Beginnings in Brighton and Hove
In 2008 a small group of us saw a way to make a meaningful contribution to help Brighton and Hove achieve its healthcare outcomes. We noticed that in healthcare we spend lots of money on specialised care for a small percentage of the population, and could see ways that spending more money early on could positively impact the care journeys of more people, and create cost savings overall.
We founded Brighton and Hove Integrated Care Service (BICS), a not-for-profit social enterprise owned by GPs, practice managers, nurses in primary care and by our staff, and began delivering our vision through a referral management service for the population of Brighton and Hove.
Finding new pathways beyond Brighton
From the beginning our work was guided by three principles to:
i) do least harm first through intervention
ii) extend the skills of others
iii) only use specialist skills where they are needed.
Referral data provided a chance to understand the care people need, and enable informed decisions in designing more effective models of care. Since 2008 we have helped redesign in excess of 200 clinical pathways, including those for neurology, ENT, gynaecology, dermatology, MSK, mental health, dementia and many others.
We also developed the idea that clinicians should do clinical work only, maximising time spent with patients and guided by clear pathway protocols and IT systems that were designed around their needs. As well as supporting general practice to do more, well, the learning from referral management allowed us to apply our expertise further afield in Croydon Referral Support Service, while also helping to inform the commissioning of services in Brighton and Hove.
In 2009 we and our partners began to create integrated services with the aim of improving the access time and experience for people in Brighton and Hove. The integrated care model – using data to redesign care and co-creating with clinicians – was an evolutionary way of working. Supported by integrated IT systems clinicians were able to do administration in real time, increasing the time they could spend with patients.
By 2010 we were running an integrated dermatology service, the MSK Integrated Care and Treatment Service and the Brighton and Hove Community Eye Service.
Partnerships are key to our healthcare system being able to use its resources wisely. Partnerships can bring together the right health and social care expertise around care needs. As a membership organisation we invite the collaboration of our GP member practices, and our approach has always been to work with the any other provider that it makes sense to – be that in the NHS or the independent sector.
In 2010 we felt a growing concern about people’s mental health and wellbeing in Brighton and Hove. In 2011 through a partnership between BICS, Sussex Partnership Foundation Trust (SPFT), Mind, Turning Point, and six GP Practices we co-created the Brighton and Hove Wellbeing Service aimed at supporting people with depression and anxiety in the city . The service has grown to become hugely successful and an example of what can be achieved by sharing the distinct expertise of each partner organisation.
Working at scale in Sussex
Our experiences in creating integrated services like dermatology have taught us much about what is required to help make integration successful. Creating one common pool of resources encourages parties across sectors to develop a sense of shared responsibility in designing and running a service, different from the usual fragmented distribution of money within healthcare which can sometimes drive unhelpful behaviours. We also began to appreciate that it’s easier to get people to the right care if a service is larger in scale.
So in 2014 we partnered with Sussex Partnership NHS Foundation Trust, Sussex Community NHS Foundation Trust and Horder Healthcare to create Sussex MSK Partnership, a prime provider responsible for delivering musculoskeletal services across Brighton and Hove, Mid-Sussex and East Sussex. Working with a large population on a whole care pathway creates more possibilities to create a service that puts people in control of their healthcare journeys.
Evolving Primary Care
At our beginnings we believed that thriving primary care creates healthy healthcare systems and so every service and every opportunity we have engaged in we have been helping primary care be sustainable and strengthen its position. In 2014 the Prime Minister’s Challenge Fund offered an exciting opportunity to use money to get practices to work together to redesign general practice. Collectively changing the model created new approaches including: establishing a cluster infrastructure in primary care in Brighton and Hove, creating an Extended Hours Service, testing new models of pharmacy and developing a Workflow Optimisation process for practice administrative tasks that frees up GP time.
Over the last nine years by supporting collaboration, learning and training to expand skills in primary care in Brighton and Hove we have brought an additional £10m into general practice that wouldn’t have been available otherwise.
Meaningful change and ‘What matters to you?’
In 2014 we refocused our core purpose on supporting a shift in the view of care from ‘what’s the matter? to ‘what matters to you?’ The task as we saw it was to standardise care and provide bespoke care. We began to wonder if in the shift from what’s the matter to what matters to you we had really understood what matters?
Our work in the last two years has shown us that scale is important – our healthcare system needs to improved at the macro level. But the understanding about what matters to people and responding to that need happens much more meaningfully at the micro level. So starting small is the crucial first step. Starting small, you can you achieve scale at significant pace.
In 2015 we listened-in to what matters to us as an organisation. We heard from our membership a commitment to a deep quality of care and an aspiration to enable positive change that we call Care Unbound. Renewed in this purpose, we stopped being Brighton and Hove Integrated Care Service (BICS) and became Here. We chose this new identity because it reflects the quality of presence we believe is required to respond to what matters to the people and communities we serve.
Continuing the journey
Listening to what matters is an approach we feel has enormous scope, from redesigning care for people with long term conditions, to strengthening primary care -the first port of call for most of us with care needs. It will also mean we are ready to recognise new opportunities to partner and co-create create solutions to help people live well.