Sam Walters joins South Nottinghamshire Integrated Care Partnership as Programme Director

A warm welcome is extended to Sam Walters as the new Programme Director for the South Nottinghamshire Integrated Care Partnership (ICP), which brings together local health and care organisations to work with local communities and help people in South Nottinghamshire live happier, healthier lives.

Sam joined the team on 15 June 2020 and her post is hosted by Nottinghamshire Healthcare NHS Foundation Trust.

The position is a perfect fit for Sam, who brings both a wealth of senior NHS experience and extensive expertise of partnership working across sectors to support better care for local people.

A graduate in physics with mathematics and a Masters in Business, Sam started her career in the private sector for Rolls Royce and Associates and British Rail, in her own words ‘messing around with submarines and trains’, before beginning a 26-year career with the NHS in 1992.

During her time in the NHS, Sam has worked across a wide range of disciplines, including finance, governance, public health and primary care, as well as in senior roles leading commissioning organisations, managing community services and establishing one of the country’s largest cancer networks.

Her last position, before returning to the NHS, was Executive Officer for a national mathematics-based charity in the education sector. Sam not only brings a unique perspective of the NHS to this new position but also a wide range of knowledge and expertise of partnership working across different organisations in both local government and the voluntary sector.

She says: “I have been very fortunate to work across the Nottinghamshire health and care system and I think the relationships I have built over the years will provide a solid foundation for driving the development of the ICP forward.

“Historically, there has been a lot of innovation and great integration work going on across the patch and providers already work incredibly well together; there is always more that can be done and I’m really looking forward to the challenge of moving to the next level of integration.”

What’s more, Sam is huge advocate for patient and community engagement, saying: “My overriding passion is to listen to patient experiences and stories and use them to make positive changes to local services and I intend to bring this passion to this new role.

“My key motivation is the desire to improve people’s lives, and the best way to do this is to listen to their views and learn from the experiences of people and local organisations.”

A mum of two, Sam’s keen outdoors enthusiast lifestyle has been shaped somewhat by her new all-consuming exposure to Minecraft, Roblox and all things TikTok. She loves running (very slowly she emphasises), boot camps, dabbles with rock climbing and the occasional obstacle course race. Her more sedentary interests include space and science-fiction films and books.

Dr Nicole Atkinson, Clinical Lead, South Nottinghamshire ICP, says: “I am absolutely delighted that Sam has joined the team. Her experience and expertise will be invaluable in driving forward the development of our partnership.

“She already has the relationships to hit the ground running and ensure we are strategically placed to bring organisations together and ultimately improve the health and wellbeing of people living in South Nottinghamshire.”

Mid Notts GP and ICP Clinical Lead Thilan Bartholomeuz focuses on a positive development in the fight against Coronavirus

There’s been another positive step forward in our fight against Coronavirus.

A trial by Oxford University has found that an anti-inflammatory drug that was already commonly used in the UK reduces the risk of death in hospitalised patients with coronavirus who need oxygen.

The drug, called Dexamethasone, reduces the risk of death in coronavirus patients on ventilation by as much as 35% and patients on oxygen by 20%.

As a result doctors and nurses have been able to immediately start using it and the Government has confirmed there is already enough in the country to treat more than 200,000 people.

Until a vaccine is developed which will help prevent people getting coronavirus, the next best thing is having treatments that help people sick with coronavirus recover. The news about dexamethasone is an important step in improving further how we can care for those with become the most sick with coronavirus and I hope that you are all able to take some comfort from this as I do.

I also know that this is just one of many trials taking place in countries around the world. I hope this will be the first of many announcements that will soon see us with more knowledge and tools to fight coronavirus as a vaccine is developed.

The actions you are taking by staying at home, staying two metres apart and continued handwashing may seem small compared to the developments from big drug trials. But we will only beat coronavirus through collective action. Please know that the actions you are taking by following the Government’s guidance has slowed the rate of infection and allowed researchers valuable time to make this breakthrough which will undoubtedly save lives.

Thank you all for your response. Please stay safe and if you have any questions check the official advice first at nhs.uk/coronavirus.

Hucknall Community gets creative to support local GP Practice with PPE for patients

A GP Practice in Hucknall has benefited from a community-led movement to make face masks for patients at the practice and raise money for charity at the same time.

