- adapting UHG Evercare model for the NHS

A number of PCTs are aiming to improve services for older patients through collaboration with UnitedHealth Group (UHG), an American Healthcare Maintenance Organisation

The intention is to pilot the adaptation and implementation of their ‘Evercare’ model for managing care for a vulnerable older population.

Back in November 2002, 10 PCTs began working with UHG to scope how the ‘Evercare’ model could be tailored and adapted. Following this initial work PCTs have been discussing their requirements for more hands on support from UHG in implementing an adapted Evercare model over the next 18 months with UHG.

Pre-emptive monitoring
In the US patients in the Evercare programme are monitored intensively to catch illness early. The intention is to keep older people healthy and when they do become ill, to avoid unnecessary hospital admissions by offering a greater range of services in the community and by treating them in the least intensive setting.

A primary care team is used to deliver this model. Nurses are at the centre of the model and they work closely with hospital geriatricians, and with the patient’s doctor and family to develop care plans for patients.

The starting point for implementing an adapted Evercare model in the 10 PCTs is to identify the high-risk population. The approach then will be to develop a model of care where, the role of the GP is extended through a collaborative partnership with nurses and social care staff, and where consultants are engaged as part of a community based team to enable more proactive management of the high-risk caseload. Professor John Young, Consultant Geriatrician in Bradford, sees the potential for care modelled in this way, saying, “This is a big opportunity to support some of our most vulnerable older people, both at home and in care homes - to provide them with enhanced and timely care.” Prof Young added, “At the heart of the Evercare project is a tried and tested training programme for nurses embedded in partnership working between GPs and geriatricians.”

As well as improving the way that care is provided this project can also help PCTs in their efforts to deliver success against National Service Framework for Older People standards such as: assuring standards of care; extending access to services; and developing services which promote the independence of older people. This approach will also build on the integration of health and social care services for older people.

Lyn Wilkinson, Director of Community and Nursing Services in Airedale PCT, sees clear benefits in participating in the project. Ms Wilkinson said, “We are delighted to have the chance to pilot this new programme of care in the PCT. This will improve quality of care for the most frail older people, and their carers, by reducing levels of polypharmancy, avoidable hospital admissions and offering more patient/carer involvement in care”.

High satisfaction
Independent evaluation of the programme in the US by the University of Minnesota has shown high physician and family satisfaction - 97% of families appreciated the extra care and attention received through the Evercare programme.

As a condition of taking part in this programme PCTs are participating in Action Learning Sets as part of the transformational change programme being run by the National Primary and Care Trust Development Programme. This will ensure that learning opportunities can be captured during the roll out of the project and spread more widely.

Patrick Harrison
Policy Development Manager, DOH