Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event. Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development. This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being. More information is available online: www.expo.nhs.uk

1. The Changing Vanguard Workforce
Whitstable Medical Practice
Dudley Multispecialty Community Provider
Better Local Care (Southern Hampshire)

2. Welcome
Dr Nav Chana
Chair of National Associationof Primary Care

3. Whitstable Medical Practice
Paramedics in the Community
Paul Sutton
Chief Executive
South East CoastAmbulance
NHS Foundation Trust

4. The Model
4
Integration and improved clinical decision making are key
A higher skilled paramedic
based in the community
(a ParamedicPractitioneror Paramedic
withadditional modules)
Improved clinical decision
making skills
Supportingand being
supported by the local
health economy
(integration)
Objective
Return the patient to
planned care

5. 5
Case Study
We received several 999 calls to an elderly female
presenting with a range of symptoms over a short
period of time. She had a previous medical history of
TIA, epilepsy, postural hypotension and hypertension.
She was seen by a member of the Community
Paramedic Team who identified a possible high risk of
admission to hospital. Due to the relationships the
team have built within the Whitstable Health
Community, we were able to make prompt referral
within the local community.
An Admission Avoidance Plan was developed within a
short period of time. The Ambulance Service and
Community Teams now have access to this.
A member of the team visited on behalf of a GP an
elderly male who had an acute history of diarrhoea.
He was complaining of dizziness and not being able
to eat. Examination revealed he had a substantial
postural drop in his blood pressure.
The Community Paramedic was able to give
treatment and advice on scene and was therefore
able to avoid admission to hospital with the GPs
agreement. The same Paramedic reviewed the
patient the following day and found an improvement in
the patient’s condition with improved symptoms and
oral intake.
The patient expressed his appreciation for the service
provided.
Better outcomes are achieved when we work with others as a local team

6. Quotes
6Patients and GPsare seeing the benefits
I was initially fairly sceptical about a pilot involving paramedicsas I
could not see how we could maintain good standards of care, with
continuity and timely decision making.
I was wrong. The experience of having paramedics attached to the
practice has been a very gratifying one. Contrary to fragmented care,
I would say it is actually more joined up. Communication is excellent
with most visits followed by a face to face or telephone debrief and
contemporaneous note keeping that both paramedic and GP can
see.
The high standard of assessment and readiness to diagnose has
been the key together with a desire to respond to suggestions that
facilitate improvement.
It has improved the quality of my working day freeing me up to use
my time efficiently, with no loss in continuity or good patient care.
This genuinely feels like an improvement in care where all parties
benefit.
Dr Natasha King (GP WMP)
Patrick and his…community paramedic …
team demonstrate remarkable efficiency,
knowledge and skill in the service they
provide, I shall be eternally grateful to
them.
Cecil Humphrey Smith OBE.

7. 7
Successes
• GP triage home visit requests ensuring that w e are sent to appropriate calls.
• Feedback to GPs either directly or via EMIS visit notes enable GP review of assessments, diagnosis and treatment.
• Use of Ipads w hile visiting gives access to patient history, medication, allergies, test results, etc. Also all visit notes can be uploaded to Emis for GP to
review before discussing treatment w ith the Paramedic.
• Know ledge of the GPs expectations prior to the visit.
• Incidental findings - Additional time w ith the patient has resulted in findings, eg. high blood pressure, to be found w hich had not been previously know n.
Also non compliance w ith medication unknow n to the GP.
• Freeing up of GP time.
• Willingness of the team to "go the extra mile" w hen necessary. e.g. returning later in the day to review patients progress, ensuring medication is
delivered by the Pharmacies.
• Quicker and more timely response to urgent visit requests.
• Carrying PP PGD based medicines has resulted in immediate dispensing of medication w hen appropriate.
• Greater aw areness and compliance w ith Admission Avoidance Plans.
• Flagging up, at an earlier stage, frequent 999 callers for Admission Avoidance Plan by the surgeries.

8. 8
Challenges
• Adjustments w ere necessary for a more efficient and effective service. e.g. communication improvements.
• Continue to expand understanding of other community based services and how w e can w orkmore effectively w ith them.
• Paramedics learning to improve their on scene time management. Lack of experience w orking w ith time constraints.
• Integration of 999 calls w ith GP visits.
• Governance
• Maintaining a quality service in the light of success producing increased demand..
Drivers
• Clinical outcomes
• Local performance
• Conveyance – alternative pathw ays
• PP attrition/satisfaction
• Productivity
• Clinical career framew ork for paramedics
• Reduce transport units and enable ITV
• Mileage
• Relevance to new commissioning models and architecture
• CFR management
• Strategic fit – urgent care

9. Dudley Multispecialty Community Provider
Teams without Walls
Paul Maubach, Chief Executive Officer, Dudley CCG
Paul Bytheway, Chief Operating Officer, Dudley Group FT
Dudley Multidisciplinary Team Members
NHS Partners include, Dudley Clinical Commissioning Group, Dudley Group Foundation Trust, Black
Country Partnership Foundation Trust & Dudley and Walsall Mental Health Partnership Trust.

