Merton Health and Well Being Strategy Dr Geoff Hollier. Welcome Who am I? Very happy to have the opportunity to work with colleagues establishing the HWBB over the past 18 months. The borough of Merton Mixed population health inequalities
Who am I?
Very happy to have the opportunity to work with colleagues establishing the HWBB over the past 18 months
Who are we?
What do we do?
A new organisation – 26 practices = membership = 211,000 population
First co-terminous arrangements in Merton for heath care and social care
Partnership working using collective resources, energy and commitment to ensure healthier population/environment.
Combine Merton CCG priorities with those of the LA and voluntary groups. Provide a platform for us to ensure we focus on a few areas but achieve maximum output from them.
MCCG delighted to lead on Long Term Conditions (LTC) and End of Life Care (EOLC).
Right services, right time, delivered by the right person.
· Ensure detection of those at risk - Stratification Register in every practice
· Care management plan for each patient on the risk register with the integrated primary care team. Regular review and appropriate input including social care and community nurses and others, as required
· Virtual ward for those who need services to remain at home where appropriate – staffed by a general physician/geriatrician, rehabilitation team and social care
Enable patients to take care of their own health through expert patient programmes & excellent information, e.g. COPD Met Alert
Continue to promote CMC – results show those needing EOLC who are on the CMC Register over 60% achieve preferred place of care and death, as opposed to those not on the Register.
We will support other initiatives
HWB Strategy is the beginning
Together we must make it work for our population