What is Focused Care?
How it all began…
In 2009, when Hope Citadel first set out to work in areas which had been previously under-doctored, it was very clear that it would take more than a prescription to fix many of the problems encountered by GPs and practice staff in the standard appointment system. A year later, after exploring already established models, the first ‘Focused Care Practitioner’ joined the surgery team at Hill Top Surgery in Oldham, to see if they could find solutions. The aim was to make the invisible patients visible and bring down barriers to universal services.
How does Focused Care work?
Patients are referred by practice staff, local community workers or even the police, when the usual care plan does not appear to be working. The Focused Care Practitioner then works with the patient’s household to begin to unpick situations, assessing need and using local health and community contacts in order to begin to bring stability to an often chaotic situation. They bring together agencies and patients, and also establish accountability for the patient and for the agencies involved, meaning that appointments are attended, practical support is provided and a glimmer of hope and change comes to that household.
Its all about Team
Focused Care works on a team basis, with regular meetings to review cases. Based inhouse and, typically, working 2 days per week per surgery, the Focused Care worker works alongside the practice team to find solutions. All activity is recorded on the surgery clinical system so all staff are aware of the patients current situation. The practice team gets together with the focused care worker to discuss cases every month, this allows the co-ordination of clinical intervention, social intervention and allows creative solutions to emerge. These case discussions are the bedrock of the process through which perceptions of the patient are changed.
It actually WORKS!
Time and again lives have been transformed by the extra care provided by the our team, giving support, coping mechanisms and backup for when life gets too much to handle.
Local commissioners have also realised the benefits of the whole person approach. Oldham CCG commissioned the model to be piloted in a neighbouring surgeries which was spread to six other surgeries in Oldham
Its time to GROW
In 2012 the Oglesby Charitable Trust was looking for ways to help reduce health inequalities in Greater Manchester, and now with the Shared Health Foundation has championed and supported the set-up of the Focused Care CIC in December 2016.
Since then, three years of funding has been provided by the Transformation Fund of Devolution Manchester to roll out our unique model to multiple other surgeries within Greater Manchester. Focused Care has also been established within Oldham and across Heywood, Middleton and Rochdale Borough. We currently have 32 workers based in over 80 surgeries across Greater Manchester’s most deprived areas with a combined caseload of over 5000 patients since the project began. This brings expertise, experience and support to surgery teams, leading to hope and transformation for individuals, households and communities across our city.
In November 2019 Focused Care began a pilot in Dublin with two workers pioneering Focused Care Ireland with the team at Summerhill Medical Practice and Mountjoy Medical Centre.
As Primary Care Networks have developed, so has the Focused Care offer to compliment social prescribing teams in areas of high deprivation.
If you would like to know more, or enquire about bringing Focused Care to your surgery or area, please click or tap here.
Focused Care – About us
Focused Care CIC has been created out of a partnership between the Shared Health Foundation and Hope Citadel Healthcare CIC. The Focused Care board are passionate about reducing health inequalities and empowering people to take responsibility for their own health. The board have a wide breadth of experience across health, social and business sectors and are instrumental in overseeing the integrity and development of the model going forward across Greater Manchester and beyond.
Team Members:
Gemma Briggs – Manager GM
Board Members:
Hope Citadel Healthcare CIC
Hope Citadel Healthcare provide GP services to their registered population in a caring, compassionate and safe way that leads to clinical excellence. They want to improve patient quality of life, and where possible make interventions and diagnoses that improve health.
Hope Citadel works in partnership with other NHS and non-NHS organisations, believing that their patients, families and communities can change to lead to healthier lives. Hope Citadel specialises in delivering wholeperson healthcare in areas of deprivation that have been previously under-doctored.
Hope Citadel Healthcare CIC: www.hopecitadel.org.uk
Shared Health Foundation
The Shared Health Foundation is an initiative of the Oglesby Charitable Trust and set up to address health inequalities across Greater Manchester. In our city region, the very poorest face a life expectancy over a decade shorter than the most affluent.
Working with individuals, communities, health professionals, voluntary sector and business partners, they encourage a person-centred approach. Through nurturing innovative ideas and replicating best practice, they empower individuals to take responsibility for their own health.
The Shared Health Foundation strongly believes in the Focused Care model as a means for helping some of the most needy in our city to make a return to the road to stability, recovery and transformation.
Shared Health Foundation: www.sharedhealth.org.uk
Greater Manchester Health and Social Care Partnership
The Greater Manchester Health and Social Care Partnership is the body made up of the 37 NHS organisations and councils in the city region, which is overseeing devolution and taking charge of the £6bn health and social care budget.
The Greater Manchester Health and Social Care Partnership team is the group of people who came together on April 1 2016, from the former health and social care devolution team and the former NHS England Greater Manchester team. The purpose of the team is to ensure Greater Manchester delivers on its vision to deliver the greatest and fastest possible improvement to the health and wellbeing of the 2.8m people of Greater Manchester.
Jon Rouse, Chief Officer of Greater Manchester Health and Social Care Partnership, which is supporting the scheme, said: “The outcomes from Focused Care are heartening. Our mission is to deliver the greatest and fastest improvement to health for the 2.8million people in Greater Manchester.
“We can see that this is transforming patients lives and in turn taking the burden off some of the acute services that these patients tend to use in times of need.”
“It is important that we transform the lives of the people in Greater Manchester who need it most.”
Greater Manchester Health & Social Care Partnership: www.gmhsc.org.uk
