Nottinghamshire’s first PCN-based ‘first responder’ takes a pro-active approach

Byron Primary Care Network (PCN) in Hucknall has recently expanded its multi-disciplinary primary health and social care team with the appointment of Maddi Connelly, Nottinghamshire’s first Primary Care Network Paramedic Advanced Community Practitioner, who started in her new role on 2 November.

With more than 14 years experience as a paramedic for East Midlands Ambulance Service (EMAS), previous roles with a home visiting service based at a GP surgery, and with a First Degree in Health and Social Care, Maddi came into the role well prepared and excited for how she could make a difference.

Byron PCN, which covers Hucknall, has a significant elderly population and a growing number of residential, nursing and care homes, so the new role has been designed to provide face-to-face support for these residents within their community.

Developed in collaboration with the PICS PCN support team, the aim is to support care for complex needs of frail or elderly people within their own home where possible, helping them to live well everyday with long-term and chronic conditions and also meet their regular acute/urgent needs.

Maddi will see new residents to make a whole-life assessment of their needs, including nutrition, medication requirements, mobility and risk of falls and safeguarding issues. She will liaise with patients’ GP to keep them up to date and arrange pathways and assessments for further support and care in the community.

Dr Adam Connor, Clinical Director at Byron PCN, says: “The Paramedic Advanced Community Practitioner role is an integral part of our Primary Care Network offer to our patients and residents, and we’re thrilled to welcome Maddi onboard.

“It’s an important role and part of a holistic approach to care for the complex needs of frail or elderly people in Hucknall. Maddi will work closely with residents, families, care home staff and GP Practice staff to ensure our patients receive quality care to meet their needs and to avoid unnecessary hospital admissions.”

Maddi says: “I’ll see residents of care homes regularly on my ward rounds, which I’ll do every couple of weeks, so I’ll become a familiar face and I’ll get to know the patients. I’m medically trained, so I understand their conditions and I’ll be able to see how they are on a good day. I’ll be able to make a medical assessment of a patient, how they’re responding to treatment, whether they’re improving or deteriorating, and put them on the right care pathway.

“I understand medicines so I can call the GP to get advice and manage a prescription referral. I can also make referrals to the Occupational Therapist instead of the patient needing to see the GP first. And I can see if someone needs to go to hospital and care for them while that happens.”

“It’s me that they’ll know – I’m a friendly face who they’ll be aware of. Seeing the same person all the time is really important for a lot of people, and particularly with people living with dementia.”

Maddi’s role will also offer advice and support for patients and their carers to adopt self-management strategies for their own health and wellbeing, and because she’ll know who they are and about their support network, this advice will be tailored and supported with regular check-ups to ensure progress, rather than deterioration.

Maddi’s extensive induction involves visiting the care homes and accompanying practitioners as they see their patients. She’ll be learning where she can take pressure away from GPs, hospitals, Pharmacists and District Nurses, while enhancing the whole-life care experience of the patient.

Maddi explains: “I’ve got ideas for what I want to do, but first I need to get to know the community pathways and the people who provide social and health care within the PCN so I can learn what support I can bring in to a patient’s care plan.

“It’s also a two-way relationship with practitioners; I need to support them and fit into their established routines and relationships with their residents and patients, particularly colleagues in the care homes.

“Then, as care home staff, GPs, nurses, phlebotomists, dieticians, therapists, practice staff and social prescribers get to know me, they can also refer patients to me when they need my expertise. For example, Occupational Therapists will sometimes see a medical need and would usually refer the patient back to their GP, but now they can bring me in. It’s about building trust with everyone. The more I see and the more I learn, the more I can help and advise.”

Maddi looks for challenges in her career, explaining: “I’ve always wanted a bit more of a challenge throughout my career. I spent 22 years with EMAS, where I started out as an admin assistant and worked through the ranks. I trained as a technician, and then I trained again and became a paramedic in 2006.

“A lot has changed since I first became a paramedic – it’s not all emergency work like it used to be. There is more social work involved, so EMAS supported me to go back to university for a BSc in Health and Social Care and I spent some time doing home visiting in Derby, where I learnt about how GP Practices work.

“My last role at EMAS was phone triage, where I learned to make assessments over the phone. When I heard about this role, I was missing face-to-face contact with patients and was ready to do something different.

“It was a challenge to leave EMAS after all that time, but I found this role really interesting. I wasn’t daunted by the scope of it, because I have the experience and I knew that I could do it. It’s also exciting, because if it takes off it can be rolled out further. The opportunity was there, so I thought why not take it?”

Training support for Broxtowe Care Homes produces results

Back in July, we covered the stories of Jessica Waterhouse and Wendy Berridge, two Advance Care Planning Nurses, who have provided exceptional support for care homes in Broxtowe throughout the pandemic.   As we come to the end of a second lockdown, South Notts ICP news talks to Wendy and Jess about how the help and training they provide has helped skill up care home staff across the Borough.

