Mid-Notts Place-Based Partnership announce new Chair

Mid-Nottinghamshire Place-Based Partnership (MNPBP) is pleased to announce the appointment of Theresa Hodgkinson, Chief Executive of Ashfield District Council, as its new Chair.

The Mid Notts Partnership brings together over 15 health and care organisations including local authority, community services, GPs and hospitals, as well as wider partners such as the community, voluntary and social enterprise sector.

Working in partnership with people within our communities, the organisations collaborate to deliver the MNPBP’s shared ambition, which is: “Working Together to enable everyone across Ashfield, Mansfield, Newark and Sherwood to live healthier and happier lives, to prosper in their communities and remain independent throughout life”

The news of Theresa’s appointment comes after previous Chair Adam Hill, Chief Executive at Mansfield District Council, announced his departure from the MNPBP to take on a new role at Rushcliffe Borough Council.

Adam said: “It has been a real honour and privilege to be chair of the Mid Notts Placed Based Partnership. Bringing together partners and stakeholders in a collaborative approach has helped to deliver real changes in the community along with improved health and wellbeing for the residents of Ashfield, Mansfield, and Newark and Sherwood council areas.

“The commitment from partners across the public, private and third sector is inspiring, and it has been great to see so many new and improved projects delivered throughout the area. These include the Bellamy Health Prevention Project, the creation of a new Community Hub in Ashfield, the introduction of Social Prescribing support across Mid Nottinghamshire, and the delivery of support for the physical and emotional health of children and young people in Newark and Sherwood, to name a few.

“These projects have been successful due to partnership working and I am extremely proud of the legacy and foundations that have been developed during my time as chair. I am pleased that Theresa Hodgkinson will be taking up the mantle of Chair following my departure, and I know that the partnership will continue to thrive in her hands.

Thilan Bartholomeuz, Clinical Director of Mid-Nottinghamshire Place-Based Partnership, said of the news: “I was saddened to hear that Adam Hill announced his departure. Adam has brought energy and direction to the role of PBP Chair and has a clear passion for improving partnerships within the mid-Nottinghamshire area. I, and the wider PBP executive Team will be sorry to see him go but are excited to welcome Theresa into the new role.

“Theresa brings a wealth of experience and a proven commitment to partnership working, which will be invaluable as we continue to address challenges and seize opportunities in the mid-Nottinghamshire area. Her leadership and vision will build on the solid foundations laid by Adam and drive us forward in delivering meaningful improvements for our communities.”

Stepping up from her previous role as Vice-Chair of the partnership, Theresa has worked within Local Government in Nottinghamshire for over 35 years and previously held the post of Director of Place and Communities. Since her appointment as Chief Executive Officer at Ashfield District Council in 2021 the council has progressed rapidly, and the district is due to see unprecedented levels of investment in its services over the next five years.

Theresa said: “I am honoured to be the new Chair of the Mid-Nottinghamshire Place-Based Partnership.

“This Partnership enables us to bring together health and social care services across Ashfield, Mansfield, Newark and Sherwood. Alongside colleagues, I aim to help improve and join up services, tackling health inequalities in a purposeful and coordinated way while working alongside and championing the voices of our communities in Mid Nottinghamshire.

Theresa’s focus on working within priority neighbourhoods and ensuring all residents have the same access to opportunities, coupled with her previous experience as Vice Chair of the Partnership, means her appointment is a positive step for the future of the MNPBP.

She continued, “Our health and wellbeing is strongly shaped by the conditions in which we are born, grow, live, learn, work and age throughout our lives. I am positive that by working with key stakeholders including councils, NHS, wider Public Sector organisations, third sector, businesses, and education institutions to name a few, we will be able to deliver our plans to bring a lasting benefit to the lives of people who live, learn or work in Mid Nottinghamshire.”

Learning from Rosewood PCN’s pioneering work with vulnerable patients

The work of a Primary Care Network (PCN) and GP Practices in part of Mansfield is having a significant impact in reducing health inequalities.

The Rosewood Primary Care Network, covers five GP Practices in Mansfield town centre and the south of Mansfield District, with a combined total of more than 51,000 patients.

Dr Kathy McLean, the Chair of NHS Nottingham & Nottinghamshire Integrated Care Board visited the PCN in October to hear about their pioneering initiatives working with vulnerable patients in the area and some of the challenges local GP Practices are facing, with the aim of continuing to build upon their positive work.

