Rad­i­cal Alaskan health plan pi­loted to save Scots NHS

Sunday Herald - - 19.03.17 NEWS -

BY JU­DITH DUFFY

SCOT­LAND is test­ing out a pi­o­neer­ing sys­tem of health­care de­vel­oped in the re­mote Amer­i­can state of Alaska. The Nuka model of care is run for Alaskan na­tive and Amer­i­can In­dian peo­ple by a state-funded health sys­tem. Tri­als are now tak­ing place, backed by the Scot­tish Gov­ern­ment, as part of a ma­jor drive to­wards the in­te­gra­tion of health and so­cial care ser­vices.

The Nuka model in­volves ded­i­cated teams of GPs, nurses and other health pro­fes­sion­als such as psy­chol­o­gists and di­eti­cians pro­vid­ing care for a small list of pa­tients. There is also an em­pha­sis on ed­u­ca­tion and train­ing in the com­mu­nity, and tra­di­tional Alaska Na­tive heal­ing is of­fered along­side health and so­cial care ser­vices.

The sys­tem, which was de­vel­oped in the 1990s, has re­sulted in a 36 per cent re­duc­tion in days spent in hos­pi­tals and the slash­ing of emer­gency cases by 42 per cent, ac­cord­ing to re­port by health think tank The King’s Fund. The South­cen­tral Foun­da­tion, which runs the Nuka model, is also said to have trans­formed health­care for Alaskan na­tive peo­ple from “among the worst in the United States to among the best in the world” over three decades. The pi­lot tests in Scot­land range from set­ting up small teams of mixed health pro­fes­sion­als in GP prac­tices to “so­cial pre­scrib­ing” ini­tia­tives of­fer­ing health-re­lated ac­tiv­i­ties such as dance classes and cook­ery clubs.

Maxine Jones, pri­mary care de­vel­op­ment ad­viser with Scot­tish-based think tank In­ter­na­tional Fu­tures Fo­rum, who vis­ited Alaska in 2012 to see the Nuka model in ac­tion, said she be­lieved it could work for Scot­land. “The fo­cus [for Nuka] has been very much on putting the pa­tient first and de­vel­op­ing the ser­vice ac­cord­ing to what the pa­tient thinks, as op­posed to what the health pro­fes­sion­als think,” she said.

“They have a tagline: it is all about re­la­tion- ships – so ev­ery­thing that hap­pens is geared to­wards op­ti­mis­ing re­la­tion­ships, both be­tween the pa­tient and care providers and also among the care providers them­selves.”

Jones said the Nuka model was based on a com­pre­hen­sive team, in­clud­ing a GP, nurse, health­care as­sis­tant and ad­min­is­tra­tor, look­ing af­ter a list of 1,400 pa­tients. She said this was a rel­a­tively small num­ber com­pared to the cur­rent GP prac­tice size in Scot­land of around 1,800 and up­wards per each full-time doc­tor. “Be­cause the teams are deal­ing with rel­a­tively few pa­tients, they are able to give pa­tients the time they need, so they are able to do things like care and sup­port plan­ning and help­ing peo­ple with well­ness as well as ill­ness is­sues,” she said.

Jones said the model could work for Scot­land and was al­ready be­ing tested out, but cau­tioned it would take some time to evolve. She added: “I be­lieve it could pro­vide the so­lu­tion to the cri­sis in pri­mary care cur­rently. How­ever, there are sig­nif­i­cant bar­ri­ers to over­come – for ex­am­ple, it is very hard for prac­tices to be able to only see 1,400 pa­tients per whole-time equiv­a­lent GP. That is un­heard of amidst a GP re­cruit­ment cri­sis. One of the beau­ties of Nuka is it has a whole range of ex­tended ser­vices avail­able where peo­ple can be sent im­me­di­ately, whereas most prac­tices here maybe have a phys­io­ther­a­pist, for ex­am­ple, that comes in once a week. It would need to be a lot more com­pre­hen­sive.”

An­drew Strong, as­sis­tant di­rec­tor of pol­icy and com­mu­ni­ca­tions at the Health and So­cial Care Al­liance Scot­land, said the Nuka model should be tested out as part of the in­te­gra­tion of health and so­cial care ser­vices.

Shona Ro­bi­son, above, Scot­tish Health Sec­re­tary, said: “The roots of their sys­tem are in­te­grated health­care so­cial care and men­tal health, with a very strong em­pha­sis on pa­tient and fam­ily in­volve­ment in care decisions. Presently we are test­ing var­i­ous el­e­ments of this in Scot­land.”

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