Changing Futures – Open to Tender

Provision of Changing Futures Main Delivery Service 

Ref: CPU 5137

Nottingham City Council is seeking to appoint an organisation for the primary delivery of frontline support and learning and development activity under Nottingham City’s Changing Futures Programme.

The Nottingham City Integrated Care Partnership (ICP) has successfully bid for national funding as part of the Department of Levelling Up, Housing and Communities (DLUHC) ‘Changing Futures’ (CF) programme. This will be a short term programme delivered to the end of March 2024, providing specialist services, partnership delivery models and developing system change in order to achieve better outcomes for people who experience the most significant Severe Multiple Disadvantage (SMD). SMD is defined within the programme as affecting people who experience at least 3 of 5 forms of disadvantage, including: homelessness, substance misuse, mental ill-health, domestic violence, and interaction with the criminal justice system.

The objective of the Changing Futures Programme is to ensure that people living in Nottingham City who experience SMD receive joined up, flexible, person-centred care from the right services, at the right time, and in the right place to meet their needs. The focus of the programme is on achieving system change to enable the development and delivery of joined up services that provide effective healthcare, support and other forms of assistance to the most excluded, marginalised and vulnerable individuals who experience SMD. Partnership working is integral to delivering the CF programme and achieving the ambitions for system change.

The Councils’ detailed requirements are defined in the Service Specification, which is available, within the tender pack, via registration on the East Midlands Procurement Portal: https://bit.ly/36WcBjP

The duration will be for 21 months, commencing 1 July 2022 until 31 March 2024 at a contract value of £2,340,807 for the duration.

From homeless to a new life with the help of Rushcliffe Social Prescribing service

After being referred to the Rushcliffe social prescribing service, Macauley Diuk has started a new life…

“I’ve gone from not having anything to this. I’m still learning, but it’s amazing to have this stability.” Macauley Diuk, 27, is speaking from his new home in Bingham where, supported by the Rushcliffe social prescribing service and local charities, he has embarked on an exciting new life.

But things weren’t always so rosy. Before meeting his Social Prescribing Link Worker Morgan Sharpe, Macauley was living on the streets in Nottingham and South Nottinghamshire. He says: “I was living pillar to post on the street, in mates’ houses. I’d march everywhere just to keep warm through the night – I don’t walk, I march to anywhere my head is at the time.

“I was living like this for four or five years – I didn’t have a home to go to. I went to prison for a bit, but when I came out in 2016 I had years of just existing, not really living.”

To get to where he is today, and throughout his journey, Macauley has been supported by a number of local agencies. Initially, he was helped by Framework, who he first spoke to when he was living on the street. He says: “They first made contact while I was sleeping rough. I had a great support worker called Jan, who moved heaven and earth to help me out, but it just didn’t happen at that time.”

Macauley was referred to the social prescribing service by his GP during lockdown, which is when Morgan picked up his case. Because of the pandemic, and the amount of contacts the service were making over the phone, she struggled to get hold of him for a while. When they finally got in touch, Macauley was clear that he wanted a face-to-face meeting, Morgan had to think outside the box.

Macauley says: “In the first instance it was someone to talk to who really knows her stuff – you can talk to her about anything to be honest, so it was good. She took me down to the Ruddington Allotments and I worked very hard at the allotment, as did everyone who was there.

“I started to feel comfortable there, and it was a great place to talk things through. Being together in that environment was incredible; I felt I could be me. It had a completely different feel to previous health professional consultations – a different dynamic.”

Morgan says: “It was a much better environment for Macauley. He didn’t really get on with conventional statutory settings and that prescribed kind of consultation with the traditional health professional and patient dynamic.”

Macauley put Morgan in touch with Framework to get his background and she linked in with Jan, who helped by putting her in the touch with the right people in housing and at the council and explaining what support he would need in place.

She says: “Everybody I spoke to all knew Macauley and were surprised he hadn’t been housed yet – nobody had a bad word to say about him. People who find themselves in Macauley’s situation can sometimes become quite bitter, but everyone said what a nice guy he was and how he had fallen through the cracks. They all wanted to go above and beyond for him because of the kind of person he is.”

It wasn’t a simple process though. There was a lot of paperwork and Macauley didn’t have a bank account or any ID at the time, so it was difficult for the housing organisation to send information to him.

