Provision of care in the home needs to take account of the broader context and include community assets, the importance of wellbeing and prevention, and the role played by unpaid carers and other services such as healthcare and housing.
Community providers can learn from each other and take action locally to address some of these challenges, including by sharing learning and best practice, developing collaboration across different parts of local health and care systems, and delivering an increased focus on supporting staff development and progression.
Community-based health and social care services encompass a diverse range of professions and services, including social work, nursing, occupational therapy, reablement services, pharmacists, and intermediary care facilities. General practice and wider primary care services and networks are core to the organisation and delivery of related healthcare, with social care being provided by local authorities, independent agencies, and the voluntary and community sector. Community based services work with people in their own homes but also within communal settings such as residential care and nursing homes, and within supported living. New models to provide more intensive care and treatment for people with complex needs such as virtual wards have also been developed. Most services for people with mental health needs and/or a learning disability operate as community-based with hospital-based care reserved for focussed periods of assessment and treatment.
What are community-based integrated services? (Integrated care)
Explore community-based integrated services
How do community-based services support integrated care?
This requires two significant cultural shifts: towards a more psychosocial model of care that takes a more holistic approach to supporting the health and wellbeing of a community; and realignment of the wider health and care system to a population-based approach – for example, aligning secondary care specialists to neighbourhood teams.
Community-based services can respond to a wide spectrum of health and social care needs of people living in their own homes or group settings through their expertise and resources. They contribute to people experiencing integrated care when the professionals and services collaborate around the needs of individuals and families, and facilitate them being involved in decisions over their treatment and care. New integrated pathways including shared-care agreements enable people living in the community to access specialist care through hospital-based clinicians collaborating with general practitioners and community-based teams. Another important aspect for better integration is when health and care services adopt asset-based approaches in which they actively connect with community-based resources and local networks.
What do integrated community-based services need to succeed?
Enabling service development and improvement within the primary, community and preventative care sectors and emerging Primary Care Networks is not simply a matter of funding. It also relies on leadership, training, fostering a culture of adaptation and innovation, and good incentives and governance.
Despite PCNs now delivering new services their development has not been uniform, with success often being dependent on local factors. This means that systems have a role to play in promoting integration at place through primary care leadership, providing supporting infrastructure and committing to transformation.
Sufficient capacity, an appropriate blend of expertise, and supportive infrastructures including digital care records and relevant technologies are essential building blocks of community-based support. Alongside these, the overall design of the local system including performance management and funding flows should encourage and not dissuade collaboration between health and social care services, through focussing on holistic outcomes and joint processes. Shared cultures encourage working across professional boundaries and the creation of more flexible and person-centred packages of care. Inter-professional development can facilitate such joint practices, particularly when these involve people with lived experience within the training design and delivery, and as co-participants. Leaders at senior and practice levels provide the encouragement and support for professionals to work more collaboratively and embed opportunities for people with lived experience to contribute to the design and review of community-based services.
What is the evidence for outcomes and impact?
The main impact of vertical integration was to sustain primary medical care delivery to local populations in the face of difficulties with recruiting and retaining staff, and in the context of rising demand for care. This was reported to enable continued patient access to local primary care and associated improvements in the management of patient demand.
This review suggests that a movement towards focusing on integrated models of care for multimorbidity is likely to offer some positive effects over usual care, such as reduced depressive symptoms, particularly if models have a theoretical basis, are comprehensive (including patient education, self-management structured interprofessional collaboration and professional support) and are targeted at those with high morbidity.
Community-based services, particularly those which connect with local assets, encourage people to have the skills and confidence to self-manage aspects of their care, and support informal carers, have been shown to improve people’s wellbeing, delay deterioration in overall health, reduce crises in their care, and enable them to remain longer in their dwelling of choice. Integrated pathways can facilitate timely access to appropriate professionals and services to respond to changes in people’s conditions and situations. Reductions in admissions to hospital are not consistently demonstrated in research on a population basis due to the many health and social factors which contribute to people accessing hospital based care.