A number of patients at Whyburn Medical Practice originally contacted the Practice to ask how they could support the team throughout the pandemic and whether they needed PPE. As the Practice had PPE available, the team considered how they could take up the kind offers of help.

Some of the staff in the Whyburn team expressed an interest in purchasing the masks for their own personal use, their friends and family. They came up with the great idea that any donated masks would cost £2 and the proceeds would go to charity.

The response has been amazing. Patients, the Practice Patient Participation Group, community groups and staff have all got involved making masks for the practice. Local faith groups also encouraged people to get involved. So far over £100 has been raised for charities, including breast cancer research and Duchenne UK.

This initiative has proved invaluable now that under new guidelines from the Government, patients attending appointments at the practice are required to wear a face covering.

The masks are available at the Practice for patients who don’t have their own mask when attending an appointment. The team ask that people who take a mask contribute a £2 donation to charity.

Dr Adam Connor, Lead GP, and Byron Primary Care Network Clinical Director, said: “This is very much a community driven initiative and we’ve been overwhelmed by the generosity of staff, patients and the local community.

“There’s incredible community spirit in Hucknall and local people have been very supportive to the local NHS, both before and during the pandemic. It’s wonderful to see everyone coming together to support us and to help keep us all as safe as possible.”

South Notts Integrated Care Partnership Clinical Lead, Dr Nicole Atkinson said: “This is a fantastic example of how a partnership between a Practice and its local community can have a real impact on the care and safety of patients. It’s very timely as it’s important that patients visiting our local practices for an appointment wear a mask in line with Government guidance.

“We welcome all our local communities interested in supporting their local NHS to get involved with supporting patients at local practices.”

Are you inspired by this initiative? Have you done anything to support your local NHS throughout the pandemic? Send your stories to: antonia.smith2@nottshc.nhs.uk

The importance of bubbles is the focus this week by ICP Clinical Lead Thilan Bartholomeuz

Bubbles have been the focus for many of us this week. Specifically the news from the Government that some people can form a close group for extra support, known as a support bubble.

It’s not open for everyone but will make a big difference to the mental health of those who can now join with others.

The people who can form a support bubble are single adults (those who live by themselves or with children under 18) who can choose one other household to join up with. This means they can go inside their house, stay overnight and do not need to stay two metres apart while they do it.

I know this will be hugely welcomed by single parents and older people who have been by themselves largely since the pandemic lockdown began. It means you can get extra help and hopefully will feel less alone and isolated.

But once you pick who is in your bubble, you cannot change it. You need to remain together so that you do not risk spreading coronavirus. It also means that if anyone in your bubble develops coronavirus symptoms (a high temperature, a new, continuous cough or a loss of, or change to, your sense of smell or taste) you all need to self isolate.

And when you are not with the members of your bubble, you must adhere to the usual roles of keeping two metres apart and regular handwashing.

Importantly, if you are shielding you cannot form a support bubble yet. Those who are shielding are still advised to maintain strict social distancing and stay two metres apart from others – including those they live with.

However, this is being kept under review and the Government will be setting out further advice for this specific group in the coming weeks, now that the peak of the pandemic is past.

For those of us who these rules do not apply directly too, hopefully the community spirit that we have seen come to the forefront during the response to coronavirus will allow us to feel some pleasure that those more isolated members of our neighbourhoods can now get some more help.

And hopefully this shows that we are taking another small step forward in coming out of lockdown and towards all of us being able to meet up with all of our loved ones sooner rather than later.

Please stay safe and if you have any questions check the official advice first at nhs.uk/coronavirus.

Some simple advice on face coverings from ICP Clinical Chair and local GP Thilan Bartholomeuz

One of the recent major announcements was that from June 15 anyone using public transport and/or visiting a hospital will be required to wear a face covering.

This will be a big change for a number of us so I wanted to give some simple advice on what this means.

Firstly remember that a face covering is not the same as the masks that health and care staff have been wearing. These should continue to be reserved for those who need them.

Instead a face covering is something simpler which can be made from home – in fact the Government has provided guidance on how you can do this here.

Secondly, a face covering will not necessarily protect you but can help prevent you spreading coronavirus if you have the infection but haven’t shown any symptoms yet.