Morgan contacted The Friary, a homeless charity in West Bridgford where people can get a shower, something to eat and additional support to help them get into accommodation. She explains: “The Friary offers homeless support and an advice centre and service to help people with benefits and housing issues. They were able to support Macauley with all the paperwork and legal issues he needed to sort out.”

Macauley says: “If it wasn’t for Morgan, Framework and the Friary, I would never have got this far. They have all helped me restart my life.”

It finally all came together and Macauley moved into his new home, with The Friary continuing to support him by providing a van to pick up furniture donated by The Arches, a Nottingham charity which gives away furniture for people moving into empty properties.

Macauley has been in his new house for three months now, and has also received support from Bingham Helping Hands. He’s learning to manage his life, including the tricky challenge of budgeting, and is continuing to play football for Ruddington.

He’s got plans for the future as well, wanting to become a life coach and share his experiences, as well as doing his FA coaching badges 1 and 2 early this year.

Morgan has continued to support him as he embarks on this more stable chapter of his life and says: “I’m helping him to settle in, checking in and making sure he’s OK. He’s doing amazingly well and I’m confident he’s going to build a great future for himself. He’s a credit to himself as well – he’s had help, but he’s done so much for himself. We might have opened the doors, but he has walked through them.”

And the final words go to an emotional Macauley: “The support I’ve received has been incredible. They have saved me. The chips were down, but they’ve lifted me up. They’re all angels; everyone who has helped me is an angel.”

Five years on: how GPs personalised medicines for patients

Back in 2017, Nottinghamshire’s GPs helped pioneer the personalisation of medicine care by early investment in Clinical Pharmacist roles within primary care teams. Despite the pandemic, there have been really exciting developments within the roles as the pharmacy teams have grown in expertise, knowledge and experience, including the addition of Pharmacy Technicians in 2020. Fast forward to March 2022, and the outcomes are clear with improvements to patient care and reductions in GP workload.

Residents in South Notts now benefit from 23 Clinical Pharmacists and 6 Pharmacy Technicians who provide services for over quarter of a million residents. The roles are crucial members of multi-skilled teams that are led by GPs and have been created as part of the NHS’s Long Term Plan to provide the right care by the right person at the right time.

But what exactly do they do, and what’s next?

The team provide additional expertise and capacity by focusing on how a patient responds to medication, advising how to manage medicines and looking at whether other options are available. They support GPs and Practices to audit and review their prescriptions, medicines and stock, and support patients coming from hospitals. As Harvinder Sandhu, Clinical Pharmacist at Peacock Practice, Carlton explains, “I help people with complex, acute and chronic conditions through changes to their medication. I’m there throughout the journey for them and can follow up on their outcomes. It’s very rewarding to see patients before and after an intervention and know that I have made an impact on their life.”

Dr Umar Ahmed, GP and Clinical Director for Arrow Health Primary Care Network, explained the impact on patients, “Clinical Pharmacists can spend longer and delve deeper with patients to create a tailored plan that works for them and we are seeing real success stories. One patient had been on lots of high dose opiate medication for chronic pain but despite this, was still in pain. On top of this they were unable to maintain a job due to side effects of brain fog and severe fatigue. The Clinical Pharmacists led a structured and strategic reduction of her medication so we could reduce the side effects whilst not worsening the pain, which enabled them to get back into work.”

The roles were designed and recruited in partnership between the GPs and Primary Integrated Community Services (PICS), a local healthcare provider. Gerald Ellis, PICS’ Clinical Pharmacy Programme Manager, highlights and explains the next innovations in the service. “11 Clinical Pharmacists are now qualified and competent to prescribe and the remaining 12 are on the pathway, which will be a massive benefit to GPs and patients. We’re supporting the teams to run specialist clinics to support patients with chronic long-term conditions that affect their breathing, heart and circulation system, or if they have Diabetes or are at high risk of heart failure. They’re trained to such a degree that, if appropriate, they can operate at an Advanced Care Practitioner offering advanced diagnostic skills. And they’re going to continue supporting the roll out of electronic repeat dispensing, making the process quick and seamless for patients and helping reduce wait times when calling Practices.”

Nisha Desai, Lead Clinical Pharmacist within PICS, explains how her team responds to the particular needs of residents in Nottinghamshire, and highlights the benefits for clinicians and GPs of bringing together a team of specialists within PICS.

