Agenda item

To submit by the Head of Adult’s Services in relation to the above.

The Chair welcomed representatives from Betsi Cadwaladr University Health Board and the Chief Officer from Medrwn Môn to the meeting.  He also welcomed Dr Dyfrig ap Dafydd a General Practitioner from Llangefni who also leads on the GP Cluster project on Anglesey.

Submitted – a report by the Interim Director of Social Services in relation to where the Health Board and the County Council are working in partnership to change how support is provided within communities.  These areas of work will be fundamental in changing the approach over the coming years. 

The Interim Director of Social Services and the representatives from the Betsi Cadwaladr Health Board, Dr Dyfrig ap Dafydd and the Chief Officer of Medrwn Môn reported as follows :-

·           GP Cluster Model - In order the improve Primary Care Practitioners’ ability to support their communities the GP Cluster Model is being strengthened across North Wales.  A Cluster brings together all local services involved in health and care across a geographical area. Working as a cluster ensures care is better co-ordinated to promote the wellbeing of individuals and communities.  There are 11 GP surgeries that operate in the Anglesey Cluster area. 

On Anglesey there is one cluster which has seen recent improvements with additional Physiotherapists and Pharmacists involved within the service.  Advanced Practice Physiotherapists allow people presenting with musculoskeletal problems to be seen locally as an alternative to seeing their GP.  The Physiotherapy led service provides a fast local access and early management for patients, preventing clinical deterioration and the risk of developing chronic conditions.  The Anglesey Cluster have been working closely with the Mental Health and Wellbeing Centre, Abbey Road to set up support provision for Tier 0 Mental Health patients within the practice. 

Anglesey Cluster will be focusing on and further developing the following areas from April, 2019 onwards :-

·      Social Prescribing Model working with Medrwn Môn to develop the service further around the community hubs in order to pull patients away from GP practice;

·      Further work with the Police and Crime Commissioner in developing the SPOA and early intervention support for vulnerable people and their families.

·       Launch of the Anglesey Social Prescribing model in April.

·           Community Resource Team - Within the Anglesey Cluster there will be 3 Community Resource Teams (CRT).  Within each area, there will be office space that will allow staff from across Health and the Local Authority to work alongside each other and access their own IT networks/systems.  The CRT’s in Anglesey will mean that the Adult Social Workers and Occupational Therapists will primarily work from these locality bases.  The goal of the CRT’s is that by the end of 2019/20 all adults living on Anglesey will have simple and direct access to a Community Resource Team.  Teams will provide a seamless service by providing a co-ordinated approach to health and social care.  Some support will exist at locality/cluster level and will be shared across all areas i.e. Income and Charging Support, Specialist Medical Services (Diabetes, Heart Failure, Podiatry, Dieticians, Speech and Language Therapy, Arts Therapy, Mental Health Support Workers, Specialist Nursing and Housing.  The CRT’s will be configured to meet demand both in and out of hours (Nightowls service); will be central to developing resilient communities; support monitoring of high risk patients to support admission avoidance and support early discharge from hospital and support people back into their communities. 

·      Care of the Elderly GP (COTE) supports patients in care homes and supports the delivery of TEPs (Treatment Escalation Plans) to reduce inappropriate admissions to secondary care.  The focus is now to allow people to be able to stay within their home environment for as long as possible and that services are available locally to support people.

·      Social Prescribing – All 7 Local Asset Co-Ordinators are in post and have been linked to individual practices in order to support Primary Care.  The social prescribing service has been introduced to the Cluster areas to achieve more appropriate use of health and social services, improve health and well-being outcomes and enable patients to be pro-active in managing their own conditions and well-being.  The service propose to maximise the use of community assets, build on the use of volunteers and existing voluntary services so that people can access the right support and be accessible to as many people as possible within the community.

·      Falls Prevention – falls and fractures in the elderly are debilitating to patients quality of life and places a large demand on primary, community and secondary care services. 

