Community Care Collaborative: Transforming Primary Care in Wrexham

After receiving £97,0000 from Welsh Government’s Foundational Economy Challenge Fund in March 2020, Community Care Collaborative (CCC) has been trialing an alternative model of health and social care within Wrexham. The innovative way of working still supports patients’ medical requirements but introduces new systems that prioritises their social and emotional needs.

The Community Care Collaborative (CCC) is a Community Interest Company that provides an innovative and integrated approach to healthcare in Wales.

Founded by Dr. Karen Sankey in 2018, CCC developed a very clear vision for primary care after realising that the current model was failing at several levels.

Through research and testing, it found that patients often visit a doctor with an issue that has a social or mental health basis, which it believes GPs are not equipped to deal with in the best way.

Added to this, it’s thought that the volume of patients that a GP is expected to see in a day on top of other duties such as medicines, makes it impossible to provide an adequate service to every single person.

The solution is a model which delivers “an alternative model of health, social care and wellbeing in which GPs (doctors) are able to focus on providing medical care, and where, through working collaboratively at a community level with other agencies and patients themselves, the social and emotional needs of patients are given equal priority to their medical needs”, as its mission statement shares.

“The Challenge Fund seemed to me to be very much about trying to do things differently and about taking a chance to really give something a go to find out whether it works or not.”

Before receiving a Challenge Fund grant, CCC had already secured contracts to trial this model at three GP practices in Wrexham and had been granted permission to take over its first practice in September 2019 with the second and third following in January and April 2020.

However, the Challenge Fund grant has been essential in enabling CCC to develop its ideas further and successfully set up and recruit in a vast number of different areas of health and social care over the last 12 months.

Alison Hill of Capacity Lab, who assisted in bringing the model to life said that, “The Challenge Fund seemed to me to be very much about trying to do things differently and about taking a chance to really give something a go to find out whether it works or not.”

Firstly, CCC recruited a permanent emotional wellbeing team which is present at all three practices and aims to provide a first point of contact for patients that are in need of wellbeing support directly after booking an appointment.

What commonly happens in these cases is patients are referred on to other mental health organisations and can bounce back, so a key focus of this team is to reduce onward referrals by providing services in-house such as support groups, medication reviews, memory assessments and psychotherapy.

The organisation has seen that utilising this model alone has seen onward referrals reduce by over 57% compared with the previous evaluation period (Apr-Sept 2019).

Not only does this mean that patients are being provided a more appropriate and immediate response, but the cost savings to other health and social care services are likely to be significant. A social impact evaluation of CCC’s Emotional Well-Being Team found that it had delivered social value worth more than £1million in its first 12 months to November 2020, representing a social return on investment of 6.42:1.

More important to those involved is that 33% of people supported within this model (who were asked for feedback), said that without support they may have taken their own lives, further demonstrating the positive impact that the model is having.

To support the referral process, CCC recognise that as first responders to calls, front desk staff play a vital role in the patient process so it invested in training to develop them into ‘Care Navigators’. People within this role now have the knowledge to respond to individual patient needs and signpost them towards the relevant team, rather than automatically referring them to a GP.

Due to the high level of demand during Covid-19 and the huge upheaval of a system that has been in place for years, the booking system is an area that CCC is still working to make as effective as possible through continuous testing and experimentation.

Alison says, “We tried eConsult (Lite), which didn’t work out so we changed it and adapted it…it’s improving, but that is something that we haven’t got right yet and we still need to work very much on.”

Despite the obstacles faced by the pandemic, CCC is really proud of its progress this year, although there are some areas where work still need to be done, especially in recruiting full time salaried GPs.

Although CCC has been able to employ some part time doctors, Alison explains that a huge obstacle primary care is currently facing is that many GPs are working as temporary doctors known as locums, which she says, “In terms of finances, it’s going to destroy primary care.”

As they move towards the goal of recruiting more full time GPs in 2021, the team is confident that this integrated model will prove attractive to GPs, as it gives them more opportunity to concentrate solely on medical needs and to patients as they will be able to access a much wider range of inhouse support.

As CCC looks towards the future, it will be concentrating its efforts on recruiting full time salaried GPs, and building partnerships from within the Welsh Government’s FECF Community of Practice, as well as other organisations that can help to replicate this model across Wales.

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