The SevernSide Frailty-ACE Service: Pioneering Patient-Centred Care

Innovative Care Coordination

SevernSide’s Frailty-ACE Service is redefining care for the frailest in our community with a novel, coordinated approach. This service ensures that frail individuals can receive comprehensive care at home, avoiding unnecessary hospital admissions.

Patient-Focused Objectives

At the heart of Frailty-ACE is the commitment to meet urgent care needs within the comfort of a patient’s home, aligning with their preferences to deliver the best outcomes.

Dedicated Team and Holistic Operations

A dedicated team, including Primary Care clinicians, an Advanced Clinical Practitioner, and a Social Worker, work collaboratively with mental health and professional care services to provide extensive support.

Integration and Impact

The service integrates a variety of healthcare provisions, such as Frailty NHS@Home and 24-hour GP services, allowing for in-home assessments and continuous care.

Pilot Success

The pilot showcased significant success, managing the needs of over 200 complex patients and achieving substantial reductions in hospital admissions, highlighting the effective model of joined-up care.

Positive Outcomes and Savings

This integrated service not only improved emergency department performance but also resulted in significant cost savings and bed day reductions.

Sustained Service and Community Support

The F-ACE Service’s success has warranted its continuation over the winter period, further demonstrating BrisDoc’s dedication to serving and enhancing the wellbeing of our community.