Care homes were particularly affected by the first wave of Covid-19, but the assistance provided by Wendy and Jess helped care home Managers cope better with the increased scrutiny and pressure of the pandemic.

Wendy and Jess, who work for Primary Integrated Community Services (PICS), were initially employed to support with the roll out of the ReSPECT   programme, which is a national patient held document, completed following an Advance Care Planning conversation between a patient and a healthcare professional.

They had no sooner started than the Covid-19 pandemic hit, meaning plans needed to be changed and they had to explore new ways of working to support care homes.

Wendy and Jess jumped into action, mobilising partners across the PCN and inspiring and encouraging the GP practices, community cervices and care home staff to come together to care for the patients in care homes.

Wendy says: “We started at the beginning of the first lockdown period so we couldn’t deliver training in person in care homes and our role was focused around virtual training. Initially, we started daily and weekly phone calls to all 31 of our care homes and that continues even though we have a care home teams in place and they are doing weekly care rounds of our homes.”

Jess explains: “Back in March, I collated a database with all the homes on and we made sure we communicated all the important information and guidance they needed. So, for example, we passed on the British Geriatrician guidelines for Covid, all the PPE information etc and we created a toolkit for observations to support GP consultations.

“Any new guidance went out, and continues to go out, via email and our WhatsApp group. We have two WhatsApp groups – one for Nottingham West residential and nursing homes and one for learning disabilities and mental health homes. I think the reason why this model is so successful is the constant communication, training and information we provided to the homes though lockdown has put the homes one step ahead.”

Given we are in the middle of the second wave, regular communication, training and support for care homes is more important than ever and the inspiring duo have been focussed on empowering care home staff to start completing the RESPECT forms themselves rather than thinking it’s a specialist responsibility.

Jess says: “We support with the education and then the follow up support. Our aim is to get every single resident in Nottingham West, whether in residential nursing or learning disabilities, with a ReSPECT form in place. And that’s what we’re continuing to work to now.

“We also do verification of death training. A lot of the nursing homes haven’t really done that but because of COVID we can offer that. While we’ve been able to deliver face to face training during the Summer we are now focused, once again, on offering intensive support and training digitally.”

This constant expertise and support has had a fantastic response from care home staff.

Wendy explains: “I think the message that we’re not going to go away and we are here to support them has resonated. Care Homes have never had the level of support that they are getting now and while some do initially struggle with what that means for them – is it going to mean more work when they’re already under pressure with Covid, lockdown and visitors – I think that they have really embraced the opportunity to learn more and after training do feel more confident.”

Jess adds: “And I think the real test is that they have all had CQC and none of them have been called up on any of their practices, which is pretty good going for 31 homes.”

Care Home Manager at Moorlands, Sandra Watson, says: “Both Wendy and Jess have been a great support, they have given reassurance throughout the whole pandemic. They have made me feel like I was doing everything right and guided me at any point when I needed it. When I felt at my lowest, they picked me back up and gave me strength to start again. The training has been helpful and they have followed all my requests regarding entry to premises. I could not have wished for better support.”

This is a viewpoint also shared by Heather King, Care Home Manager at The Grange:

“Jessica and Wendy have supported our home throughout this pandemic. From the WhatsApp group for managers, to the support they have given ringing the home to make sure that we are ok and have everything we need, listening to our concerns or maybe just even being a sounding board for our frustrations.

“The training was fantastic. The staff were so interested in the ReSPECT training and it was discussed among the team for many weeks afterwards. I myself am writing respect forms, feeling much more confident as a result of their training, and they are always on hand to give advice. Words cannot express how grateful I am to them both and their advice and training has been invaluable. We are ready for the Verification of death training which we are having this week and we are all looking forward to welcoming them both at The Grange once more.”

Wendy and Jess have also fostered a culture of mutual support and shared experience with the homes in Nottingham West. Care Home Managers share ideas and support each other, sharing their issues and tips.   They even now support other homes further afield.

Jess says: We all want to learn and support each other. The WhatsApp group is great for that and it’s picked up again now. It’s about saying we can do this better if we learn from each other. We are non-judgmental.

“I think it also works as we were right in the middle of it and very accessible. We don’t always have all the answers but we network with others like Infection Prevention and Control teams and PHE to find out the answers. We are like a one stop shop.”

Wendy adds: “We all have the same goal to make things better for residents, we are dealing with the most vulnerable people that we look after and it’s reality we’re living through at the minute.”

Clinical Psychologist Dr Joanna Levene joins South Notts ICP Clinical Leadership Team

Reflecting our partnership commitment to mental health, we’re delighted to announce that Clinical Psychologist Dr Joanna (Jo) Levene has joined the South Notts ICP’s clinical leadership team.