Dr Milind Tadpatrikar, Clinical Lead at Rosewood PCN and his team described how they worked with practices to deliver a range of interventions with hard-to-reach groups in their area, including:

  • Learning Disability (LD) patients – since employing a dedicated LD Nurse, the number of LD patients receiving a health check rose from 36% to 83% in 2023/24, which it is hoping to increase further in 24/25. The professional relationships developed between the LD nurse and patients have been instrumental in achieving this. The LD Nurse is a joint appointment with Mansfield North PCN and works across both areas.
  • Housebound & Care Home patients – A dedicated team of nurses and care co-ordinators carry out weekly ‘ward rounds’ at care homes and have already delivered 61% of annual reviews so far in 2024/25.
  • Severe Multiple Disadvantaged (SMD) patients – A dedicated PCN-funded care co-ordinator works with a range of local agencies to access specialist care and support for 335 registered SMD patients with variety of needs including homelessness, substance misuse and domestic abuse.

Following the visit, Dr McLean said; “It’s vital that health leaders, like me, spend as much time as possible speaking with the people who care for our patients, day-in, day-out, hearing about the challenges they face and the successes they have.

“Rosewood PCN and its practices is doing some great work to tackle health inequalities, working proactively with different groups of vulnerable patients who they have identified as having difficulties accessing good healthcare. Their work is a great example of how resources can be pulled together across health and social care to achieve excellent outcomes for patients.

“We are extremely grateful to Dr Tadpatrikar and his team for sharing their experience. Rest assured, all the learning from this visit, including the challenges faced by the PCN, practices and staff, will play a part in shaping future healthcare across our area.”

Rosewood PCN visit
Pictured at the visit are: Leanne Monger –Deputy Place Partnership Director, Mid-Notts PBP; Dr Milind Tadpatrikar Clinical Lead, Rosewood PCN; Sharon Atherton, Digital & Transformation Lead, Rosewood PCN; Andrea Lucken, PA to Clinical Lead and SMD Care Coordinator, Rosewood PCN; Dr Kathy McLean, Chair, NHS Nottingham & Nottinghamshire ICB and Claire O’Mara, Primary Care Senior Transformation Manager, NHS Nottingham & Nottinghamshire ICB.

Dr Andrew Foster: Introducing the Nottingham & Notts Primary-Secondary Care Interface Partnership

The Primary Secondary Care interface group has been working since 2021 to improve the way that staff at Nottingham University Hospitals and those working in General Practice work together.

Their focus is to improve patient care and clinical outcomes by strengthening relationships between these two groups of staff by building and trust and taking real action to change behaviours and processes that can complicate patient care and damage this partnership.

The group has delivered tangible changes, and the work of the group has been recognised locally and nationally with other organisations learning from their experience and working to create similar projects.

Key Achievements

The group has generated around 90 projects aimed at improving the interface between primary and secondary care. As a result, many of those things which have historically caused additional work and frustration should now happen much less often. Notable examples include:

  • Hospital discharge summary audit – Over 7,000 discharge summaries have been audited to understand the type and scale of inappropriate transfer of work from secondary to primary care.
  • Co-produced presentation outlining five asks that improve patient experience at the interface
The Five Asks Scheme
 
1. Communicate clearly and concisely. Where actions are required by the patient or GP, make this clear and easy to identify in all correspondence.
2. Refer a patient to another speciality within NUH where this relates to the original problem, or a directly related medical condition, rather than asking the GP.
3. Follow up the results of tests NUH have undertaken, informing the patient and completing any actions, as required.
4. Issue a fit note, wherever appropriate for the full duration needed.
5. Provide patients with prescriptions for new or altered medications when seeing them in an NUH outpatient setting
  • Primary Care Presence in NUH Inductions – GPs now participate in junior doctor and consultant inductions, providing insights into the Primary Care perspective and fostering a culture of collaboration from the outset of their careers.
  • Jointly agreed letter templates regarding inappropriate request to GPs – Templates agreed with and supported by NUH leadership to support General Practice to correct unsuitable demands.
  • Primary-Secondary Interface event June 2024 – Attended by GPs and Consultants and supported NUH and the LMC to increase engagement with the work of improving relationships.
  • NUH Fix It WhatsApp Group –
  • No more “repeat chest Xray in 6 weeks” – An often-cited frustration in General Practice. Hospital staff now take responsibility for arranging repeat chest x-rays following discharge.

The Interface Group categorize their wide-ranging activity across six domains (Culture & Relationships, Continuous Improvement, Clinical Integration, Digital Integration, Training and Development and Communications) and have a pipeline of future improvement plans.

