HEALTH MATTERS
DR Paul Bowen, clinical chair of NHS Eastern Cheshire CCG, and GP with McIlvride Medical Practice, Poynton REGULAR readers of this column will know that the Caring Together programme is joining up health and social care services across Eastern Cheshire.
Its aim is to provide community-based care that helps people to stay well and supports people with long-term conditions to live independently at home – where they want to be.
What you might not know is that Caring Together has recently established community hub prototypes in two localities to test new approaches to joined-up care. Known as Team Knutsford and Team Bollington, Disley and Poynton, the two hubs have made important progress since June – and Eastern Cheshire’s other three localities are in discussions about how to create hubs in their areas.
Team Knutsford has been progressing with the following projects:
The dementia pathway project has made it easier for people with complex or advanced dementia to see a consultant.
Appointments for patients needing a review have been combined with other long-term condition reviews where possible, which has reduced the number of appointments needed.
A unified nursing project has brought together health workers from different organisations to provide joined-up care that also makes better use of health workers’ time.
Another project is bringing together health and social care partners, third sector organisations and the public to develop a standardised approach to end-of-life care.
A local care service directory will signpost a wide range of community and voluntary services, helping people to manage their own care at home.
Flu clinics in September were used to test people for atrial fibrillation, an irregular heart rhythm which is hard to detect and is a leading cause of stroke.
A community paramedic project has seen a community paramedic and matron making twice-weekly visits to care homes to train staff and reduce avoidable emergency call-outs.
Meanwhile Team Bollington, Disley and Poynton have been busy with projects of their own.
Healthcare staff and patients have worked together on plans for a unified approach to management of diabetes.
A whole-system approach to older people’s services identified 15 frail patients who received a lifeline personal alarm and bespoke care plan.
A medicines management hub has trained GP practice staff in efficient, cost-effective repeat prescribing.
Finally, a number of teams have been working together to create a single list of information on support services for carers.