Plans have been developed which propose new ways for the city’s council and NHS to work more closely together in future.

The plans set out options for further integration of the leadership of Portsmouth City Council and NHS Portsmouth Clinical Commissioning Group (CCG). This marks a continuation of a process of closer partnership which has involved senior joint appointments, and resulted in a range of positive changes such as targeted early health and social care support for children and families, a shared clinical record available to frontline NHS and social care staff, and integrated domiciliary care teams to help people return home after a hospital stay.

There are three key recommendations:

• More decision-making to the Health and Care Portsmouth joint commissioning committee
• Integrating the council and CCG approach to finance, including the creation of a joint role
• Proposing future arrangements for the CCG’s accountable officer role.

In terms of the third point, the recommended course of action is that the CCG’s accountable officer functions are incorporated into the function of the Portsmouth City Council Chief Executive. The CCG will continue with its strong clinical leadership model, including clinical leadership for Health and Care Portsmouth and having a clinical chair for its governing board.

A paper containing these recommendations was considered by Portsmouth City Council’s cabinet on 9 July, and will go to the CCG’s Governing Board on 17 July. It will then be considered by the city’s Health and Wellbeing Board. If agreed by all three bodies, approval would then be sought from NHS England with regards the proposed changes to delivery of the CCG’s accountable officer role functions.

Dr Linda Collie, the CCG’s clinical leader and current accountable officer, said: “For many years now, our ambition has been to bring health and social care together, because we feel that would bring valuable, tangible benefits to people living in our city. Ultimately, our total focus must be on meeting the needs of people using services in Portsmouth, and the changes we have been making, and are now proposing, are designed to do just that.

“The CCG has always maintained a strong clinical voice at the heart of the decision-making process, and we believe these recommendations will continue that and enhance our effectiveness.”

David Williams, Chief Executive of Portsmouth City Council, said: “A huge amount has already been achieved through our integrated working with the NHS, and these recommendations are a natural progression in Portsmouth’s journey to truly integrated health and social care. We now have much closer working between the council and the CCG, and have positive relationships with the voluntary, community and social enterprise sector. These proposals mark an important next step on that journey.

“Increasingly, NHS and council teams are working together under the Health and Care Portsmouth banner, and it feels right that we should now try to make sure that the leadership arrangements reflect that progress and Portsmouth has a clearer voice within the wider health system.”

Cllr Matthew Winnington, the council’s Cabinet Member for Health, Wellbeing and Social Care said: “This paper is a statement of intent – it sets out a clear vision for how the council and the CCG can continue to work together to deliver joined up services.

“Local authorities play a unique role in the lives of our residents. Bringing together the council and the CCG means we can work together to tackle those wider issues that impact the health and wellbeing of people in Portsmouth – things like improved air quality, housing and economic development. I’m excited to be delivering on our mission to make sure we’re providing the right services for the people in our city so they are supported to live full, healthy and independent lives.”

FAQs

Why is the proposal being made?

The proposals are a natural development of work between the council and the CCG over a number of years.  They stem from requests made by both the council’s Cabinet and the CCG’s governing board to get broader and deeper integration between the two organisations. There are a number of factors involved: there are pressures on the health and social care system as a whole, and key documents (the NHS Long Term Plan and the Hampshire and Isle of Wight Strategic Transformation Plan) have set out how the NHS, local authorities and the voluntary, community and social enterprise sector can and should work together to address those pressures.

The proposals are about making sure there are structures and attitudes in place – in terms of resources, decision-making and people – to make sure the city can fulfil its desire to provide joined-up care for people in Portsmouth, delivered in the right place and at the right time.

Local authorities are uniquely placed to engage with residents on a number of factors that contribute to people’s overall health and well-being – like education, housing, leisure and transport. Bringing the council and CCG closer together means that resources, knowledge and expertise can be better combined for the benefit of the people of Portsmouth.  Together, the council and the CCG will work with the wider health and care system to influence the delivery of better, more cost effective services across the Hampshire and Isle of Wight area.

What has happened so far?