“An ageing population, like the one in Nottinghamshire, brings so much to do in chronic disease management and for patients with more complex needs. Clinical Pharmacists (CPs) can focus their appointment time specifically on medications and we can proactively conduct medication reviews.

“Our patients value healthcare professionals coming to see them. We listen to them, their carers and families, and look at how we can improve their medications. We look at the appropriateness of their current medications and if they are still beneficial for them. We tailor the medicines to suit each patient. For example, if the patient is more alert in the morning and more able to take medication then, we can advise whether they can have it earlier and make adjustments. As we’ve delivered this more patient-centric and holistic approach in care homes, Carers have told us that they get to spend more quality time with patients, rather than spending most of their time getting them to take their medicines.

“The roles are proving popular for Clinical Pharmacists wanting more patient contact. Some of the team are part-time, some work over the county and some are based in Practice, and we’ve got people working from home.

“In my lead role, I support the whole team through governance, guidance and accreditation and helping integrate them into the PCNs and multi-disciplinary teams. We also come together to share practice and support each other, and colleagues from other services in PICS provide regular training sessions for us, including caring for frail patients, opioid prescribing and consultation skills sessions.”

Top five tasks for Clinical Pharmacists

  • Discuss, explain and help patients understand their medications better, leading to more effective medicines benefit.
  • Review patients holistically across their conditions and work with carers and families to understand patients and match care to their needs and preferences.
  • Respond expertly to queries from patients and clinicians about all manner of medicine queries – helping get it right, first time.
  • Manage NICE alerts and conduct safety audits
  • Support management of local health population initiatives

Top five tasks for Pharmacy Technicians

  • Support CPs in managing discharges and transition from secondary care.
  • Support pharmacy interactions and stock availability, and research cost effective or necessary switches.
  • Review hospital and clinical letters and amend patient’s records appropriately.
  • Dealing with medication queries and suggesting alternatives for medications with supply problems or finding more cost-effective options.
  • Liaise with patients and community pharmacies about medication and repeat supplies, helping surgeries to identify patients who need recalling/reviewing.

Kathy’s Blog

I am always surprised how quickly we reach the middle of February each year, it is definitely too late for me to wish you a Happy New Year but we can look forward to the first signs of spring, a time of hope and optimism.

Before looking forward I want to recognise how busy it has been across our system, in acute care and in general practice, in homecare and residential care and for leaders and frontline staff throughout our system. Thank you again for everything you have all been doing. I know that whilst the very worst of the Omicron surge seems to be over, many colleagues are still managing considerable levels of Covid-19 demand as well as the more usual winter pressures. One statistic that really brought that home to me was learning that GPs in our patch held 486,478 appointments in December, 4% up on December 2020 which itself was considerably up on 2019. Behind the statistics lies the real story of the care delivered by you and your colleagues every day.

Just before Christmas last year, the Government confirmed that the proposed implementation date of the Health and Care Bill would be moved from 1st April to 1st July – this means that we now have three extra months to develop our plans and actions across the system to establish our Integrated Care Board (ICB) and our ‘guiding mind’, the Integrated Care Partnership (ICP).

We were on track for the initial April date, but this delay does not mean that we are pausing or losing any momentum – for most of the key steps to establish the new organisations and systems we are sticking with the earlier timetable. We will make good use of the extra time to fine-tune our plans and make sure that we deliver comprehensive handovers and a smooth transition. This can only be a good thing.

Whilst having the legislation in place and our formal structures confirmed is a necessary step, it is more important that we continue to focus on creating the right culture and behaviours for successful system working. Our purpose, which includes improving outcomes and reducing inequalities, remains our guiding light.

Last week we had an excellent ICS Board development session and agreed that we would continue to meet in public every other month until the ICB and ICP are established. This is important to ensure that there is good visibility and accountability of our system to the public. We will continue to publish our papers and agendas and offer a live-stream of the meetings.

You will be aware that there has been a recent focus on the rising cost of living linked to energy bills. At the same time local authority colleagues in particular were digesting the Government’s ‘Levelling Up’ White Paper. I mention both of those things because of the potential impact on the population we serve. Choices between heating and food have impacts on health and wellbeing and ultimately show up in demand on our health and care system. The impacts are not felt equally by everyone but by working together we can more quickly tackle the wider determinants of health. So I’m pleased that last week our two Directors of Public Health and colleagues shared their emerging Health and Wellbeing Strategies with the rest of the ICS Board.

