Patient experiences of proactive care in Wandsworth

South West London Integrated Care Board (SWL ICB) commissioned South West London (SWL) Healthwatch to review community services across six SWL boroughs. Healthwatch Wandsworth focused on proactive care. Healthwatch Wandsworth developed a survey to gather patient experiences of proactive care that was carried out by staff at Central London Community Healthcare Trust (CLCH). Healthwatch Wandsworth analysed the anonymised responses from 46 people. 

Most patients had a positive experience of proactive care. The findings highlight ways to improve and better understand the benefits of proactive care.

Patients reported good communication between GPs and District Nurses (DNs), but that communication could be improved amongst other professionals within multidisciplinary teams (MDTs). 

Most patients reported that they did not understand what proactive care was, compounded by the fact that most patients reported that they did not receive an opt-in letter describing it. 

Further research is needed to understand where gaps in communication lie and how this can be improved. This will highlight specific gaps in communication and how to better facilitate information sharing between teams. This may lower the need for patients to reshare information with different professionals, improving experiences.

Ensuring that letters are received and confirming patient understanding at their first contact when admitted on the pathway may improve patient understanding of proactive care and their involvement in their care.

 Older patients, patients with physical disabilities, and vision impairment reported having difficulty filling in forms and using e-consult services, which led to delays in care.

When asked how proactive care can be improved, 17% of patients made suggestions to improve accessibility (the most common theme mentioned). 9% of patients reported needing further information, advice and guidance around accessibility 

Proactive care should ensure that the Accessible Information Standard is adhered to and patients are offered multiple ways to engage with services.

41% of patients agreed that proactive care helped them to regain or maintain independence. 71% reported that it helped them to avoid unplanned A&E visits. 

Most patients felt that they have an active role in their care.

Further research is needed to identify factors that impact patient independence. Services could ask more questions at the beginning of the pathway to understand achievable goals for independence. They should ensure this is discussed by the multi-disciplinary team and included in follow-up with patients. Questions could include whether accessibility is related to patient independence. Additionally, they may want to ask if factors related to the type of care offered may inadvertently restrict patient independence.

Further research is needed to identify factors that enabled 71% of patients to avoid unplanned A&E visits to help services increase the proportion of patients avoiding A&E and provide learning to be used more widely.

89% of patients reported knowing who to call if they had questions about their care. 50% of these respondents reported that they would call their GP. 61% of patients said they did not require further information, advice or guidance to support their health, but 39% of patients said that they did.

It may be useful for CLCH to understand what information, advice and guidance patients may need, and barriers preventing them from receiving information.