The two organisations have worked together for a number of years as part of the Health and Care Portsmouth programme, and already share a number of statutory posts – including in Adult Social Care, Children, Families and Education; and in Public Health. There are also shared commissioning functions and teams.

By sharing knowledge, expertise and resources we have been able to achieve much, including:

• Health visitors and children’s social workers have been co-located since 2016; in addition a diverse range of health and social care professionals has been brought together to deliver a Targeted Early Help and Prevention service for children and families.
• Adult community health, social care and therapies have been co-located to deliver multiagency care and co-ordination.
• From June 2018 the CCG has commissioned an Integrated Primary Care Service incorporating the provision of three interconnected services: Out of Hours (OOHs), the AVS, and GP Enhanced Access. This will ensure safe, effective delivery of primary medical care services 24 hours a day, 7 days a week, and improve access to primary care.
• A specific Blueprint for Adult Social Care in Portsmouth has been launched, with a cross-organisation programme board to ensure its delivery.
• A joint health and care domiciliary care service specifically to enable people to return home as quickly and safely as possible after a hospital stay.
• A collaborative approach has been taken to include the voluntary sector as an equal partner in the provision of health and care to Portsmouth residents. Through the signposting service, an easy access route for GPs has been available to access non-medical support from the voluntary sector for their patients.
• A single clinical record across health and care providers in the city to improve communication between health and social care professionals. All GP practices within the city, Solent NHS Trust, and Adult Social Care use ‘TPP SystmOne’ as their primary clinical system – better for patients, and for the clinical staff.

A new physiotherapy triage service means direct access to care for Portsmouth residents.

People with muscle and joint-related pains can now get direct access to a new service available across the city. Following a successful trial, the First Contact Physio service is now available in all GP surgeries in Portsmouth; this puts patients directly in touch with a physiotherapist, without the need to see another clinical professional.

The new triage service is being delivered by Solent NHS Trust as part of Health and Care Portsmouth, and is running in surgeries across the city Monday to Friday 8am to 12pm.

Musculoskeletal (MSK) symptoms are one of the most common reasons for repeat consultations with 1 in 5 people contacting their GP with a problem.

With over 200,000 people living in the city, First Contact Physio will benefit many people as well as freeing up GP appointments for those who need them most. When they contact their surgery, patients with symptoms like back or neck pain, or a hip, knee or shoulder complaint, may be offered a same-day telephone appointment with a specialist physiotherapist. The consultation will provide an opportunity for patients to gain advice or treatment to speed up recovery.

Theresa Costello, Musculoskeletal Physiotherapist at Solent NHS Trust, said: “We are very pleased to be rolling out this service. Many of the patients we help just need support and guidance, from the right clinician, on what they can do to help alleviate or manage their symptoms. This can be done quickly and effectively through our telephone triage consultation without any further appointments being required. For patients that have required further assessment, it has been fantastic to be able to offer  them early access to the physiotherapy service. This has enabled patients to have an assessment, receive a diagnosis and start appropriate treatment far sooner. We are the only service in the locality that is managing on-the-day demand for MSK conditions from primary care with the telephone triage model.”

Muscle and joint related symptoms are often a common reason for both urgent and repeat GP consultations; however, the majority of these do not need to be assessed by a GP. Last year, the service helped to free up 2,940 urgent primary care appointments across Portsmouth. The feedback that has been receiving from both patients and primary care teams has been resoundingly positive.

One service user said: “I think this is an excellent service, the person I spoke to was very professional. They took the time to explain my symptoms and gave me exercises to help my condition.”

Another patient added: “I was very surprised at how quick it was. The physiotherapist was able to arrange an appointment for me and the person I saw was fantastic. They helped me so much that I haven’t had to go back.”

Dr John Thornton, from Kirklands Surgery in Portsmouth, said: “It is a highly efficient system that gets patients help in a timely fashion from experts in their field and as a bonus frees us up as GPs to help those who need our other skills.”

Dr Linda Collie, GP and Chief Clinical Officer at Portsmouth Clinical Commissioning Group said: “We know we need to change how health services operate in the city and this is one of the ways we are trying to improve out of hospital care for our residents.

