We are working with LD:North East in order improve the care and support we offer patients with learning disabilities in our area. We have 2 expert Care Co-ordinators working across our Primary Care Network for adults and children and a Health and Well Being Coach. Their input is enabling practices to understand challenges and consider new ways of working in order to reduce barriers to medical care for this patient population.
Funding source
ARRS
IIF Top Up
PCN Management Lead
Mrs Lin Murray
PCN Overall Accountable Person (CD or Deputy CD)
Dr Lunn (Clinical Director)
Team Lead
Dr Kate Grisaffi GP West Farm – PCN Lead
Michelle Taylor LDNE – Day to day lead
Julie Redpath LDNE – LDNE team lead
Individuals Team Members Supervision / Education
Dr Kate Grisaffi GP West Farm – PCN Lead
Areas of responsibility
Quality
Metrics needed
LD Health checks – IIF £11,000
From PCN DES 2022/23
A PCN must:
a. identify and include all patients with a learning disability on the learning disability register, and make all reasonable efforts to deliver an annual learning disability health check and health action plan for at least 75% of these patients who are aged over 14;
b. record the ethnicity of all patients registered with the PCN (or record that the patient has chosen not to provide their ethnicity); and
c. appoint a lead for tackling health inequalities within the PCN. We have picked the LD population within the PCN as experiencing inequality in health provision and/or outcomes, and have developed a plan to tackle the unmet needs of that population.
To develop that plan, a PCN and commissioner must have jointly:
a. utilised available data on health inequalities to identify that selected population, working in partnership with their ICS, including local medical or pharmaceutical committees, and local authority commissioners;
b. held discussions with local system partner organisations who have existing relationships with the selected population to agree an approach to engagement;
c. held engagement with the selected population to understand the gaps in, and barriers to their care; and
d. defined an approach for identifying and addressing the unmet needs of this population.
The PCN’s finalised plan to tackle the unmet needs of the selected population must include:
a. locally defined measures agreed with local commissioners in line with, and co-ordinated between, wider system strategies to tackle drivers of inequalities;
b. delivery of relevant interventions or referrals to services that provide these interventions for the selected population; and
c. ongoing engagement with the selected population
Who leads on team metrics
LDNE , Dr Grisaffi and Dr Lunn
Staff Place of work / Practice
Dr Kate Grisaffi – PCN Lead West Farm
Michelle Taylor – Health and Wellbeing Coach LDNE
Julie Redpath – LDNE Team Lead LDNE
Lesley Winter – Care Coordinator LDNE
Steven Ellis – Care Coordinator Children LDNE
