Rammya Mathew: It’s time to raise the profile of community trusts

For the past few years I’ve been working for one of the largest community trusts in the country. Whenever I tell friends, or even colleagues, that I work in the community, I’m met with wonder. Most people understand hospital medicine and primary care. But community care, although it’s a crucial part of our healthcare system, receives little attention, and as a result it’s poorly understood.

In my time working at the trust I’ve discovered just how expansive community care is. Our trust cares for a population of more than four million patients throughout London and Hertfordshire, which our chief executive often reminds me is equivalent to the population of Wales. We also provide around 1.5 million visits a year to people in their own homes (more than what many acute hospital trusts provide in the way of elective outpatient appointments). We provide more than 100 clinical services, and our biggest stakes are in community nursing and health visiting.

But we also have rapid response teams and “hospital at home” teams, which enable our older population to be cared for at home. We provide intermediate care (including inpatient rehabilitation) and early supported discharge services, which help maintain the flow out of our acute hospitals. Through our community palliative care teams we support patients who wish to die at home. And we provide specialist care in the community through our heart failure, diabetes, and respiratory teams. We also play a pivotal role in health promotion through our health visitors, school nurses, dietitians, dentists, and sexual health teams.

With the overall ambition to provide more care in the community, it’s important to raise the profile of the work we do in the community. We’re already a professional home to some groups of consultants working in the NHS, but the lack of exposure to community work means that it’s not a natural choice for everyone. There’s a unique opportunity, through the development of integrated neighbourhood teams, to bring more specialist skills into the community and to create new consultant roles for work in large multidisciplinary teams, providing more seamless care to patients—particularly those with complex needs who require a more tailored approach to their care.

For years NHS policy has theoretically supported the movement of resources from hospitals into the community, most recently through Claire Fuller’s vision of integrated primary care.1 We must not overlook the crucial role that community trusts can play in this respect—being well positioned to employ specialists in the community, through having access to a wide range of teams and strong links back to primary care. Community trusts can be the connectors that the system desperately needs, but we risk losing this opportunity if we continue to perpetuate the illusion of a two dimensional system of acute and primary care.