·      Mental Health Development within our communities – the North Wales Local Implementation Teams (LIT) have been developed to ensure implementation of the changes to mental health services set out in the strategy ‘Together for Mental Health in North Wales’.   The aims of the LIT is to use the 5 ways to Wellbeing as the foundation of emotional and psychological wellbeing i.e. working with voluntary and third sector agencies to review their role with people at risk of severe mental health crises; developing local alternatives to admission i.e. crisis cafes, strengthened home treatment services and step-down services; ensuring Welsh language needs are considered and provided; working with statutory, voluntary and third sector agencies to review the unmet needs of people with mental illness and to ensure gaps in service provision are addressed.  Awareness raising training package has been developed i.e. bar staff, taxi drivers, hairdressers, and tattooist and nail parlours. 

A Mental Health Housing pathway has been developed in order to ensure that people with mental health issues are provided with equal opportunities in securing appropriate accommodation.  A multi-agency group meets regularly to identify and prioritise housing needs.  A step-down pilot project has been developed by the Council’s Housing department. 

·       Môn Community Link work with Medrwn Môn

Medrwn M֧ôn as the Local County Voluntary Council have been a vital partner in assisting both Health & Social Care Services to support communities differently through the development of Môn Community Link.  A dedicated Link Officer deals with all enquiries and referrals and gives information and advice or will pass the referrals to one of a team of 7 Local Asset Co-Ordinators.  The support is available to those within the communities who may feel isolated or lonely, or would like to take part in more activities in their local area.  Referrals to the service can be made by a number of partners including Social Workers, GP’s, Community Mental Health Teams, Physiotherapists, Third Sector Organisations or by the person themselves.  The facility can allow people to be able to live within their home environment longer.

The Committee considered the report and raised the following main issues:-

·      Reference was made to availability of appointments within GP Surgeries with some people experiencing problems attaining appointments to see their GP’s.  Dr Dyfrig ap Dafydd responded that whilst it seemed that GP surgeries have different procedures as regards to the appointments systems he noted that doctor surgeries need to learn from each other and share examples of different appointment systems and approaches.  He noted that he favoured a triage system which gauges whom a patients needs to be seen rather than a GP appointment.  Dr Dyfrig ap Dafydd said that he appreciated that the on-line appointments system needs to be enhanced together with skyping, emails and phone calls system to the surgery.  It was expressed that the matter will need to be considered within the Cluster meetings;

·      Reference was made to access to Mental Health services as some people are having difficulties attaining an appointment with a GP.  The representatives from the Mental Health Team responded that people who are already within the Mental Health system either through primary or secondary care should have all the contact details to the Mental Health Team.  However, for people who are experiencing new crisis or need the service of the Mental Health Team, documentation is available but could be better publicise.   Most of the new referral come from the GP practices but there are private care Mental Health workers working at GP practices which could be improved; a suggestion of a ‘drop in session’ within the surgeries.  ICAN centres can also give support and guidance to Mental Health issues is been considered.  The Chief Officer of Medrwn Môn said that through the Môn Community Link a low level services is afforded to people who wish to know about activities and services available within their communities. Referrals from GP’s, Police, Social Services, Occupational Therapists, Third Sector and people themselves or relatives can be dealt with through the Môn Community Link;

·      Reference was made that joint working with Social Services and Betsi Cadwaladr is focused on team working.  Questions were raised if one of the services within the team was unable to execute the support given to patients would it be detrimental to the team working of the project.   An example was given that if Physiotherapy was under pressure and unable to achieve the goals of the joint working partnership.  Mrs Ffion Johnson responded that Physiotherapy and Occupational Therapies is considered as part of a facility within hospitals and there is a need to change the culture to enable these professionals to be located within the communities and to enhance their skills as they work independently.  She noted that more physiotherapy sessions are afforded with GP surgeries now and there is a need for change in mind set and culture of people that it is not always a GP they require.  It was also said that workforce planning needs to be considered to train more people within specific medical professions;

·      Questions were raised as to who was leading the working in partnership to change how support is provided within communities.  The Interim Director of Social Services reported that there is a governance structure in place through the Public Services Board, Integrated Health Board and Regional Board with representation of all the partnership parties members of these Boards.          

The Chair thanked the representatives from the Health Service and Medrwn Môn for attending the meeting.

It was RESOLVED to note the work undertaken in partnership with the Health Board and the local authority to change how support is provided within the communities.

ACTION : To receive a progress report on the partnership working to the Partnership and Regeneration Scrutiny Committee in twelve months.