The last 12 month

We are proud to have engaged with Phase 1 and 2 of the successful Covid-19 vaccination programme at St. Marys Medical Centre.

Recruited highly skilled staff through ARRS into crucial neighbourhood team roles, such as occupational therapists, clinical pharmacists and care co-ordinators.

The whole team have worked collaboratively on the EHCH DES to provide a full structured medication review (SMR) and a separate GP review. This has enhanced relationships with the care homes and improved care for the residents. We have implemented and been running the weekly rounds and MDTs.

Worked with care home managers to put ReSPECT forms in place as part of the residents’ Personalised Care Plan (PCP).

Have worked with local services to start the mental health transformation project, which will build a team including peer support workers, mental health practitioners, psychiatrists and social prescribers as part of the Integrated Placed Based Team.

The next 12 months

Implementing systems and proactive care around dementia and memory assessment.
Further enhancing our neighbourhood work to focus on falls prevention, hospital avoidance and frailty across care homes, the housebound and wider community.

Continue to serve the Stamford and Bourne area to reduce health inequalities.

Build relationships with local PCNs to work towards the Integrated Care System (ICS).

What we are most proud of

Our Covid-19 vaccination programme and the incredible response of the many individuals dedicated to providing an efficient service, despite the many challenges.
Building a highly skilled and varied workforce to tackle the challenges and population health management in our areas.

Establishing core processes to allow for improved communications, access, and care for our patients.

The work of the whole team to deliver the EHCH DES.