10. Our model is based on the following principles:
1. Shared ownership
2. Shared responsibility
3. Shared benefits
Maximising the potential of:
• The individual (in their community)
• Our staff in supporting the individual
• Our staff working effectively with each other

11. The difference to our patients
“I feel safer now, really secure. The service is fantastic - although my GP had tried to help I was
getting nowhere. They are someone to turn to when you feel you have no one and I can’t thank the
Voluntary Sector Link Worker enough.
“Since he came on the scene it’s all gone one way, and that’s up. He made me aware of places I
didn’t even know existed and I dread to think what my situation would be if he hadn’t helped me. If I
can give a mark to represent his support it would be 10 out of 10, he has given me a lot of backing.
I’m really chuffed”. (Mr Ivan Carter, patient)
“I am really pleased with all the Link Officer has done for me. I have now lost
weight and feeling happy about that. Having this bus pass means I can get out
and about more and do not have to worry about the cost of bus fares. I can
now visit my Dad more often and he says the Link Officer has been a big help
to me. I really enjoy volunteering at the community centre, sometimes we play
quizzes and I really enjoy that. (Jayne)

12. In the past as a case manager it was often
hard to access the services and the help
you felt your patient would benefit from. It
could be very time consuming finding out
the appropriate service and then the
appropriate person to refer to, however
with the MDT meetings this has improved
considerably. Inowhave a network of
colleagues to whom I can refer or simply
ask for advice. This has improved my
efficiency greatly and lead to a service
improvement for patients and their carers
It is rewarding seeing how
integration has re-energised team
members and the enthusiasm of
key professionals in the service
has encouraged more staff to
want to become involved in this
new way of
delivering health and social care.
The new integrated way of working has helped
me: better integrate with teams, understand
what services
can offer and has given me greater autonomy
this has directly
improved patient pathways of care and reduced
unplanned admissions to hospital.
The difference to our staff

13. Why this has been successful
• Clinically led, person centred
• Bottom up approach
• Different mix of workforce used to their maximum potential
• Teams without walls, working beyond organisational boundaries
• Staff driving the pace of change
• Confirmed by successful outcomes

14. Our challenges
For our teams
• Engaging everyone to see the benefits of the model and
take them with us
• Not having single patient record
• Expanding the workforce (e.g. shortage of ANPs)

15. Better Local Care (South Hampshire)
The Changing Vanguard Workforce
Dr Nigel Watson
GP Lead

16. Our Multi-Specialty Community Provider in
Southern Hampshire
• Around 30 GP practices working in partnership with Southern Health
NHS Foundation Trust.
• Supporting population of 220,000 in three initial localities (Gosport, East
Hampshire and South West New Forest).
• Supported by 16 local health providers, commissioners,
local authority and third sector partners.
• Significant growth across Hampshire anticipated…

17. Better. Local. Care.
• Better Local Care aims
to provide better
access, experience and
outcomes for patients
closer to their homes.
• This means fewer
people will need to go
to hospital, but more will
be supported to take
control over their own
health and wellbeing.

18. Breaking the Mould
• Direct access to a specialist at a surgery for patients with musculoskeletal pain
thanks to partnership between GPs and Southern Health NHS Foundation Trust.
• Consultant Physiotherapist for Musculoskeletal Services provides sessions at
the Arnewood Practice as extended scope musculoskeletal practitioner.
• Among the first Better Local Care developments in South West New Forest.
• More rounded MSK pathway for patients.
• High level of assessment, diagnosis and management, quicker assessment and
treatment, and longer appointments.
• Empowering patients.
• Scheme started on 1 July - so far achieved an 100 per cent patient satisfaction
rate of “very satisfied.”

19. Improving Access
• Patient experiencing a mental illness offered quicker, longer
appointments with an appropriate nurse at a Gosport surgery.
• Southern Health Community Psychiatric Nurse on-hand at
Forton Medical Centre in Gosport for two-half-day sessions a
week.
• Aims to improve access to an appropriate mental health
professional in a GP surgery, offer longer appointments and
further improve patient care.
• Prior to the scheme, GPs referred up to 12 patients a month to
a hospital clinic. Since it started two patients referred.

20. Discussion