Thirdly, even with a face covering on you must still keep to social distancing rules which means if you develop symptoms you and the members of your household still have to isolate at home to prevent the infection spreading to others. You must also wash your hands before putting them on and taking them off, again to make sure you are minimising the chance of spreading coronavirus.

There are some exceptions to this, such as children under two and those with respiratory conditions already who may find it difficult to wear a face covering.

I hope this has helped provide some simple messages. You can check out the latest information from the Government on face coverings here to make sure you are up to date.

Please stay safe and if you have any questions check the official advice first at nhs.uk/coronavirus.

Blog 9- These are the hands

Dr Sonali Kinra is our ICS lead for GP Retention. This is her monthly blog series where she gives an insight into her role and more.

Another month passes by and all of us continue to adapt to the new normal. Some of us have lost our beloved colleagues and patients as a direct or indirect consequence of Covid 19 and carry that emotional burden with us. Do not underestimate the impact on your mental health and emotional resilience. Remember to take annual leave, check in with your colleagues and reach out to ask for help. There are a variety of resources on Nottinghamshire LMC Wellbeing section and is well worth a visit. Our NHS People is also offering coaching sessions and having used it I would highly recommend it. I am happy to announce that Shiny mind App now has 350 users signed up and have utilised 1600 resilience sessions – we have also opened this up for our community nurses and integrated care home teams. We have made the sign up process easier through this form. Come join us.

I have been reflecting on my move from partnership to salaried role 4 months ago due to relocation. Being a partner can be bitter sweet- it requires balancing clinical need with the regulatory demands, working within defined budgets and ensuring staff wellbeing. And just like everyone else GP Partners have risen to the challenges thrown by Covid 19 taking their teams along with them for which we remain grateful. Partnership can feel daunting but it’s an opportunity to be independent and influence healthcare outcomes for your population. To all those trainees due to complete their training and to others within the system I encourage you to consider GP Partner roles- Nottinghamshire LMC has resources & job vacancies listed on its website you may find useful and equally feel free to speak with me to explore this further.

In the last month we have been exploring opportunities available for mid-career GPs. Mid-career GPs are the largest subgroup of GPs ranging from 5-25 years in practice. The contributions made by them vary from running the practice as partners, doing sessional work to providing primary care leadership within the system. There is more we can do for this cohort. Discussion at the PCPB (primary care workforce board) and transformation funding emphasised the need to do more for this group and Phoenix Programme has been working up proposals to support the same.

Another recurrent theme from these meetings has been the need for integrated professional learning & multidisciplinary supervision with additional roles joining us in primary care networks. Nottinghamshire Alliance of Training hub(NATH) has been working on these proposals. There are also exciting offers for advanced clinical practice and an online training package for nurse mentors in primary & social care to achieve new supervision and assessor standards- follow them on twitter for further information. I continue to work on GPN leadership programme and liaising with nursing and midwifery cabinet. Hoping to share with you steps ahead soon. A New to practice implementation group has been delegated the responsibility to plan for the universal offer of support for GPs & GPN who are within 2 years of qualification. Phoenix Programme or NATH can give you further details

I also held virtual support sessions for locum workforce group which was well attended. We had representation from LMC and ICS. If you were unable to attend the webinar recording is available here. Dr Kirran Bilkhu is holding regular virtual support group for those taking a career break/ returning to work- if interested in joining then please email us .

It is hard to ignore the protests following the brutal killing of George Floyd in Minneapolis and the impact it is having globally and closer to home. We must feel empowered to stand up and speak up against injustices. This personal message from Sir Simon Stevens ( Chief Executive NHS) & twitter thread by Dr Nikita Kanani(medical director primary care NHSE &I) seems encouraging and steps in the right direction. Practices & other organisations within Nottingham & Nottinghamshire ICS are currently undertaking risk assessments for their staff given the disproportionate impact of Covid 19 based on ethnicity, age and other comorbidities. Please do engage in the process as it will help plan for a safe, sustainable &equitable future.

Next Generation GP is holding regular webinars and I recently attended Interactive online discussion with Prof Michael West- Leading with compassion in time of crisis. Michael talks about compassionate leadership and self compassion and the importance of inclusive leadership. Meta Analysis of 49 studies showed that regular huddles or debriefs within a team increased effectiveness by 37% so remember to continue with team huddles and briefing.

