely on clinical issues. A case study on the evolution of Health Care Coordinators can be found here.
By 2016 the Federation was growing.
VAWAS was expanding to meet growing patient needs and increased requirements from the Clinical Commissioning Groups.
In April of that year our next contract launched - a Practice Aligned Mental Health Service.
This was a brand new service - the first of its kind - which would offer high quality care and support in the community to people with mild and moderate risk mental health conditions.
We worked collaboratively with Tees, Esk and Wear Valley Mental Health Trust to create a service for people who fell through the gaps in the current system between being able to access therapies and meeting the criteria for secondary mental health services.
The service provided continuity of care through assessments and regularly reviewed patient plans, assisted discharges and connections to community services.
A commitment to early intervention has seen the wait for an initial assessment fall below 2 weeks across Durham Dales, compared with an average of 18 weeks nationally.
As our range of contracts and services developed, so too did our approach with a distinct shift of focus from activity to outcomes.
While our contracts would state that we need to make sure a specific number of patients were seen in a set amount of time, we worked with Commissioning Groups to look at measuring the effects of our services on patients.
Rather than a patient being seen as and end in itself, we looked at what happened next.
Did our intervention solve the person's problem, did it improve their health?
What impact have we had on hospital admissions? Have they decreased as the result of people getting quicker access to appropriate, preventative care?
This increased patient focus added a new layer of measurable outcomes about the quality of the health care we were providing.
In 2017 we launched Extended Primary Care Access (EPCA) - a way to support our member practices to be able to offer more same day appointments, and more outside of normal hours.Part of this service was encouraging patients to call 111 in advance - either to be booked in for an appointment, or to be directed towards other options or self care advice. This meant clearer paths for people to quickly get to the right service for their needs. With a GP, Emergency Care Practitioners and Advanced Nurse Practitioners based in hubs, we’ve made it easier for patients to get seen sooner, taking significant pressure off urgent care services.
The cost to the NHS of a patient being seen by our EPCA service is only 60% the cost of them being seen in an urgent care unit. As well as quick, appropriate care to patients, we’re providing value for money for the health service
Our Practice Support service is another that has developed significantly since 2014, with clinical and administrative staff available to support member practices when they need it.
Our pool of highly talented staff are able to slot in and out of surgeries across Durham Dales, providing consistency of care and service to patients.
Because we work at scale across the area, we can recruit and develop a small number of staff to work full time across the area, rather our Practices either being short handed, or having to recruit lots of part time staff.
It’s all part of an approach that is about working alongside practices, for the benefit patients.
Similar to the Practice Aligned Mental Health Service, our Integrated Diabetes Service was another that we built from the ground up.
We worked with the North Tees and Hartlepool Foundation Trust to develop a system which involved a specialist Diabetic nurse working to up-skill Practice Nurses across Durham Dales.
In turn, Practice Nurses would then be able to lead clinics for people with diabetes, creating individual treatment plans which improved patients’ knowledge and their ability to better manage their health.
A strong educational programme - developed as an offshoot of this service - has also been effective in preventing the development of diabetes in at risk groups.
Collectively, our Integrated Diabetes Services has produced some of the best outcomes for diabetic patients.
Our business model is all about efficiency.
While we hold a number of different contracts for different services, we treat them as one collective in the way we recruit, develop and deploy our staff.
Take our Extended Primary Care Access service - effectively providing an additional two hours of appointments for patients between 6pm and 8pm. Recruiting an Emergency Care Practitioner (ECP) to work 2 hours per day, 5 days a week would be challenging.
On top of that, the work of hiring, training, developing and managing that staff member would be the same as a full-time employee.
But ECPs also play an important part across our other services - home visits, relief cover at one of our member practices, or seeing one of our frail or elderly patients at a care home.
Our logic is to have a smaller number of staff working more hours across a number of contracts, rather than more staff working short hours wholly within one particular service.
Staff recruitment becomes easier, as we can offer more shifts and stability. Our training and development budgets cover fewer people, so can take each one of them further.
Most importantly of all, it means patients who come across our staff in different settings experience a consistent, high level of care.
This combination of efficiency and continuity allows us to deliver high-quality services whilst also funding our management infrastructure.
We’re unlike other health federations in that our small management team bring a range of different skills and experiences from outside the NHS.
That mix of expertise - from business and the commercial sector to charities and the military - adds a unique perspective to how we operate.
We explore, innovate and develop new ideas that bring benefits to patients and support our member practices with coordination, project management and specialist HR and financial advice.
Through our business intelligence and development, we analyse and monitor trends helping to identify potential issues, and proactively seek solutions.
From a strong evidence base, we can focus on delivering better outcomes for patients, and better value for money for commissioners.
Just as the Federation was set up to help practices deal with the changes in the NHS Five Year Forward View, the next stage of our development will be guided by the NHS Long Term Plan.The advent of Primary Care Networks will provide a new way of working for General Practice in England.
The plan is for groups of GP practices working together and sharing resources to patient populations of around 30,000 to 50,000 people.
But in the Durham Dales, we are ahead of the curve.
In essence, this is a formalisation of the way DDHF has worked since our inception - collaboration, innovation, working at scale, and being alongside Practices to deliver for patients.