Integrated community service
Integrated community services combines both health and social care so that the patient gets the right treatment, at the right time in the right place.
The aim is to enhance the current core community, nursery team (district nurses) Isobel Hospice Team with highly skilled health care professionals to enable patients to stay at home rather than being admitted to hospital (30% of admissions to hospital are avoidable). We have listened to patients and we want patients to tell their story once, enhance the communication process between the patient and those who are caring for them, so care is delivered in an integrated way. GP practices will align to the Integrated community team to enhance this process. To enable health and social care teams to work more effectively together we will be sharing basic medical information for us to effectively manage patients with multiple long-term conditions.