Each site comprised a CCG and a service provider. Community nursing services were provided by four NHS organisations (community trusts, combined acute and community trusts or community foundation trusts) and one social enterprise. In all of the case sites, community nurses were located in geographically based teams serving a number of general practices. Teams were accessed by a single point of entry system, whereby there was one centralised telephone number for referrers and other patient enquiries. For tables summarising the characteristics of the case sites and the numbers and types of participants, see Chapter 2. The following text provides more details of the commissioning and provider organisations. Pseudonyms have been used and any similarity with existing place names is unintentional.
Alderton West
(Data collection 25 May 2015–10 May 2016.)
Alderton West is a large urban area. Deprivation in the area is higher than average and life expectancy for both men and women is lower than the England average. Smoking-related deaths are higher than the
England average. Mortality rates for those aged< 75 years from cancer and cardiovascular disease
are significantly higher than the average for England. One NHS commissioning organisation, the NHS Alderton West CCG, is responsible for managing the contract with the community care provider, Alderton Community NHS Foundation Trust (ACFT), on behalf of two other CCGs, which also commission services from this provider. Alderton West CCG is associated with approximately 50 general practices covering
a population of approximately 300,000. ACFT provides> 30 different community services for adults,
including some inpatient beds. The district nursing teams are organised in multidisciplinary integrated teams of varying sizes and cover the whole city. ACFT provides community services for a total of four CCGs, covering a population of> 1,000,000.
Beechbury
(Data collection 14 April 2015–25 April 2016.)
The second case site, Beechbury, is a large urban area. There is a high level of deprivation compared with the average for England and a higher than average proportion of people smoking and dying from smoking-related diseases. Premature deaths in those under the age of 75 years from cardiopulmonary diseases and cancer are also higher than the England average. The NHS Beechbury CCG is one of three
CCGs that cover the city. Beechbury CCG’s area of responsibility comprises > 40 general practices covering
a population of approximately 300,000. Community nursing services are commissioned from Beechbury Community NHS Healthcare Trust (BCHT), which provides a range of health services across the area. BCHT also delivers care commissioned by the two other CCGs for a total population of approximately 800,000. Despite the existence of separate CCGs, many aspects of commissioning and quality and performance oversight are conducted jointly across the CCG group in collaboration with BCHT. Beechbury CCG and
BCHT also work to deliver community-based care in partnership with local authority and voluntary sector organisations, as well as other NHS trusts. The health and social care structures for delivering care in the Beechbury site have undergone significant redesign over the last few years and community nurses work in a number of MDTs. Team management posts are held by staff from different professions and support from a range of senior clinical staff is built in to the management structure, including a named individual whose remit is overseeing quality issues.
Cedarham
(Data collection 6 July 2015–29 May 2016.)
Cedarham is a large urban area. Community services are commissioned by NHS Cedarham CCG which covers nearly 50 general practices serving approximately 300,000 people. Community nursing services are provided by a combined acute and community care organisation, Cedarham NHS Foundation Trust (CFT). One other neighbouring CCG also commissions services from CFT, which provides services for an ethnically diverse population of approximately 600,000 people. Deprivation in the area is higher than average. Life expectancy for men is lower than the England average, but for women it is higher than average. Smoking- related deaths and mortality rates among those under 75 years for cancer and cardiovascular disease are higher than the England average. The supervision and oversight of quality issues in CFT community nursing services is the remit of a senior manager with a community nursing background, who has direct contact with locality managers. The development of integrated care is an organisational priority for the trust.
Dogwoodheath
(Data collection 18 February 2015–11 February 2016.)
NHS Dogwoodheath CCG is one of three CCGs with responsibility for commissioning community-based care for people living in a large urban environment, with a population of approximately 300,000. Commissioning is conducted independently by each CCG in the area. The health of people living here is generally worse than the England average, with the rate of smoking-related deaths and the number of people dying prematurely from cardiovascular disease and cancer being considerably higher than average. Community nursing services are delivered by Dogwoodheath Respond (DHR), a social enterprise. Community nurses work in MDTs, usually managed by a team leader with either a nursing or a therapy background.
As well as working with approximately 60 local general practices, both the CCG and DHR collaborate with a range of other organisations involved in delivering care, including acute and community-based NHS trusts, local authority organisations, the private sector and the voluntary sector. Both Dogwoodheath CCG and DHR work closely together to monitor quality issues. Communication and collaboration between them are facilitated by their occupying premises near one another.
Elmhampton
(Data collection 11 February 2015–30 November 2015.)
Elmhampton is a large, predominantly rural area also containing several large towns. The population of around 500,000 people is slightly older than the national average and has a higher than average life expectancy. Levels of deprivation are below the national average, although pockets of deprivation do exist. The prevalence of smoking and obesity in adults here lies within the national average range, and
smoking-related deaths, as well as cardiovascular disease or cancer mortality in those aged< 75 years,
are lower than national rates. NHS Elmhampton CCG operates in several localities with approximately 80 general practices. It is the sole CCG for the area and commissions community nursing and some other services from Elmhampton NHS Foundation Trust (EFT), also covering the same geographical area. EFT has been delivering community services for 5 years and working with the CCG since its inception. At the time of the study, EFT was in the process of service redesign, working towards integration. A particular priority for the service is to develop specific integrated pathways to assist particularly vulnerable patient groups.