1. Integrated Care in Erewash The story so far ………
Date: 13th February 2014

2. Meet the team
GPs, senior staff from CCG, Community & mental health trusts, secondary care trusts, healthwatch, CVS, Optum (United health UK) DHU and Adult Care
Recently reviewed membership, looking to include community pharmacy rep.

3. The New Erewash Model Feedback from previous Stakeholder Forum:
“It’s great, but people don’t just fall in office hours, Mon – Fri”
“SPA – seamless and timely”
“Data collection and info sharing in NHS/adult care systems may need further development”
This is the Erewash model. Simplified versions on tables.
Brief overview: 2 main flows – rapid response & pro active care

4. Progress of Integrated Care in Primary Care and the Community
Shared Access to IT systems
7 day service – SPA & Community teams
Sitting Service
Welcome Home Service
SPA – 5 day service
Community Delivery Teams
Care Coordinators
Risk Stratification
Rapid response
In response to previous comments:
New services being piloted now, will need to be fully evaluated
Brief description of each service
Catalyst = Patient and stakeholder feedback

5. Rapid response, including SPA Proactive Care – CDTs
Care Coordinators
Rapid response, including SPA
Proactive Care – CDTs
Longer term rehab/specialist services
As the model encompasses so many different aspects, we wondered whether it would be better to break it down into elements and present different parts in more detail over the next few events?
Care Coordination
Rapid response & SPA
CDT/case management
Support services and Specialist services
Any other requests/suggestions?
Today = Care coordinators

6. Examples of their work (case studies)
Care Coordinators
How many are there?
Where are they based?
What do they do?
Examples of their work (case studies)
6 coordinators in Erewash – now going to be rolled out across Derbyshire
Each coordinator is attached to 2 practices – same as community teams so services are wrapped round patients

7. Thank you for listening
Questions?
Comments?
Note any for the feedback.