Integrated Care in Hammersmith and Fulham

In Hammersmith and Fulham, we are making it our initial priority to develop integrated care services for older people.

Key facts:

  • There are around  198,000 patients in Hammersmith and Fulham
  • The borough has 31 GP practices
  • The partners working together to deliver integrated care are: Local patients and carers, NHS Hammersmith and Fulham CCG; London Borough of Hammersmith and Fulham; Hammersmith and Fulham GP Federation; Central London Community Healthcare NHS Trust; Imperial College Healthcare NHS Trust; Chelsea and Westminster Hospital NHS Foundation Trust; West London Mental Health NHS Trust and London Central and West Unscheduled Care Collaborative.

The journey so far….

For us, the Whole Systems programme offers the opportunity to see real structural and systematic change, so that people are at the heart of our health and social care economy.
Hammersmith and Fulham have been developing integrated care services for a number of years and our Whole Systems model of care builds on our experience of enhancing community services to improve planned care and the implementation of our Integrated Community Independence Service model. 
In April 2015, Hammersmith and Fulham put on two simulation events:  interactive days of real life case studies, acted out so patients, clinicians and other stakeholders could tell us where we can improve care for patients. The findings from these events are being used to directly inform our plans 2015/16 and beyond.

The future…..

We’re excited about: 
  • Patients in Hammersmith and Fulham will receive care focused on them as a person and not their illness
  • Front line staff will be able to deliver efficient high quality care as the system  reduces duplication and they feel part of an integrated multi-disciplinary team focused on improving people’s outcomes 
  • There will be an emphasis on learning from positive experiences of care 
  • There will be further co-production with lay partners
  • We will improve the way we work with the resources in our communities in delivering our model of care

"We are committed to delivering radical and innovative change through the Whole Systems Integrated Care programme, so that our local residents and patients experience seamless care and support which focuses on their wellness and not their illness. People being in control of their own needs and the care they receive is our primary goal and we recognise that the system needs to change to enable this so that services are commissioned, delivered and paid for differently."