Implications for Delivery Models
Key Recommendations
1
Each clinical pathway group looked at how pathways of care for particular conditions or groups could be improved. In this chapter, we draw these recommendations together to consider how we can strengthen the organisation and delivery of care in the round to make those improvements.
Key Recommendations for the next 10 years
2
There should be systematic implementation of measures to prevent physical and mental ill health, and to make it easy for individuals and their families to make healthy choices.
3
We put forward a vision for primary care in Y&H and the way in which this should be taken forward. In particular, we highlight the potential to exploit the role of pharmacists to support improved health and better access.
4
A greater range of health services should be provided as locally as possible and we outline the range of care that could be provided in patients’ homes.
5
Specialist care should be concentrated only where and when this is necessary for optimal patient safety and improved outcomes (e.g. out of hours, when the full range of specialist expertise may not be available in every single district general hospital).
6
The impact of these twin trends of increasing localisation and greater specialisation on district general services should be assessed by PCTs and the SHA in the light of individual local circumstances. It is vital that models of care are implemented with regard to the wider impact on other services, the local community and other parts of the system. The ambition and energy generated through this process should not be squandered by implementing proposals oblivious to unintended consequences.
7
In our view, given the geography and varied population density of Y&H, there is not a single blueprint for the organisational models to deliver the improved outcomes outlined in the report. These need to be developed in light of local circumstances.
8
Integrated models of care spanning specialist centres and district general hospitals (supporting the sustainability of services at both types of hospital) should be considered wherever they support optimal patient pathways – such as the model for acute stroke recommended in the acute episode chapter of this report.
9
Highly specialist care (e.g. critical care) should be supported by effective clinical networks. To be effective, the CPGs proposed that these networks should be managed by one organisation.
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