Working alongside Dr Nicole Atkinson, Dr John Brewin and Dr Aamer Ali, Jo will bring her extensive understanding of working in mental health and driving integrated working to this new position.

Jo has a wealth of experience, having worked in health and social care across Nottinghamshire and the East Midlands for nearly 30 years. Her career has spanned NHS, local authority and voluntary sectors, 25 years of which have been focused on mental health.

Jo currently leads the Physical Health Psychology Team at Sherwood Forest Hospitals NHS Foundation Trust (SFHFT) and John Eastwood Hospice, where the team works with patients with complex physical health problems, as well as providing support to staff to develop their psychological skills.

This is an area Jo is particularly passionate about, saying: “Like a lot of mental health professionals, I started working with a specific mental health focus, and over the years moved into palliative care, then into cancer services, and now lead the broader physical health psychology team.

“I think one of the best ways of describing the patient experience was from one of my patients, who described themselves as feeling like a Lego person. She said: ‘I go and see this specialist and he’s interested in this bit and I go and see another specialist and they’re interested in that bit, but no one seems interested in me as a whole person’. I believe in knowing people as a full person.

“If you think of a Venn diagram, then we know there’s this huge overlap in the middle where people with mental health problems have a higher incidence of physical health problems, and we know that people with long term physical health problems are at greatly increased risk of mental health problems.

“There’s a whole range of complex reasons for that, and it makes no sense for our systems to work in silos given this understanding. I think that, in the modern world, we need to move away from silo working, from seeing people as Lego people and just being interested in that arm or that leg. We need to understand the way people’s physical and mental health interact.”

Jo is also a lead for the City Step 4 Adult Mental Health Psychological Health Team, providing psychological assessment and therapy to adults with complex mental health needs, especially complex trauma. Jo views health and wellbeing as strongly embedded in a socioeconomic context and is keen to highlight and address structural inequalities as part of her work. “We know that childhood trauma or Adverse Childhood Experiences (ACEs) increase the risk of a whole range of poorer physical and mental health, economic and social outcomes.   We also know that ACEs are more likely to occur where there is social and economic deprivation. I strongly believe that we need a system-level approach to tackling problems from both ends.

She is currently Macmillan Psychology Clinical Lead for the East Midlands Cancer Alliance, part of NHS England, and is passionate about delivering an integrated approach to healthcare, aiming to move ‘No Health Without Mental Health’ from policy to reality.   Cancer is a good example of an area which is traditionally considered the domain of physical health services, but we have created a model for the East Midlands to address the psychosocial needs of people affected by cancer, which we know are considerable.Jo has also worked with the Mid-Trent Critical Care Network to deliver psychological skills training and supervision to Critical Care staff across the region.

Recently, Jo’s team has worked in close collaboration with the SFHFT senior leadership team to design and deliver a robust staff wellbeing programme in response to the pressures of COVID-19.

She explains: “I think the whole idea of the ICS, the ICP and the integration of services across organisations is moving away from the competitive environment of health and social care into really working in collaboration. That’s my hope – better collaboration across organisations but also across specialisms. This will deliver a better, more effective and more efficient service for patients.”

Jo is looking forward to working with a wide range of disciplines and organisational partners to understand and improve the health and social care needs of the South Notts ICP area, and regularly provides training on wellbeing and resilience to NHS colleagues.

She hopes to prioritise building psychologically safe and resilient organisations as part of clinical lead role, but this is not without its challenges, a fact that Jo is fully aware of.

“I think it’s challenging, and different individuals and organisations will be at different stages of how onboard they are with that,” she says. “But the key thing is building relationships, having conversations, and appreciating what’s important to people to individuals, communities and organisations.

“We need to understand how we can bring those priorities together and see where the commonalities are, but also identify the differences and work with them too. That’s where the Primary Care Networks come in. You have that very local intelligence which feeds into a broader picture. It’s about being able to listen to local needs and making sure there’s an equity of offer.”

Bearing this in mind, Jo is positive about the direction the South Notts ICP is taking and is determined to raise the profile of mental health and its relationship with physical health across the partnership, as well as working to improve mental health across the whole lifespan, from birth into older age.

“There’s some great work already happening across the South Notts patch, like the Primary Care Psychological Medicine, which started in Rushcliffe and is now working across South Nottinghamshire.

“That’s a great example of where we’ve linked the physical with the psychological so we don’t have people bouncing around services, enabling us to work intensively with people to improve their wellbeing.”

When she’s not working, Jo enjoys spending time with family and friends, especially if it involves eating good food! She dabbles in various exercise regimes to keep fit and has developed a love of online yoga during lockdown. Jo also volunteers in community activities and, when time allows, is a fan of watching musicals.