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Integrated social care referrals

After the successful implementation of a new clinical gateway for referrals into secondary care for all of Manchester’s GPs, the city council’s social care team is now joining the initiative too. PSE spoke to the city council’s head of customer access, Kathy Weaver.

When demand for hospital services in Manchester began outstripping supply and the resources available, healthcare commissioners in the city put in place a ‘gateway’ system, whereby referrals from GPs would be screened to decide if hospital really was the most appropriate place for that patient, or if some other kind of service or centre in the community would be better.

The latest version of that system, called the Integrated Care Gateway, has been in place since 2012 for GPs across the city, and for Manchester Mental Health & Social Care NHS Trust since October 2013 for routine and urgent primary and secondary care adult referrals.

The city council has been running its own project to make referrals into social care part of the same system – thought to be the first time this has been done in the UK.

After a long period in development, the project began its pilot phase across six GP practices in January.

Manchester City Council head of customer access Kathy Weaver told PSE: “Manchester operates a single point of contact, in line with a lot of other local authorities. Sometimes we get incomplete information from our health colleagues, or there are uncertainties about what information is required for customers to be accepted for a social care assessment. Obviously we have eligibility criteria for social care, as all local authorities do.

“This lack of clarity results in additional phone calls generated from both health and social care, which create delays for customers and patients in getting the right service.

“After discussions with representatives from the clinical commissioning groups [CCGs], and from Manchester’s Families, Health and Wellbeing directorate, an agreement was reached to include our social care contact assessment – part of our workflow – within the Integrated Care Gateway (ICG) currently used by all GPs in the city council area.”

Integration

Coming onto an existing solution that GPs are already familiar with offers a number of benefits, while also meaning the infrastructure was already in place without the city council having to develop anything from scratch.

GPs already have the referral software on their desktop, and it’s intended that any relevant primary care health professional should be able to make a social care referral using it.

The demographic information about a patient is pulled directly from the clinician’s system, so it doesn’t need to be re-keyed at the council end. The council’s social care management system, provided by Corelogic, is called Framework I and is also known as MiCARE, while the ICG is provided by Accenda.

Automatic record matching

Weaver explained: “When they click the button that says ‘refer to social care’, the contact assessment document pops up, and the fields are mapped against the clinical data. The demographic information is pulled straight from the clinician’s system, saving a lot of time.

“We ask the GP to include some further information specific to that patient’s personal care and social care needs, and that’s then sent directly through to us.”

If there are any gaps in the information provided, the health professional is automatically prompted to fill it in.

Then, using the NHS number as the defining field, the ICG server looks straight into the MiCARE database. If that social care service user has an existing record, it’s automatically matched and the data is accepted, with no human element necessary.

Weaver said: “The creation of a contact assessment will be routed directly into our social care database – from the GP surgery, into the secure ICG, directly into our database.”

If after searching for a match using first the NHS number, then name, address and date of birth, nothing is found, then a secure email is sent (using GCSX) to the Contact Manchester inbox. That is followed by a manual search to match up those records.

Weaver said there was “nothing more frustrating” for people than constantly being asked for the same personal details, which this new system does away with.

It also gets rid of the problem of what could politely be referred to as ‘non-standard’ referrals; those that come across in strange formats, on barely readable faxes with poor handwriting, or with scant information. Now, because the referral is prepopulated
with the data directly from the health professional’s system, and there is mandatory information about the referral required, such problems should be a thing of the past.

Detailing a person’s needs

There is some work involved for the health professional; they need to set out their concerns to explain in more detail why a social care referral is required. These are split across five categories: personal care, mobility, eating and drinking, daily living, and medication.

Weaver said: “We’ve tried to make it easy for the health professional, and given them a series of dropdown boxes, so it makes sense for them. We’ve broken it down into those five domains, and just ask the health professional to detail their view as to why that person needs that service. That information wouldn’t be in their clinical system, or if it was, it would be as free text, which we can’t pull through to fill our fields with.

“All of our contact staff are trained to screen that referral against our social care offer for eligible customers. If they meet that, they’ll go through for a needs assessment, if they don’t, they’ll be signposted to the most relevant service.”

The benefits

Aside from the benefits outlined above, the project is also a big plus in terms of information governance, thanks to the safer and more secure transfer of sensitive personal data.

