South West London, Bourne Health
Croydon is considered one of the most deprived boroughs in the UK with very high disease burden, particularly vascular diseases like diabetes, general cardiovascular disease, hypertension and obesity. On top of that it is said to have the largest number of care home beds of any London borough with over 3000 in the South West and Surrey. Bourne Health looks after around 20 to 25% of those beds.
Since 2020 Bourne Health has proactively gone out to those care homes and created care plans for every resident, with regular check ups with a multi-professional team that includes GPs, paramedics, pharmacists and advanced nurse practitioners. That resulted in a 50% reduction in unplanned hospital admissions. This is something which is easy to scale and Bourne Health has shared that knowledge across the entire borough.
Working with patients suffering long-term conditions, Bourne Health has developed an ‘MDT Hub’, which brings together consultants, GPs, physios, mental health practitioners etc to look at more complex care needs across the entire borough. This means patients are not having to “ping around different parts of the system”.
Finally, another really good example of what Bourne Health has done as a neighbourhood is around the pharmacy. They encourage local pharmacy providers and community pharmacists to engage in minor ailments and some of the long term conditions. They also work on patient and pharmacy education around things like what you can use your local pharmacy for (eg: contraceptives, minor coughs and colds). That has work so well that they have amongst the highest uptake of pharmacy first referrals in the entire borough.
To hep scale this work, they’ve also done a programme with their GP Federation to teach all local GP’ around the key learning, success factors, what are the things that didn't work so well etc. This is then shared across the neighbourhood.
“I think with any change, particularly when there's a new naming convention, it can seem like it is something new - this is work creation.
“But I think if we just adjust ourselves slightly, we take a slightly different approach, or do more of the good stuff that we're doing - it will reduce the burden on us.
“It will improve patient experience, improve patient outcomes, and it will mean that across the entire neighbourhood or system, we have a much better way of doing that work. So I think it's a slight mentality shift that might be needed.”
Omar Din, CEO of Bourne Health
