Integrating services and providing health and care closer to home

Published on 19 Apr, 2017

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How the Integrated Care Pilots work

Integrating health and care in York, Selby and Pocklington

Award winning integration of health and care

Conversations with the local community and our engagement work with local providers are paving the way for the integration health and care in the Vale of York.

The community told us that they wanted a better integration and co-ordination of services which is why our five year plan sets out a strategy for locally based, integrated services that put GP Practices at the centre of the health and wellbeing system.

Patients shared their opinions with us, including ‘I want to tell my story only once’ and ‘better co-ordination of care’ and these led the way to three integration pilot projects we delivered in conjunction with our partners in primary care, acute care and the voluntary sector.

How the Integrated Care Pilots work

The pilots are staffed by a multi-disciplinary, multi-agency team that act as care co-ordinators ensuring care and support packages are put in place as quickly as possible and in the best interests of the individual and their carers. 

Patients have one care record and their care is co-ordinated through a single contact point.  This is either a GP, a care manager, a district nurse, a community matron, an Occupational Therapist, specialist mental health worker or any other health and social care practitioner that the individual has regular contact with.  This person retains accountability for their patient and acts as the facilitator to all other services and interventions. 

Our pilot projects are testing approaches to deliver proactive, community-centred care and are the first steps to look at alternative ways of combining and integrating the resources of the public sector, independent sector and assets in the community.

Initially focusing upon the frail elderly and those with long term conditions, the pilots are focusing upon ways to assess, diagnose and deliver care to enable individuals to remain at home or return there as early and safely as possible following ill-health or a crisis. 

Integrating health and care in York, Selby and Pocklington

The journey to develop fully integrated care pilots continues. The focus is currently on three pilots, one each in Pocklington, Selby and York. Each draws on the strengths of primary and secondary care, the voluntary sector and social care providers to test different models of delivery and inform best practice. Click on the links below to find out more information.

York Integrated Care Team

Selby Integrated Care Hub

Pocklington Integrated Care Hub

Award winning integration of health and care

We have been awarded Integrated Care Pioneer status for our collaboration work with partners to embrace innovation and deliver high quality care through a seamless health and social care system.

We were selected to be part of the Pioneer community for our ambitious work that focuses on driving tangible health and care improvement through our integrated care pilots. We were also identified as exemplar in our work to tackle barriers to delivering integrated care.

Our work features in People helping People, Year 2 of the Pioneer Programme’s Annual Report and in a short video that accompanies the report document.