If like me you wish to read something different then have a look at this poem from the book These are the Hands- Poems from the Heart of NHS. In Dr Kathryn Mannix words- This is a five-senses celebration of our workforce, our ideals and our sense of pride in being people who provide a health service for the very people we come from. Of us, by us and for us: our NHS.

As Always

Sonali

@SonaliKinra

South Notts ICP update

As we begin to prepare our response and recovery to COVID, to support this and the work ongoing through the Local Resilience Forum, we have started to set the foundations for more effective integrated working across South Nottinghamshire under the South Nottinghamshire ICP.

Governance

A draft South Nottinghamshire ICP Governance structure has been developed to enable the delivery of ICP activity and will be shared with ICP partners week commencing 8 June 2020.

Programme Director

The new ICP Programme Director, Sam Walters, will take up her new post from 15 June 2020. Sam will be hosted by Nottinghamshire Healthcare NHS Foundation Trust and work on behalf of the partnership.

Clinical Leadership

Dr Aamer Ali, a geriatric consultant from NUH, joins the ICP clinical leadership team, and will be working alongside ICP Clinical Lead Dr Nicole Atkinson and Dr Stephen Shortt. Read more about Aamer here. There is also a vacant clinical post aligned to mental health.

ICP Operational Group

As the system moves out of the COVID crisis and into recovery, the ICP has established a weekly operational group to restart key activities and provide focus for emerging priorities. This group includes the South Notts locality team, ICP clinical team, providers and the ICP Programme Director.

Emerging ICP priorities

Following a review of the draft workplan, six priority areas have suggested as a focus on over the next 6-12 months.

Priority	Purpose	Timescale
Enhanced Health in Care Homes	Implementation of the Primary Care Network Directly Enhanced Service	July 2020
Care Coordination	Service transformation opportunity across the ICP from March 2021	March 2021
Frailty	Roll out of the · Rockwood frailty score · Advanced Care Planning · Falls prevention and management	October 2020
Comms and engagement	Implementation of the ICP communication and engagement strategy	Throughout 2020
Health and Wellbeing	Activities to tackle on the wider determinants of health – awaiting feedback from LRF discussions	From July 2020
Learning from COVID	Share learning and implement new ways of working from across the partnership – awaiting feedback from LRF discussions.	From July 2020

Key leads are currently being identified to take these work areas forward and the intention is that sub-groups will be established to manage and implement the work areas.

To keep up-to-date with our news, follow us on Twitter.

Top ten tips for Population Health Management (PHM)

Maria Principe, PHM Programme Director for the Nottingham and Nottinghamshire ICS, gives her top tips for anyone working to deliver population health management.

Population Health Management (PHM) is one of the key ways that we at the Nottingham and Nottinghamshire Integrated Care System (ICS) are working to develop the most effective and efficient system integration across our patch.
The city and county both have areas of high deprivation and the PHM approach will help us to focus on reducing inequalities and to work together across health and care to improve wellbeing for everyone.
PHM requires health, local authorities and other stakeholders to come together in new ways and we are proud of what we have achieved together so far. Here are my top tips for developing a successful PHM programme.