The possibilities for economic development and increased prosperity offered by the Levelling Up proposals are an opportunity that I know we will want to grasp – a stable income and a fulfilling job are the cornerstone of positive health and wellbeing. And all of this needs us all (the NHS, Local Authorities, the wider public sector, the voluntary and community sector) to come together with a single purpose – that is the promise and the opportunity ahead of us.

A final example of excellent joined-up working in this way is the targeted work to ensure that everyone possible is protected against Covid-19 through the vaccination programme. Not content with ensuring that the mass of people we needed to be boosted before the end of December received their booster, since the turn of the year, the vaccination programme has rapidly pivoted to a new, extremely localised and personalised approach. Success now looks like ten more people protected rather than ten thousand and this means the whole approach has changed. This agility and the joined-up working between NHS, local authority and the voluntary sector is hugely impressive.

A couple of final pieces of housekeeping, I want to welcome Nick Carver as the new Chair of Nottingham University Hospitals NHS Trust, joining this month from East and North Hertfordshire NHS Trust. Nick is planning to meet with leaders and colleagues from all across the system over the coming months and I know that he will make a significant impact in delivering the improvement plan for NUH’s staff and patients. In addition, the recruitment process for our new Non-Executive Directors for the ICB is nearly complete and the work to identify our Executive Directors is also well underway. I hope to be able to share the news on these appointments shortly.

Now that the Covid restrictions are mostly behind us, I am personally really looking forward to meeting with colleagues face-to-face and getting out and about on the front-line. I am out in NUH in early March and I would be happy to hear from you if you have a great service that you want to showcase to me – do drop me a line on kathymclean@nhs.net.

Until next time, best wishes,

Kathy McLean

Nottingham City Changing Futures summary

Changing Futures is a national programme funded by the Department for Levelling Up, Housing and Communities (DLUHC) and The National Lottery Community Fund (TNLCF). It will run until April 2024.

In July 2021, the Nottingham Integrated Care Partnership (ICP) was successful in its bid to join the programme, and will receive just under £3.9 million to meet the needs of people who experience severe multiple disadvantage (SMD) in Nottingham City.

Nottingham City Changing Futures will build upon the work of Opportunity Nottingham, in order to accelerate system change in the City, evidencing how resources held across partners can be maximised to achieve better outcomes for people experiencing SMD, as well as reducing pressures on services and frontline staff.

During the last six months, partners from the across the City have been meeting to commence delivery of the programme in Nottingham. To date this has included development of the programme delivery model and commencing recruitment processes for some of the key roles within the programme, including the role of Programme Director. Bobby Lowen has accepted this role and will commence in post in March 2022.  Bobby joins the Changing Futures programme from Nottingham City Council where he has worked in commissioning for over 10 years. He has a passion for working with people who are experiencing Severe Multiple Disadvantage (SMD) and believes that creating the conditions for strong partnerships has the potential to improve lives.

During the course of the programme, the aim is to provide support for over 350 people facing SMD in Nottingham City. Service requirements for programme delivery are now complete, and it is anticipated that a delivering agency will be appointed in April 2022. SMD Practitioners have been appointed in mental health, primary care and probation, hosted by Nottinghamshire Healthcare NHS Foundation Trust, the Nottingham City GP Alliance and Probation service respectively. All are due to start in post in February 2022. Al-Hurraya will provide Specialist Navigators to support people who experience SMD from BAME communities. POW Nottingham will host a Specialist Navigator to support women and girls who experience violence and Juno Women’s Aid will host a Specialist Navigator, specialising in support to women and girls who experience domestic abuse and sexual violence. All three agencies are busy recruiting and will begin supporting beneficiaries in March 2022.

People with lived experience have been involved with the programme throughout, from the initial bid to the current phase of delivery planning. The Changing Futures Expert by Experience Board has met monthly since it was established in September 2021 and will form part of the programme governance.

