Enhanced Care at Home in Warwick

Enhanced Care at Home in Warwick: early indications show that just over 100 unplanned admissions to hospital have been saved in the last 6 months.

In May 2017 we told you about an exciting project being funded in a joint venture of local charities and which involves GPs and Advanced Nurse Practitioners (ANPs) supporting and giving proactive care to patients in Warwick.

Warwick Relief in Need Charity, Warwick United Charities, Warwick Provident Dispensary Charity and King Henry VIII Endowed Trust alongside the main benefactor, the Charity of Thomas Oken and Nicholas Eyfller, are supporting the project. The Oken and Eyffler charity have awarded funding of £75,000 a year for three years to provide enhanced medical care to patients who live at Park View

Care home and Warwick patients who are housebound in their own home.

Patients are being offered care from a small team of GPs from Priory Medical Centre and The New Dispensary and dedicated ANPs who are employed by South Warwickshire Foundation Trust. Visiting once a week, the team offer an initial assessment, give clinical and medication reviews, discuss advanced care planning at end of life, as well as supporting relatives and care home staff. The team are also undertaking proactive visits to housebound patients to help prevent unnecessary trips into hospital and support those returning from hospital. The outcomes so far are very positive with all staff reporting a huge difference being made in the proactive care of patients.

Early indications show that just over 100 unplanned admissions to hospital have been avoided in the past six months.

Dr Nick Yeats, lead GP said: “The Oken Nurses have been in place since May and are making a significant improvement in the care provided to housebound patients. Not only do they visit acutely unwell patients who live within the Warwick town area, they are also in proactive at following up vulnerable patients discharged from hospital or move to the area. Informal feedback from patients has extremely positive and they have freed up valuable time for GPs to focus their time and energy on the more complex and unwell patients. They are an invaluable member of both the teams at the New Dispensary and Priory Medical Centre now.”

Clive Mason, Chair of the Charity of Thomas Oken and Nicholas Eyffler said; “We’re so excited and proud that after more than 400 years, the concerns of the Charity’s Founders, to care for the people of Warwick have been wholeheartedly met through this fantastic work. With the help of the other major charities in the town, the Enhanced Care at Home Project, under the inspired leadership of Dr Nick Yeats and with such committed ANPs, is already making a significant contribution to the improvement of care at home of patients in Warwick.”

The project will be funded until April 2020.




Healthcare partners working together to enhance care for local people


Communities in South Warwickshire are benefitting from close partnership working between South Warwickshire NHS Foundation Trust (SWFT) and local GPs.


With support and funding from the Warwick Charities of Thomas Oken and Nicholas Eyffler, King Henry Vlll Endowed Trust, Warwick Relief in Need, Warwick United and Warwick Provident lead by the Oken Eyffler Team, SWFT together with NHS South Warwickshire Clinical Commissioning Group and local GP Practices Priory Medical Centre and Chase Meadow  Health Centre have enhanced community and GP services for housebound and care home patients living in Warwick.


What started as a pilot project in May 2017 has developed over the last three years to provide proactive medical and nursing care to patients who are not mobile or able to easily access GP services. GPs and community nurses are now working in partnership to support these patients to stay well in their own home and reduce the likelihood of needing emergency treatment.


Integrating the work of community teams and general practice has resulted in better relationships, improved communication between organisations, reduced hospital admissions, A&E attendances and GP visits, supported early discharge and encouraged patients to optimise their own health and wellbeing.


Following the success of the initial pilot, the project has been rolled out to all care home and house bound residents in Warwick and Kenilworth so that more residents in the local community can benefit from this joined up approach. This new way of providing care for patients with limited mobility, not only enhances their experience, but it is also much more efficient and sustainable for our NHS services.


Anne Coyle, Managing Director at South Warwickshire NHS Foundation Trust said: “This has been a really successful project for all parties involved. Seeing how positive the outcomes are for patients has been fantastic. Being able to provide them with the right support, at the right time, has had a resounding impact on their health and wellbeing, as well as reducing the impact on the wider health and social care system. It has been an absolute pleasure working with GP colleagues and The charity of Thomas Oken and Nicholas Eyffler and I look forward to progressing this project in other areas.”


Clive Mason, Chair of The Charity of Thomas Oken and Nicholas Eyffler said: “We are delighted that this innovative and exciting project, jointly funded by the Warwick charities, has been of such benefit. With the excellent cooperation and support from all concerned, it has achieved a really positive outcome for the health and welfare of our older residents in Warwick and will now be expanded by SWFT to a much wider population in South Warwickshire. It is hoped that the joint Warwick Charities will continue to fund other innovative projects in the future.”


Nick Yeats, GP at Priory Medical Centre said: “The Oken project has transformed the way we provide health care to our housebound patients, individuals who are often some of the most frail and vulnerable in our society. South Warwickshire NHS Foundation Trust and all five practices in the Kenilworth and Warwick Primary Care Network are now working hard to expand this project at pace, significantly allowing a much larger number of patients to benefit from this innovative and forward-thinking approach to care. We are very grateful to all the charities involved for their significant support over the last 3 years and look forward to the next step, it is an exciting time.”