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Posted on 20 Dec 2019

We held our second South Notts ICP development  event recently and it was well attended by health, social care and local authority representation, including district councils. We reflected on South Notts not being a place that people identify with as such, but it is our patch and it’s where we need to make a difference and do our best for the population who need and use our services. It’s also a patch in which colleagues have worked together over many years and where we already have a tremendous amount of good practice and strong partnerships that we can build on.

John Brewin, Convenor of the ICP, reflected on the offer for primary care, social care and community care. The current structures and models are not fit for purpose or sustainable. We have a changing patient demographic, an increase in demand and more people living longer with Long Term Conditions. By helping with these issues, we can do more to help the acute providers and reduce demand which will make a huge difference to the system. The ICS, ICPs and PCNs need to become real entities, with the powers to make changes and improvements for our populations. We need to plan for a timeline of 3-5 years and there are some important staging points during that period.

What emerged were common ambitions across several different partners. A willingness to do things better rather than just talking. Prevention, frailty and mental health will be a priority for us. There was a great deal of hope and shared ambition in the room.

Considering the PCNs were only established in July, we have Clinical Directors in post and 100% extended hours coverage. We also have a South Notts social prescribing model.

The Primary Care Psychological Medicine pilot has sustained some of the benefits realised and patients are using health services less frequently as a result. Integrated Care Teams are doing virtual huddles now, although co-location would make that easier. Adult social care is undergoing some workforce remodelling to see if this has potential.

Across the patch there are good examples of patient involvement with a virtual network across the south. The local response to the Long Term Plan on how we deliver health and social care for the next 5 years was well received.

Workforce is an issue for us, and supply is a challenge. Turnover is high, as is sickness. To deliver the changes we need for our patients we need to engage and develop our workforce.

The rest of the session focused on Frailty Syndrome with features of falls, immobility, confusion, incontinence and polypharmacy. We need to avoid patients getting worse and if possible, make them a bit better. The care also needs to be personalised and those outcomes need to matter to all the providers. Language is very important – patients are frail, not just because they are old but because they have multiple problems.

The next development session will be in mid-February, with a public launch later in March. It’s an interesting journey and we watch with interest to see some tangible benefits of this change to system working.