Although the specific organisational arrangements were different in the healthcare communities, the overall functions performed were similar. Figure 5.1 is a simplified representation of the common underlying structure.
The first point of contact for the patient is usually the GP clinic in which they are registered and most scheduled appointments are made with their GP. There are, however, a number of other agencies to which the patient may turn for unscheduled care – GP Out of Hours, Walk in Centres, A&E, Ambulance Services and NHS Direct etc. From these initial contacts, patients may be referred to local Acute Hospitals who offer a wide range of specialist treatment in out-patient and in-patient services. On discharge from the Acute Trusts or by referral from GPs and others, the patient may receive care in the community. Walsall Community Health offer 73 specialist services and Northamptonshire Provider Services offer 66. Care may also be provided by a Mental Health Trust or other providers who may be charities or private companies. Social Services may also be involved as social care is provided for the patient. It is, of course, possible that patients may be referred for care outside the LHC, for example, to hospitals that offer a national service in a particular specialism, but the great majority of patient journeys take place within the local health community in which they are resident.
There are, therefore, a multitude of different services and organisations associated with each LHC and a typical patient journey may involve quite a number of them.
The overall task of caring for patients is sub-divided in a variety of ways in this structure and, if a patient is to be treated in a co-ordinated way, the sub-divisions create different kinds of task interdependencies between the agencies involved. We utilised a classification developed by Thompson3 to look for different kinds of task interdependencies and to explore their implications for information sharing. In figure 5.1 three different kinds of task interdependency are identified that have to be managed across organisational boundaries.
5.2.1 Pooled Interdependency in Unscheduled Care
When there is pooled interdependency in a shared task, different activities can be pursued independently but all engaged in the activity share a common resource pool. In the local health community the most obvious example of pooled interdependency is the provision of a number of front line healthcare services to which patients can turn – their GP, GP out-of- hours, Walk-in-Centres, A&E, NHS Direct, Accident and Emergency etc. Although each can deal with a patient independently they are all part of the NHS and should deliver care according to the same standards and procedures. It can be argued that they should also have access to the same electronic patient records in order to ensure they deliver good quality healthcare.
5.2.2 Sequential Interdependency in Handovers and Referrals
Sequential interdependence occurs when one agency completes its work on the task and passes it to another agency for them to undertake their work. Obviously the quality of information in these ‘handovers’ affects the degree to which the overall task can be effectively undertaken. In the LHCs it is very common for patients to be referred from one service to another, especially in the referral of patients by their GPs for specialist services in acute care and to all the services that community care offers.
5.2.3 Reciprocal Interdependency in Shared Community Care
Reciprocal interdependence is the essence of close teamwork, when different agencies have to co-ordinate their task activity with the work of other agencies in the same timeframe. There are many examples in healthcare where this kind of close teamwork is essential, for example, surgeons, anaesthetists, nurses and technicians working together in an operating theatre. However, in the LHC there are also many examples of multi-disciplinary, multi-agency teams coming together to provide healthcare for a patient at home where boundaries between agencies have
Figure 5.1: The Local Health Community
to be managed for effective joint working to occur. In these forms of ‘shared health and social care’ the ability to share patient information in real-time could well have an impact on the co-ordination of healthcare for a patient.
5.2.3 Reciprocal Interdependency in Shared Community Care
Reciprocal interdependence is the essence of close teamwork, when different agencies have to co-ordinate their task activity with the work of other agencies in the same timeframe. There are many examples in healthcare where this kind of close teamwork is essential, for example, surgeons, anaesthetists, nurses and technicians working together in an operating theatre. However, in the LHC there are also many examples of
Patient Patient Acute Trust GP NHS Direct Presentation A&E GP Out of Hours Community Services Private Providers Social Services Patient Care Care Community Care Mental Health Ambulance and Emergency
Poole d Reciprocal Referrals Discharges and Results Walk-in- centres Processing Treatment PCT Commissioning Sequential Unscheduled Care
multi-disciplinary, multi-agency teams coming together to provide healthcare for a patient at home where boundaries between agencies have to be managed for effective joint working to occur. In these forms of ‘shared health and social care’ the ability to share patient information in real-time could well have an impact on the co-ordination of healthcare for a patient.