Emma Cox (Associate Director of Delivery – Surrey Downs and Health and Care Partnership) and Dr Hilary Floyd (Co-medical Director Surrey Downs and Health and Care Partnership) presenting on the following at 7.45pm
• The work of Surrey Downs Health and Care Partnership, and the place-based activity that looks to support our local communities in addressing the wider determinants of health
• An overview of the Pulling Together Programme and the agenda for change in partnership working
Minutes:
The Panel received a presentation on the following matters:
a) The work of Surrey Downs Health and Care Partnership, and the place-based activity that looks to support local communities in addressing the wider determinants of health.
b) An overview of the Pulling Together Programme and the agenda for change in partnership working.
Dr Floyd followed on from the earlier presentation by Dr Charlton and advised that healthcare delivered in the community had been impactful on Epsom and St Helier Hospitals, and that during the pandemic, there had been more emphasis on community delivery.
There were lots of elements of the service that rapidly increased or developed. This was aimed at preventing people presenting to A&E and how to speed up discharge from the hospitals by linking in primary and care and general practice to keep people at home. This has helped Epsom in respect of its bed utilising and flowing through quicker. Social Care was also vital in this delivery.
Dr Floyd talked through what Surrey Downs Health and Care Partnership is as a vehicle for bringing together all the partners that are key in delivering better healthcare and wellbeing outcomes for the population. Within this there is an emphasis on ‘place’, and an acknowledgement that these initiatives should be delivered where people live.
The partnership brings together the NHS, community partners, the voluntary sector, local government, and other providers that service the community.
The Partnerships covers Dorking, Epsom and Ewell and East Elmbridge, and a population of about 320,000 patients.
The Partnership is formed of 6 PCNs to jointly look at the needs of PCN areas to delivery better care and boost up the capacity of General Practice by delivering collectively. This will include the work of the boroughs and district and voluntary sector moving forward.
Dr Floyd talked the Panel through the Partnership board.
The Partnership has developed a transformation programme to look at how things can be done differently, especially after the pandemic. This highlighted lots of issues and it is accepted that a lot of things ‘stopped’ during the pandemic, especially elective procedures. They are now looking at re-referrals for these patients.
The issue of having an Integrated Community is a key issue for the Partnership and they are looking to integrate roles such as district nursing back in at PCN level, as opposed to a GP level. Workforce is a determining factor in this.
Dr Floyd went on to explain that a key element of their transformation programme is ‘Thriving Communities’, and that this is being driven by population health management. This seeks to understand what might be causing ill-health and a lack of wellbeing in groups of the population. Dr Floyd reflected that often decision makers think they know the answer, but this is often incorrect; a patient attending the GP with stress and anxiety will often have an underlying social/economic determinant and the programme seeks to address this.
Dr Floyd reflected on the Pulling Together event and reflected that the aim was to look at how to develop strong relationships with communities and to work with Councils and the voluntary sector to look at what else can be done to make things better for patients. Dr Floyd touched specifically on the health inequalities experienced by some groups during the pandemic and how the Partnership can reach out.
Dr Floyd reflected that she held vaccination programmes for both the traveller and the homeless communities, and that this led to a discussion about what initiatives i.e., pop-up clinics would be helpful in address the health needs of these communities.
Looking at the work of the PCNs, Dorking has been linking in with care homes to address the needs of this group in respect of collaborative working. East Elmbridge is looking at how they can work with the Council regarding the health of refugees. The ICP PCN had recently held a community open day, and Epsom have done a lot of work around social prescribing and wellbeing coaches and frailty prevention. In Banstead, a lot of work is being done around mental health and more work in care homes.
Dr Floyd touched on the work of her surgery in Leatherhead and the social initiatives (such as gardening) and up-skilling in areas such as IT that were being undertaken to improve health and wellbeing. They are working towards the possibility of having a wellbeing café where people can drop in and socialise and engage with others. There is the aspiration to create a village feeling to reduce isolation and they are looking at how they can achieve this.
From the Pulling Together Programme, building up links with lay partners and volunteers is being looked at, and to engage the district and boroughs, and adult social care to understand the communities and to address the wider determinants of health to ensure a community can support itself.
Dr Floyd advised that looking at the winter health pressures is key however this should also include community services, and what needs to be kept running post-Covid to ensure the wellbeing of residents. The Partnership is currently looking at allocating some funds towards keeping services such as transport, shopping services and befriending to help the community through the winter. They also have a small pot of money for emerging issues to ensure they can respond as a system.
The following matters were addressed:
a) The pre-Covid plan to link all systems together. Dr Floyd advised that this is correct, and that this was simply halted due to the pandemic. The question was posed as to what the barriers to the future progression of the transformational plan are.
Dr Floyd advised that workforce and funding present the greatest barrier however that there are now enough pots of money to help support this work. Further to this, building momentum and identifying the people and the communities will take time and effort.
Additionally, raising awareness of the services available to communities, and how this is communicated is also an issue. The Partnership needs to strengthen its relationship with local Councillors, districts and boroughs and lay partners if this is to be successful.
b) How much of the matrix/results has/have been derived from NHS England.
It was noted that to date, results have been based on looking at other areas, however recognising that our own ‘place’ is different to others, we need to grow and develop our own projects and initiatives as to ensure that we showcase our best work that can then be replicated and expanded.
The aim will be to start small with a few key areas and then grow on the success of these projects.
c) The work of the voluntary sector and plans for carers.
It was noted how valuable carers are and that over the pandemic the carers register has been improved to put them in touch with organisations that can offer support. One of the workshops on the Pulling Together Programme was specifically looking at carers to work out implementation of the carers’ strategy on the ground, and across the place. Carers remain at the forefront of work.
d) Why issues relating to the workforce have become prevalent.
The Panel noted that policy change is one of the biggest factors. Several years ago, a GP had a team around them that saw a variety of professions (district nurses, CPNs etc.) ‘sit’ around the GP. There was then a change to the structures of healthcare, and it was decided that if these professionals worked across several practices, it would be a more efficient system.
Dr Floyd advised that this resulted in workforce and relationships being lost. They are now in a position where they are needing to think about how they bring this relationship back.
Some teams, such as the district nursing, practice and mental health nurses and health visitors have reduced in numbers. The Panel noted that attempts are underway to put this resource back into PCNs as to ensure that there is a team that works alongside the GP practices within this network.
e) PCN in Leatherhead and the practices within this network. It was noted that this PCN works well and is already looking at how to work across each surgery as to address various demographics.
f) The importance of digital inclusion. This should be planned for both in respect of equipment and skill sets. It was noted that this work was coming out of a period of austerity and that such impacts have been felt.