Appendix 5 PHB Local Offer
PROJECTS IN SCOPE TO THE LOCAL OFFER
Integrated Care in Practices is a ‘test and learn’ partnership between 4 practices and Age UK South Gloucestershire, currently funded by the CCG until the end of March 2016. It is modelled on the very successful Newquay Pathfinder and integrates social prescribing with the mainstream work of the practice through the latter’s multi-disciplinary team meetings. Age UK agree who amongst their patients with more than one long term condition is to be offered this support with the practice and the works with the individual to identify and then achieve their personal goals. The benefits for the individual have already been demonstrated with the average person’s self reported wellbeing score improving by 26%. Evaluation starting soon to assess whether this initiative will achieve the Newquay Pathfinder’s 40% reduction in non-elective hospital admissions.
Happy, Healthy and at Home: Cluster Integration Project is part of the South Gloucestershire Better Care Fund Programme and as such is dedicated to developing a community within South Gloucestershire in which local people have access to the information and services that help them maintain their health and wellbeing. The emphasis is on developing partnerships between individuals, their family and friends, the wider community, voluntary, public and private organisations, all working together to promote better health and wellbeing lifestyles and to support those living with on-going health conditions and social care needs. The overall goal of this multi-owned project is to develop a community-based health and care model provided from six localities called clusters. It involves bringing together a wide range of partners from statutory and non-statutory settings and agreeing ways of joint working together to provide local community members with holistic and comprehensive support. The project aims to identify any gaps in current provisions and addressing them through stimulating commissioner – provider dialogue to develop a more joint up provider offer and more flexible commissioning.
Rehabilitation, Reablement and Recovery is an approach to avoiding unnecessary admissions and reduce long stays in acute hospital beds. The “3Rs” can support people as they recover from illness or injury, or after surgery. They span both health and social care services and involve a variety of organisations including services provided in acute hospitals and in the community, including at home, and they are provided by a range of professionals and their support staff including hospital consultants, nurses, therapists, GPs and social workers. While the majority of people admitted to hospital recover from illness or injury with limited additional support, a significant minority – particularly frail older people – may need some form of active therapy over a longer period to ensure effective recovery and maintain their independence
December 2015