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Partnership at home

The aim of the project was to integrate domiciliary care staff into community teams

The project was a six month pilot between North Somerset Community Partnership (NSCP) and Brunelcare (domiciliary care agency) whereby domiciliary care staff were integrated into community teams. 

The care staff received on-going education to provide low level health care tasks under supervision from registered nursing and therapy staff.  A Professional Education Facilitator worked alongside the community teams and care staff to provide support in practice, education and training and competency development.

The pilot took place in two community healthcare teams, Marina and Tyntesfield, and impacted on approx. 50 community staff both nursing and therapists employed by NSCP.  It involved four care staff, employed by Brunelcare, who will work alongside existing community teams. 

The target audience for the pilot were patients on community teams’ caseload which traditionally has been older aged, housebound individuals.

An analysis of community nursing caseloads within NSCP identified that many people are seen by both health and domiciliary care services, with some people having up to four visits per day from care staff.  This led to fragmented and inefficient care.  It was identified that a lot of people had low complexity healthcare needs, which could be provided by appropriately trained domiciliary care staff. 

Additionally, it was identified that domiciliary care agencies were finding it increasingly difficult to recruit and retain staff as, due to the way they care currently commissioned, staff were effectively on zero hours contracts.  Shortage of available home care, not only impacted on patients, but delayed discharge from hospitals (patients were waiting for packages of care), community health (patients often cannot get care they need which may risk admission to hospital unnecessarily) and the Council (unable to commission services).

The objectives were to:

  • Improve patient experience through sharing skills and knowledge through enhanced communication between the different agencies;
  • Enhance community partnerships which enable the most appropriate professional to support the person, and freeing up capacity of other staff to treat patients with greater complexity;
  • Increase sustainability in health and care organisations by reducing duplication and collaboratively managing patients with emphasis on early intervention, prevention and public health;
  • Support care agencies recruitment process by enabling them to offer more varied roles for some staff, and by filling their traditional “dead” time supporting community nursing teams to improve the contract terms they can offer

The project was completed in March 2016.



Following a review of the project, the following achievements, benefits and lessons were identified:

Key achievements:

  • Closer working relationships have been established with the local care agency in the pilot areas. Noticeably carers will telephone the nursing team if they have any queries or concerns about somebody they are providing care towards.
  • An understanding by the community teams that staff from other agencies can provide low level preventative support that improves the overall care of patients and frees up some of the teams clinical time, to spend on those with the highest need.

Benefits identified:

  • Improved communication between the community health and care teams was achieved and enabled the most appropriate professional to support the person, and freed up capacity of other staff to treat patients with greater complexity.
  • The up-skilling of the care workers demonstrated the additional benefits of this group of staff carrying out low complexity tasks and improved patient experience, as these members of staff had more time to spend with the patient and where able to carry out more preventative tasks.

Lessons learned:

  • Relationships with the care agency were very positive; as a project group we were able to resolve all issues that arose in a positive manner; the care workers and community teams established good working relationships over the period of the pilot.
  • Feedback from the care workers showed they valued the additional skills that they learnt – and feedback from NSCP staff showed, that over time they appreciated the support of the care workers and the felt patients were receiving a thorough service.
  • Signing off competencies of staff was difficult at times and took longer than expected, partly because the care staff were only working in NSCP part time and therefore did not always get the practice required immediately.
  • Going forward NSCP are clearer about the types of tasks that care workers can carry out in the community and in care homes, and we have the training packages and competencies already designed. The governance work that was carried out at the beginning of the project and the project itself has identified other areas of care and support that care workers could be carrying out in conjunction with nursing teams.
  • The experience of placing a carer in a leg club demonstrated the benefits of this low complexity task being carried out in an environment where there was the constant support of a nurse, without patients having to wait for someone to come and finish the task off.  This environment is replicated in care homes and therefore we are exploring the benefits of training care staff to carry out some low complexity tasks whilst overseen by a nurse.

For more details, please contact Jane Impey, Service Redesign Manager at North Somerset Community Partnership.

This Page was last updated on: 19 July 2017

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