For more detailed information on Nottingham City Changing Futures including the full delivery model, operational delivery progress, and governance functions you can visit the Nottingham City Integrated Partnership (ICP) here. If you have any questions, please email  nnccg.nottmcityicp@nhs.net

It is anticipated that Nottingham City Changing Futures will commence full delivery in the summer of 2022.

You can read the full report HERE

Bulwell and Top Valley PCN survey

In order to help Bulwell and Top Valley PCN develop through 2022 and beyond, we are conducting a short survey. 

Please complete the survey, and forward to your staff and any other channels you have to put this in front of as many staff /organisation that work towards the health and wellbeing of people in the Bulwell and Top Valley community.

Please answer as few or as many questions as you are able. All feedback is valuable. 

We already have a number of things planned, including a monthly newsletter and reviewing the format of our meetings. But we need feedback to help the development, growth, reach and impact of our activities. 

Thank you for your help in advance

Dr Andrew Foster
GP Partner, Parkside Medical Practice
www.ParksideMedicalPractice.co.uk
Director, NCGPA www.ncgpa.org.uk
Clinical Director, Bulwell and Top Valley PCN

Nottingham City Changing Futures progress update – February 2022

In July 2021 the Nottingham City Integrated Care Partnership (ICP) was notified that it had been successful in its bid to join the Department for Levelling Up, Housing and Communities (DLUHC) and The National Lottery Community Fund’s Changing Futures programme. Over the course of the programme, which runs until April 2024, the ICP will receive just under £3.9 million to meet the needs of people facing Severe Multiple Disadvantage[1] (SMD).

The ambition of the Changing Futures Programme in Nottingham, is to build upon the work of Opportunity Nottingham, accelerating system change in Nottingham City, evidencing how resources held across partners can be maximised to achieve better outcomes for people experiencing SMD, as well as reducing pressures on frontline staff and services.

Since the award of initial funding, working alongside the ICP SMD partnership, a mobilisation team has been meeting regularly to progress the initial stages of the Changing Futures programme.

The information below provides an overview of activity across the programme since August 2021 and details next steps.

[1] People experiencing SMD are categorised as experiencing three of five sources of disadvantage, according to experience of homelessness, mental ill-health, substance misuse, offending or domestic abuse.

The Nottingham City Changing Futures delivery plan is rooted in the outcomes that people who experience SMD have told us they want to see achieved from the programme. Crucially, the programme model sets out not just to meet the needs of people who experience SMD through the operational delivery service, but also to influence the way in which services are commissioned and provided, creating the conditions for collective ownership of people’s needs in place of restrictive outcomes defined by individual services.

Programme Leadership

We are pleased to announce that Bobby Lowen has been appointed as the Nottingham City Changing Futures Programme Director and will take up his post at the beginning of March. Bobby joins the Changing Futures programme from Nottingham City Council where he has led commissioning review programmes for over 10 years. Bobby has a passion for working with people who experience SMD and believes that creating the conditions for strong partnerships has the potential to improve lives.

As part of his role to oversee the delivery of the Changing Futures programme in Nottingham City, Bobby will be working with system leaders to ensure that the Integrated Care Partnership (ICP) response to SMD is set within secure structures that sustain joint planning, coordination and use of resources for the benefit of all people who experience SMD (as well as at a system level) beyond the end of the Changing Futures programme.

As part of the programme leadership team, Bobby will work alongside a Senior System Change Commissioning Manager, a post that will be jointly hosted by Nottingham and Nottinghamshire Integrated Care System and Nottingham City Council – recruitment for this role is currently underway.

SMD Insight and Development Hub (IDH)

The Senior System Change Commissioning Manager will oversee the running of the SMD Insight and Development Hub (see figure 1 & 2) which will coordinate learning across the partnership. They will have responsibility for improving capture and use of data across services, in order to understand the outcomes achieved for individuals and measure the impact on services. The Insight and Development Hub (IDH) will collect data from operational delivery, informing commissioning and system change. The IDH will be responsible for improving practices (e.g. facilitating training and development) within core Changing Futures services, as well as across services that work with people who experience SMD (including non-specialist services).

Involvement of people with lived experience

Co-production is at the centre of the Changing Futures programme, and from the very start of the bid writing process in Nottingham City, we have worked in partnership with people with lived experience of SMD to ensure the programme aims and objectives are built upon their knowledge and expertise.

