Joined-up working: introducing the best teams of the yearBMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e2328 (Published 27 March 2012) Cite this as: BMJ 2012;344:e2328
Working with different agencies is not always easy, but it is vital for patients whose conditions do not fit into neat treatment silos. The shortlisted candidates for the 2012 Working in Partnership award are testaments to how team working across many different sectors can yield great outcomes.
North Tyneside Falls Prevention Service
The falls prevention service began with the premise that falls are not an inevitable part of ageing. The service screens all patients over the age of 60 at participating general practices and those identified at risk of a fall attend a review where they have a range of tests.
Steve Parry, consultant geriatrician at Newcastle Hospitals NHS Foundation Trust, believes the service is unique because it seeks out people at risk of a fall: it saw 2554 patients in its first two years.
“We have seen this astonishing number of people who never darken the doors of specialist services, people who have had falls or blackouts. Older people are stoic—they feel that falls are their lot in life,” he says.
The success has been striking—in 2010-11 rates of fracture of the neck of the femur rose in neighbouring Newcastle by 11.42%, whereas in North Tyneside they rose by just 2.46%, says Parry. And rates were lower among patients from practices taking part in the pilot.
Lots of places operate a falls service, says Parry, also a senior lecturer at Newcastle University, but the multidisciplinary nature of the North Tyneside service is what sets it apart. The partners are the foundation trust, the university, private primary care provider Norprime, North of Tyne Primary Care Trust, North Tyneside social services, North East Ambulance Services, and the charity Age UK.
“If it wasn’t for the partnership, there wouldn’t be this falls service,” says Parry.
SCI Diabetes Collaboration
The idea that knowledge is power drives the largest collaboration on the shortlist, covering all 14 Scottish health boards. The Scottish Care Information Diabetes Collaboration provides what it says is the “most comprehensive and highest quality population-based data on people with diabetes anywhere in the world.”
The collaboration began in 2000 and has evolved to cover the whole of Scotland, turning data captured from all 1050 general practices, hospitals, screening services, and laboratories into clinically useful tools for the care of diabetic patients.
The annual Scottish Diabetes Survey shows both an increasing prevalence of diabetes and an improvement in the recording of the data. For example, more than 90% of diabetic patients have their blood pressure, haemoglobin A1c, and cholesterol checked annually. Between 2003 and 2010 there has been a 40% reduction in lower limb amputations and sight threatening retinopathy throughout Scotland.
Scott Cunningham, technical consultant for the collaboration, says that good use of information technology has been vital to the success of the project.
“We’re making as much information as possible available to the healthcare team so they’re not in a little silo. All that information captured in previous consultations is available to the next member of the healthcare team, not relying on a paper trail of letters going from clinics to doctors. People can access that in real time,” he says.
Family Drug and Alcohol Court Intervention Team
Michael Shaw, child and adolescent psychiatrist at the Tavistock and Portman NHS Foundation Trust in London, uses a musical analogy to describe the work his team does with parents with drug and alcohol problems who are going through the family courts. The psychiatrists are like the conductors of an orchestra, getting all the different agencies to play their parts in harmony.
The team is a joint venture between the mental health trust and the charity Coram, alongside judges, lawyers, social workers, drug and alcohol workers, housing workers, and researchers. Team members meet parents on their first day in court and design a “trial for change” to test whether parents can overcome their drug and alcohol problems and look after their children properly. Parents must abstain from drugs and alcohol and begin to deal with the causes of their substance misuse.
A small study of 41 families that had gone through the process and 19 comparison families found that the model resulted in higher rates of children being reunited with their families (39% versus 21%). Nearly half of mothers (48%) stopped substance misuse compared with 39% in the comparison families.
Shaw describes the joint working as the “holy grail for policy makers.”
“We save money and improve outcomes for children and families,” he says.
Fit for Work Team
Leicestershire’s Fit for Work Team was one of six pilots launched by the government in 2008 to reduce sickness absence and improve health at work. However, Rob Hampton, GP principal and clinical director of the Fit for Work pilot, says that his team has a unique make- up, comprising two primary care trusts, two local authorities, and Jobcentre Plus.
In Leicestershire GPs refer patients on long term sickness absence to a fit for work team made up of occupational health nurses and case managers. The team provides access to services such as musculoskeletal therapies, counselling, and legal and debt advice.
In the first 20 months the team had over 1000 referrals, and 77% of patients returned to or stayed at work. Last July the Fit for Work pilot set itself up as a social enterprise so that it could offer its services commercially. Stress related illness is behind many of the diagnoses, says Hampton.
He acknowledges that bringing people together who had never worked outside their own sphere was difficult.
“We had a common purpose, but how do we work together? It took a while for us to bond as a team. But we have a team day every week and we have lunch—I try to make sure it’s fun,” he says.
Cite this as: BMJ 2012;344:e2328
The Working in Partnership award is sponsored by the Health Foundation. For more information about the BMJ Group Improving Health Awards 2012 go to http://groupawards.bmj.com.
Log in using your username and password
Log in through your institution
Register for a free trial to thebmj.com to receive unlimited access to all content on thebmj.com for 14 days.
Sign up for a free trial