Somerset Clinical Commissioning Group

Somerset health commissioners look for new and sustainable model of community health care

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Somerset Clinical Commissioning Group (CCG), the GP led organisation responsible for the planning and funding of local health services, considered the next phase of planning for the future development of local community health services at its Governing Body Meeting on Wednesday 19 November 2014.

Members of the CCG’s Governing Body were asked to support a model of service which aims to place the emphasis upon preventing unnecessary admission to hospital, particularly for the county’s frail elderly and people with long-term conditions, through providing more care and support in their own homes. 

Over the next five years the strategy also advocates developing a new service model for the county’s 13 community hospitals.  The review recommends that this includes:

  • ‘Step up’ community hospital beds - providing care to people admitted from home and who require 24 hour nursing care with medical review or medical treatment.
  • ‘Step down’ community hospital beds - providing care for people who have been discharged from a district hospital but who still need hospital based rehabilitation and nursing care.  
  • ‘Health and wellbeing’ centres where a community hospital offers a wider range of clinics and services but would not have inpatient beds.

The CCG’s community service review does not state which community hospitals might eventually adopt these models of services, but suggests that only a few of the existing community hospitals would have step-up beds with the majority of hospitals continuing to have step-down beds.  Health and wellbeing services should be available at all community hospital sites, but a small number of sites may in the future focus on the delivery of health and wellbeing services but without having inpatient beds.  The Clinical Commissioning Group will be discussing the implementation of this review with local stakeholders over the next six months.

An audit of community hospital beds conducted by Somerset CCG in December 2013 found just under a quarter (23%) of the county’s 312 community hospital beds were being occupied at that time by patients who could have been cared for at home; only 74% (232) of the beds were in use at that time and 22% of patients could have been better supported in an alternative residential facility, as they did not require the level of nursing support available from a community hospital.

The CCG is developing community services which aim support and care for patients in their own homes which will reduce demand upon inpatient beds. For example, in Mendip a pilot scheme is already operating which supports patients who have been in district hospital following a stroke have their rehabilitation treatment at home. 

Commending the overarching strategy and vision for community services set out in the review report, Dr Matthew Dolman, Chairman of Somerset CCG, said:   “The model of community health care we are proposing to be developed over the next five years needs to support the growing numbers of elderly and long-term ill so they can live well in their own home for as long as possible – which is what patients say they want.

“Such a model of service must be sustainable and depends upon close collaboration between family doctors, district and community hospitals, social care services and the voluntary sector.  

“Whilst a significant percentage of patients currently using community hospital beds in Somerset could be better supported in their own home or community, the right services need to be in place for this to happen.  That is why this community service review is clear that a general strengthening of community based health care needs to be implemented in parallel with any new model of community hospitals.”   

Next steps

Members of the CCG’s Governing Body approve the second phase of the “Making the Most of Community Services” review.

CCG members also recommended the use of the recently established Local Implementation Groups to consider how the proposed service model could be implemented most effectively within their areas.   This work will be carried out between December 2014 and July 2015.

A Business Case and Implementation Plan will be prepared and presented to CCG’s Governing Body following the outcome of the next stage.

Patients, carers and the public will be formerly consulted on the proposals from July 2015 to October 2015, with a final recommendation taken to CCG’s Governing Body by November 2015.

Copies of the Second Stage Somerset CCG’s community services review known as “Making the Most of Community Services” is available from the CCG’s web site at: or on request from the CCG’s Yeovil Headquarters. 

Notes for Editors

For the last decade NHS organisations have been re-designing health services in line with national policy objectives and with the aim of progressively delivering more treatment within your local GP surgery, community hospital or direct to your home. 

The need to find more joined up and cost effective ways of delivering health and social care has been given added impetus since the former Chief Executive of NHS England, Sir David Nicholson, announced in July 2013 that without major changes to service, the NHS faced a £30 billion pound funding shortfall within the next five years.

National Government has pledged to make ‘real terms’ increases to the annual budget of the NHS (currently just over 2% budget increase a year) but is not enough to meet the growth in public demand.   Somerset CCG’s share of this national funding gap means local cost efficiency savings of some £40 million pounds need to be made each year for the next five years.

The sustainability of NHS in its current form was again brought into question last month by the new Chief Executive of NHS England, Simon Stevens.

In his recently published “Five Year Forward View” Mr Stevens called upon the public to take more responsibility for leading healthier lives; to look after themselves and use their local NHS services responsibly.

Family doctors, hospitals and local authority social services were also tasked to take decisive steps to break down any barriers in the way they deliver their services and in particular, ensure that they support people living with long-term health conditions in a more co-ordinated way.



Contact Somerset CCG by phone or email

01935 384000


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