Anticipatory care planning
The journey –
The anticipatory care planning team brought together GPs, nurses and other healthcare professionals, with support from specialists where necessary. It was designed to improve the quality of patient care, reduce unnecessary admissions and thereby to reduce costs.
The programme involved the public and patient involvement (PPI) forum for south and east Dorset, working with the PCT. A multi-disciplinary team spanning health and social care was then formed to work on anticipatory care planning.
There is evidence of fewer acute hospital admissions, reduced use of clinical specialists, improved patient care and reduced cost.
|In-patient||Out-patient||Community based X|
|Mental health||Chronic illness X||Cross-systems|
|Staying healthy||Maternity and newborn||Children and young people||Acute care|
|Planned care||Mental health||Long-term conditions X||End of life|
Information, tools and techniques used
No specific change management tools were used in this programme
Anticipatory care planning has now been adopted by urgent care and community teams and integrated into mainstream practice. Care is coordinated through a Single Point of Access which is hosted by South West Ambulance. The scheme has been extended to other connecting health and social care teams to improve identification and management of those at risk of admission, care coordination and service integration. The approach has attracted Reablement resources and is working with the independent sector to mobilise community care packages to prevent risk and admission and better manage care following an acute illness.
Contact details and further information
Elise Ripley, Patient and Public Involvement Development Manager, NHS Dorset. Tel: 01305 361264, Elise.firstname.lastname@example.org
Lesley Holt, SPoA Lead Nurse, South West Ambulance