PHM is complex, but you don’t need to do everything at once. Create a simple approach. Choose little steps to achieve big transformations.As a relatively new way of working, PHM can seem a little overwhelming. However, by thinking big but starting small, you can show the impact of PHM and get everyone behind it with some relatively quick wins. Use the segmentation methods available to select a group you’d like to target, such as the frail elderly, and start with just one intervention. Measure the results, share the learning and take it from there.
Begin the information governance (IG) process as early as possible. There is a lot of data out there that is useful. Start the conversations within your system (and don’t forget wider determinants!).Get started on information sharing agreements and shared IT systems as soon as you can – with the best will in the world, it will take time to iron out all the IG issues. Information sharing across health, local authorities and the voluntary, community and social enterprise sector will be essential in the long run to maximising the opportunities offered through PHM.
Be clear on your outcomes. If you don’t have clear outcomes, you cannot target your interventions.Working through the PHM approach – Joint Strategic Needs Assessment (JSNA) analysis, population segmentation, risk stratification and impactibility – will help you to decide on the most appropriate, measurable outcomes and to pick an appropriate evidence-based intervention.
Don’t get hung up on the segmentation process. It is a means to an end, and can be sliced any way your system feels is relevant.There are a number of different ways to segment a population and some are more straightforward than others. A new guide has been published by the NHS, produced with a range of partners including ICHP, that makes it clear that while some methods need integrated data, there are some we can all have a go at today. It doesn’t actually matter which method you choose as long as it gives you the information you need to get started.
Pilot PHM on a test area, but ensure you have an integrated membership. Health only influences up to 11 per cent of an individual’s health and wellbeing, so it’s imperative to involve wider stakeholders in PHM projects. PHM is an area for all the partners whose work affects our health and wellbeing to focus on, and it will live or die depending on the ownership across a system. It’s crucial that ICSs engage with partners to get them on board and see the benefits to everyone of working together in this way.
We cannot afford to buy fish from our own pond! Use and develop local resources wherever possible by utilising your own teams such as researchers, analysts and public health – you want a rod, not a fish!You don’t have to buy in external support, although you could to get started. Your own data teams can be trained to carry out new kinds of analysis, and your clinical leaders can help support work on the ground, once they are on board with what you’re doing.
Make sure the data you produce is meaningful. Commissioners and providers want to do the right thing, but at the moment financial pressure is on. Use PHM to help, not hinder.Don’t think of PHM as an additional task – it’s actually a facilitator to you achieving what you want. By carefully targeting the groups where an intervention will have the greatest impact, resources can be better allocated to where the biggest difference can be made.
Leave finance until last. This way you will sustain clinical engagement, and will be focusing on where variation is, not where the money is! (Hold your nerve; money will follow improvement.)Again, clinical engagement is crucial to delivering a successful PHM programme and new ways of measuring outcomes and innovative ways of working may mean you need to develop new contracting agreements. Getting bogged down in the finances will just hold you back.
Have a clear 12-month plan and ensure your PHM decisions support group is updated on a regular basis.Keep everyone engaged and informed so people can see the progress being made. Make sure PHM is shown to deliver real results so it’s not just a concept or a ‘nice thing to do’.
Be prepared to be ignored. It’s not personal. Your system has a million priorities. You are one of them, but lower down the food chain. The nudge theory works… slowly, slowly.By starting small to get the evidence of the difference a PHM approach can make, and sharing the learning across the system, you should be able to demonstrate its value and get people interested in how it can help them.

Find out more about Nottingham and Nottinghamshire ICS at www.healthandcarenotts.co.uk. You can also read a blog (https://www.hsj.co.uk/service-design/developing-population-health-management-is-key-to-integration/7026973.article) from Dr Andy Haynes, Executive Lead, on why PHM is essential to system integration.

Join our South Notts ICP Clinical Leadership team

We are seeking to appoint to our clinical leadership team and are looking for a colleague who will share our ambition to improve quality, cost and outcomes of care for the local population served through delivery of a comprehensive approach to population health management in our evolving ICP in South Nottinghamshire.

The successful candidate will be a credible and proven clinical leader of mental health services and from within the South Nottinghamshire health and social care community and will provide support to Dr Nicole Atkinson as ICP Clinical Lead and Dr John Brewin as the ICP Convenor.

The role will be part of the ICP Clinical Leadership team to support engagement with our clinical/expert practitioner community (medical and non-medical) to help determine the best models or care and support that can be provided in the ICP.

The successful candidate must have experience of working with clinical colleagues from across primary and secondary care, and clinical experience of leading service change, engaging with multi-disciplinary teams and delivering at pace in a challenging environment. Above all, you will be motivated to improve the health and wellbeing of people in South Nottinghamshire.

The role will also help provide leadership coverage across the ICP in some cases deputising for Dr Nicole Atkinson. The roles will be accountable to Dr Nicole Atkinson as the ICP Clinical Lead.

The role will be appointed on a sessional basis (2.0 sessions per week). The salary will be commensurate with that of a Clinical Director (pro rata).

Interviews will be held late June / early July.

Closing date for expressions of interest is 19 June 2020.

Informal enquiries are welcomed by

Dr Nicole Atkinson: nicole.atkinson@nhs.net

See the full details here.