It promotes more integration between health and social care – a “significant” agenda for the council and for the NHS in the city, Weaver said – and improves relationships.

It cuts down on the need for avoidable contacts too, though, because phone calls from health professionals chasing a referral will no longer be required: in the next stage of the project, they will get an automatic notification that the assessment’s been received.

Because essential information for the social care team is being made mandatory, the quality of data will be improved, with less duplication. The project also meets the council’s ‘do it online’ strategic objective, Weaver said.

Pilot phase

With regard to the delayed go-live of the project, Weaver told us: “Achieving the technical solution to bring about the inclusion of the social care contact assessment within the ICG has been a challenging yet exciting journey where all partners have learnt a
great deal. We are the first local authority in the UK to develop this technology in partnership with health colleagues and Accenda, and being a pioneer can and does take time. Initial project milestones had to be constantly readjusted as the learning grew for all the parties involved.”

But six GP practices spread across the city began a month-long pilot in January (potentially to be extended to six weeks depending on how it goes), with Weaver intending to begin the full Manchester-wide roll-out by the end of this financial year.

PSE asked her whether the council would still accept and process referrals coming in via fax or other means, and she said: “Once this goes across the board, we’ll be doing a big communications push with all the GPs. If they send us a fax, of course we have to put our customers and patients at the centre of what we do and we will deal with it – but they’ll get a note back from us requesting that they use the ICG gateway, until the message hits home. It’s actually much quicker for them to use the gateway.”

Manchester’s executive member for adults, health and wellbeing, Cllr Paul Andrews, told PSE: “This project will transform the way in which we receive information from our health colleagues and allow some of our most vulnerable residents to gain much quicker access to social care services. Not only do we have the advantage of safe and secure transfer of sensitive information, using the most advanced technology, we are fulfilling one of our key objectives to do more of the council’s work online, an integral part of the council’s overall strategy.

“The invaluable work undertaken by all our partners on this project could also pave the way for more collaborative and integrated working with our partners in the future.”

Weaver was full of praise for the team at Accenda, who she called “a delight, and incredibly supportive”. She added: “They have come up with a lot of ideas which we would never have thought of, and they’ve always been positive and collaborative. They’re a very good partner to work with.”

She also praised Corelogic, whose implementation consultant for the project, Carrie Black, told PSE: “Corelogic is really excited about the imminent go-live of this project. Working with an excellent project team at Manchester and Accenda, the Integrated Health Gateway project puts Manchester at the forefront of health integration in the UK. This innovative integration guarantees quick access to services for GP referrals and ensures that the key information is passed efficiently to Manchester City Council; all of which will improve the service being provided to the patient/service user which is paramount. Corelogic is confident that this will provide other customers with a blueprint for other such integrations with health systems.”

Financials

The cost to develop the project has been £130,000, plus ongoing licence fees, which Weaver called a “significant cost…but fantastic value for money”.

She explained: “We were very fortunate, because the gateway server was already there and health had paid for it. We had to pay to develop the forms that mapped against the clinical system, and we had to pay for the development of the server to accept them. But that big infrastructure cost was already met at that time.”

Any savings would be more long term, she suggested, as the intention would be to use freed-up staff time to implement new projects and to extend this one.

Since the project was first developed, Manchester’s children’s services have joined the same directorate as adult social care, and making the gateway suitable for children’s referrals too is the next big project for Weaver and her team (including needing to get the NHS numbers for children), followed by allowing secondary care clinicians to make referrals too.

She said she also wanted to explore rolling it out to the police – who are a “huge referrer” into adult social care.

She told PSE: “We want to work more collaboratively with colleagues at Greater Manchester Police, and they hold the same demographic information on their ‘customers’ that we need. They are one of our biggest referrers in terms of child protection, safeguarding and mental health.

“I want to consider using the gateway to work collaboratively with our police colleagues, with the mental health trust, and with schools.”

That would depend on those stakeholders putting some funding up though, Weaver explained, as unlike their NHS colleagues they do not already have the relevant IT infrastructure in place.

But she said: “If we do that, in the next two to five years, then the Manchester mantra – ‘do it online’ – well, we’ve cracked it.”