How the Primary Secondary Care Interface Group began and evolved

The relationship between Secondary Care clinicians and General Practice is complicated. Many have felt historical frictions worsen in recent years as demands on the system have increased and technology, standardised communication proformas and referral triage processes have increased the distance between the two sectors.

This interface work began in late 2021, as both General Practice and NUH were facing huge pressures due to the COVID19 pandemic. All Nottingham based clinicians share the care of a population experiencing broad challenges including; access to care, worsening outcomes, and health inequalities. The system faces large backlogs of pent-up demand and long waiting lists, a workforce exhausted by pandemic pressures, and significant financial pressures.

A group of NUH consultants, staff and leaders from General Practice began meeting to explore how the two sectors could collaborate and work more effectively together to meet these challenges.

Early discussions in the interface group identified the sense of a deepening “them and us” culture. Initial meetings allowed clinicians from both sectors to express their struggles candidly and acknowledge that they were facing similar and connected issues. This transparency has been crucial in the developing of relationships, trust and a culture of collaboration.

There was a shared recognition that both primary and secondary care were struggling with similar challenges. They became focussed on finding solutions that benefit both sectors and also securing a smoother journey through the system and better outcomes for patients.

Principles

·       Don’t duplicate work that is already being undertaken elsewhere in the system·      Seek to satisfy the needs of our patients at their first presentation to healthcare services, whenever possible
·       Be open, honest & respectful to each other, recognising that we are all doing our best to meet the needs of our population·       Don’t try to solve everything. Take action that will make a difference to someone:
·       What we can do in days and weeks rather than in months or years
·       Doing something is better than nothing
·       Not everything we try will work
·       Don’t ask someone to do something that you should be doing yourself·       Developing an understanding of ‘this patient needs’ and being able to respond regardless of the care setting

Key principals keep the group’s work focussed on delivering meaningful change

A focus on early quick wins allowed the group to build momentum, grow and become an established fixture within the system. The group has expanded to include representatives from NUH clinical and organisational leadership, Nottingham City and South Notts Place Based Partnerships, the ICB Clinical Design Authority and Nottinghamshire LMC.

Representatives from NUH departments and other parts of the system attend meetings to discuss specific issues relating to their part in the interface between primary and secondary care. They meet weekly to discuss challenges and to address issues.

People involved

Nottingham City PBP – Dr Husein Mawji, Dr Andrew Foster, Claire Matthews.

NUH – Dr Mark Simmonds, Dr Alun Harcombe, Dr John Walsh, Tim Guyler, Simon Gascoigne, Kelly Jandrell, John Peach.

Research – Dr Nick Boddy.

ICB – Dr Stephen Shortt, Dr Nicola Jay.		South Notts PBP – Dr Jill Langridge, Dr Aamer Ali, Jacki Moss.

Clinical Design Authority – Dr Jeremy Griffiths.

Local Medical Committee – Dr James Hopkinson, Dr Jen Moss-Langfield.

Regular membership includes individuals with the ability to influence their organisations

A culture of open, honest, informal communication and relationship-building enables an agile approach to making decision and taking action. The work is supported by the NUH integration team who support the structure and governance of the group. This has been essential to balance the open and informal atmosphere with an ability to be organised and impactful.

Primary/Secondary Roadmap

The group has delivered multiple milestones since 2021, these include:

September 2021
Primary/Secondary Care Interface Group established to support the recovery of Long Term Conditions management
October 2021
Explored initial areas of focus including UEC attends and Spirometry
August 2022
Primary Care video incorporated into Junior Doctors Induction
September 2022
Shared Learning Programme commenced (3 year multi disciplinary rolling training programme jointly provided by NUH Heads of Service and Primary Care
November 2022
1st Primary/Secondary Care Working Group with NUH CEO and Primary Care Representatives
November 2022
Spirometry Pilot Launch
November 2022
Flu outreach pilot commenced providing opportunistic vaccinations to patients attending routine hospital appointments
January 2023
Established a Written Communications Sub Group to look at clinic letters/discharge letters/waiting list communications/TTO audit
January 2023
NUH CEO writes to all GP practices to share the Trust’s first People First Report
May 2023
2nd Primary/Secondary Care Working Group with NUH CEO and Primary Care representatives
August 2023
Written Communications Group engagement with 45 specialties to feedback issues raised by interface group and identify opportunities for improvement
September 2023
Audit of 7,000 TTOs to review what is being asked of GPs
October 2023
Reinforcement of clinical and professional behaviours enabling improvement of the interface
November 2023
Primary/Secondary Care update to NUH Trust Leadership Board
December 2023
NUH Fix IT Pilot commenced
January 2024
Primary/Secondary Care Interface Update to NUH Trust Board
January 2024
Echo on ICE business case approval
January 2024
GP/Consultant Twinning Scheme – 20 NUH Consultants and 20 GPs shadowing one another to gain broader understanding of each other’s environments
May 2024
Primary/Secondary Care Working Group meeting with NUH CEO and Primary Care Representatives
May 2024
NUH Chief Executive writes to all GP practices
May 2024
Raising the profile of this work locally and nationally through various routes including ICB, NHS England and NHS Confederation
July 2024
Primary/Secondary Care Engagement Event