“The physio triage service makes great sense for our patients. Doctors like me are not specialists in this area so it would be much more useful for our patients to see a physiotherapist directly to ensure they get the care they need more efficiently. This will free up our time to see those who need us most whilst ensuring all patients get the appropriate care and support.”

Patients also have the option to self refer to physio via the Solent NHS Trust website at: www.solent.nhs.uk/msk

Portsmouth’s Enhanced Care Home Team is providing better support for people living in Portsmouth care homes.

The multi-agency scheme pilot is expanding to cover more homes and improve the health outcomes for scores of vulnerable, older people – easing pressure on the local NHS.

Whereas previously if a care home resident fell poorly, a GP or nurse could be called out to see them, there is now far more emphasis put on pro-active care, involving a fully integrated approach which includes a core team of a GP, pharmacist, community nurses and care home staff, with a supporting team on standby when needed such as mental health nurses and a occupational therapist.

The service benefits include:

• improved continuity of care,
• improved patient safety through better clinical outcomes,
• increased satisfaction of residents and their carers with the service,
• reduction in urgent care usage,
• a reduction in wasted/overprescribed medicines,
• better trained care home staff.

The initiative, funded by the Portsmouth MCP (Multispeciality Care Provider) and BCF (Better Care Fund) to help health and social care organisations to provide new models of care, is a joint project involving NHS Portsmouth Clinical Commissioning Group (CCG), Solent NHS Trust, the Portsmouth Primary Care Alliance and Portsmouth City Council.

Pictured left to right, top row, are – Pam Macpherson (pharmacist technician), Quadri Olaniyan (pharmacist care home), Maria Rodrigues (deputy manager, Oak Grange), Morwenna Fenner (pharmacist technician); mid row – Carmen Palimaru (nurse, Solent NHS Trust); front row left to right – Charisma Williams (Home Manager, Oak Grange), Camilla Evans (GP) and Samantha Reilly (pharmacist).

Vanessa Bull, a Learning Disability Nurse, was presented with the award at Solent NHS Trust’s Celebrating Nursing conference today, Friday 10 May 2019.

The award gave patients and Solent colleagues the opportunity to recognise those who really make a difference and is part of Solent NHS Trust’s celebration of International Nurses Day 2019 on Sunday 12 May.

Vanessa works within the Jigsaw team based at Southampton Civic Offices, which supports disabled children and young people as well as their families.

She is described by her colleagues as someone who always goes the extra mile and is truly passionate about getting the best outcomes for the children that she works with.

The panel of patients, volunteers and staff, selected Vanessa for her high standards, superb care that she provides to patients and her humble and impressive attitude.

On receiving the award, Vanessa said: “It was very unexpected, but it was lovely to win the award. All the nominees were amazing and everyone does such a fantastic job so it makes the award extra special.”

Solent NHS Trust Chief Nurse Jackie Ardley said: “We are very fortunate to have some incredible people working within Solent. The panel read through many fantastic nominations and it was such a difficult decision to choose a winner.

“It is with great pleasure that I congratulate the winner – Vanessa Bull – for her phenomenal work, particularly over the last 12 months. Vanessa clearly demonstrated the Solent values and shows outstanding innovation, compassion, as well as excellence.

“The conference was such a wonderful event and it was a pleasure to be able to recognise everyone’s hard work and dedication across the day. All our nurses have been pivotal in helping us achieve an ‘outstanding’ rating at providing caring services in our recent Care Quality Commission report. Together we can continue to learn and keep even more people safe and well at, or close to, home.

“We had 11 nurses shortlisted for the award, and just to be shortlisted is such a great achievement. All the nominees should be incredibly proud of themselves.”

All nurses, both registered and non-registered and working in Solent services, were eligible for a nomination.

We are planning a new service for Portsmouth, which is intended to offer a different way of supporting people’s emotional and mental health.

The service will offer both booked and ‘drop-in’ slots, with both professionals and peer supporters. We wanted to check in with city residents whether we were on the right track, and what you thought of a couple of possible names.

Almost 300 people responded to our survey, and a quick summary of the headline findings can be seen here.