Operational delivery progress

From the design of the delivery model to recruitment and procurement processes; and writing value statements in job descriptions to providing input for service specifications, our experts by experience have been fully involved in decision-making throughout.

The Changing Futures Expert by Experience Board (see figure 2) has met monthly since it was established in September 2021 and will form part of the Nottingham City Changing Futures governance, aligning with the Changing Futures Development Board once established in the coming months.

Governance and oversight of delivery

In the mobilisation stage of the programme, progress is being reported to the Opportunity Nottingham Oversight Board as an interim measure to provide updates to wider partners on a monthly basis. Progress is also being reported to the Nottingham City ICP Executive Team and ICP SMD partnership meetings.

While the Changing Futures programme forms an integral part of the ICP’s programme to support people who experience SMD to live longer and healthier lives, it is important that the programme has its own established governance to ensure clear lines of accountability for delivery in its own right. The Changing Futures Delivery Board (CFDB) will be responsible for operational management, performance and service development, as well as oversight of strategic objectives to influence local commissioning and service provision. Plans are in place to establish the Changing Futures Delivery Board in the coming months.

It is anticipated that Nottingham City Changing Futures will commence full delivery in the summer of 2022. If you have any enquiries, please contact nnccg.nottmcityicp@nhs.net

Seeking community support with DESMOND

Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND) is a national programme that has been delivered locally by CityCare since 2018. The number of adults living with diabetes has more than tripled over the last 20 years in the UK and the need and demand for a sustainable and educational approach to self-management is critical.  Referral is largely done through GPs and other Health Care Professionals and less frequently through self-referral.

People from Black, Afro-Caribbean and South Asian (Indian, Pakistani, Bangladeshi) backgrounds are at a higher risk of developing type 2 diabetes from a younger age.  CityCare, is committed to inclusivity and tackling health inequalities in all the communities it serves, is redoubling its efforts to enable Nottingham’s minority ethnic communities to access the innovative DESMOND programme.

At present, DESMOND at CityCare is predominantly delivered in English which 90% of the communities it serves are able to access. Provision is also made for speakers of Hindi and Urdu but this still excludes a wide range of other minority ethnic groups, including Polish, in Nottingham where language is still a barrier and access to our service is currently not equitable.

CityCare is proud of its diabetes education provision but is now appealing for support from a wider network of community partners to enable more people to access and engage with DESMOND.  Our diabetes healthcare team is keen to hear from any people or networks in Nottingham that can work with us to share DESMOND and bring much-needed help and support to people living with this this serious and potentially life-limiting condition.  Please contact:

Shayasta Hasan (Diabetes Liaison Worker: shayasta.hasan@nhs.net

Juliet Thayan (Community Diabetes Specialist nurse/DESMOND lead: Juliet.thayan@nhs.net

Bulwell and Top Valley PCN Activity January 2022

Bulwell and Top Valley PCN Clinical Director, Dr. Andy Foster was on BBC Radio Nottingham (Monday 17 January) to discuss vaccine hesitancy in Nottinghamshire. He noted that ‘misinformation about the vaccine’ is one of the reasons people are avoiding getting their jabs. Listen to the interview HERE

Notts TV visited Bulwell Riverside Covid -19 vaccination centre on Saturday 22 January. Joined by Alex Norris, MP for Nottingham North, Dr Andy Foster, Bulwell and Top Valley PCN Clinical Director, Dr Arun Tangri, Senior GP Partner at Riverlyn Medical Centre, and Raza Ali, Superintendent Pharmacist at Bulwell Riverside pharmacy.

They spoke about the importance of being vaccinated, how the local GP surgeries and Bulwell Riverside pharmacy have worked together to get as many of the local population vaccinated as possible, and how much the staff and volunteers have made such a huge difference in the whole process. This interview was published Monday 24 January 5.30PM, listen HERE at 00:30

Dr Andy Foster and Dr Mark Salisbury spoke to the children at Rufford School in Bulwell and Rise Park School in Top Valley .

They talked to the children about how they can look after their health, including healthy eating, exercise, being active and not smoking; along with information about careers in the healthcare sector. They had previously introduced a poster competition with the theme ‘looking after your body.’

On this visit they took questions from the children and announced the winners and runner-ups of the poster competition.


Rufford School winning poster

Rise Park School winning poster