Learning from the Interface Group

The impact of this work has led to increased interest from clinical specialties keen to engage with the interface group. There have been discussions exploring the establishment of groups to improve the interface between other system partners such as Nottinghamshire Healthcare Trust and East Midlands Ambulance Service. The initiative has gained recognition at a national level, with group leaders being asked to share learning from the Nottingham experience through the NHS Confederation.

Key learning points

Building Relationships and Trust: Regular informal meetings where leaders create an open and safe culture enabling representatives from both sectors to engage in candid discussion about mutual concerns.

Adaptability and Flexibility: Being open to change and to challenge established norms, behaviours and embedded processes.

Audit activity and use data: The group audited over 7,000 discharge summaries from NUH to understand the type and scale of work transfer from secondary to primary care, such as requesting further tests and referrals. This evidence added credibility to calls to change processes and behaviours.

Commitment from senior leaders: Senior clinical and executive leaders from both sectors champion the work of the group with colleagues. Leaders need to have sufficient credibility and influence with colleagues to make the argument for change.

Support with governance and structure: To ensure that meetings are productive and actions are completed. The NUH interface team provide project management to ensure that projects are delivered and meetings function effectively.

How to feedback clinical issues to NUH

What already exists?

What is on the horizon?

  • Implementation of the Five Asks Scheme template letters – available on F12/Ardens [expected November]

For more information, to learn how to get involved, or to suggest an issue for the group to address, please email nuhnt.integrationteamnuh

Dr Andrew Foster

GP Partner, Parkside Medical Practice

Deputy Clinical Director, Nottingham City Place Based Partnership

Director, Nottingham City General Practice Alliance

Money Advice in Primary Care

We have live Social Prescribing Advice Link Worker Projects across three Primary Care Networks: BACHS, Nottingham City East, Bulwell & Top Valley.  Each PCN has their own money advice worker, employed by a welfare advice service in the city but embedded within the PCN and working through a social prescribing model.

The value of welfare advice in primary care was recognised as far a back as 1985: Jarman, B. (1985) ‘Giving advice about welfare benefits in general practice’.  There have been several projects like this across the UK since, with reports showing significant health impacts. So, we are delighted to have this off the ground in Nottingham. The difference being made to the lives of individuals is vast.

One example is below:

This gentleman was extremely socially isolated. He had a long history of substance misuse and PTSD due to childhood trauma. He had an industrial injury meaning he was unable to use his left arm and walked with a stick due to sciatica. He had no trust in services, felt let down by everyone. He was in serious financial difficulty leading to a worsening of his mental health. 

The money advice worker (the first person to visit his home in a long time) discovered he had numerous debts, many unopened letters and his welfare benefits had stopped.  She subsequently managed to persuade him to leave the house and go to the advice centre, securing him food and fuel vouchers to tide him over while they worked through the emergency situation.  She began working on his welfare benefits and debts that resulted in his Personal Independence Payments (PIP) being reinstated, and at a higher rate than it had previously been. He also received £7,700 in backdated payments. Manageable repayments were negotiated with the creditors for the gentleman’s debts. And, once he received his backdated PIP award, he was able to pay off all his priority debts.

Because of the support he received the gentleman reported his mental health improved significantly.  At the final meeting, he reported that, ‘a massive weight had been lifted’.  He said he’d felt they ‘cared about him as a person’, explaining he would probably have slipped back in to using drugs had he not got the help.  He now tries to leave the house every day and is able to buy ‘nice food’ for him and his cat.

As well as the financial gains, we measure wellbeing impact using the ‘MyCaW’ tool.  Initially, the gentleman’s self-reported scores were at the highest levels for both their financial concerns and general wellbeing.  By the end, their score for financial concerns had reduced to zero, and the general wellbeing score reduced by two-thirds.

If you would like to find out more please contact: :  Emma Bates, Lead for Nottingham Financial Resilience Partnership: 01332 460466; emma@financialinclusionsupport.co.uk