Welcome to my July blog. You may have noticed but my regular updates have taken a little break over the last few months – that was because of the pre-election rules. So, it’s a bumper issue this time to capture all that I had wanted to cover in May and June!

Prevention

As I highlighted last time, it is vital that we try to focus on prevention and early intervention both to improve the health and wellbeing of our population now, and to reduce demand and ill health for the future.  You can read our population health management strategy here.

For next year, we can’t do everything, but we will continue to have a major focus on smoking cessation support, and on the cardiovascular disease prevention programme – to have the biggest impact on improving people’s health now and to prevent ill health for as long as possible in the future.

Dentistry

Another massive challenge now, but also needing a long-term approach is dentistry. We published a short-term plan last year about stabilising our services, trying not to lose any more dentists and improving emergency access.

So, moving to the longer term, I’m pleased to share our long-term dental plan 2024-2029 which was recently approved and published.

Here’s some key highlights:

1. We’re investing £1.2m to recruit, retain and support those working in the profession to build up the number of dentists and dental care professionals coming to live and work in Norfolk and Waveney, as well as supporting the Suffolk school of dental development to offer services as well as training in Norfolk.
2. Oral health education and prevention for children and young people, and adults.
3. Improving access to services with a particular initial focus on children and young people and on those living in areas of deprivation to keep on trying to reduce health inequalities.
4. Further development of enhanced services such as oral surgery, and secondary care dental services, as well as orthodontic services for children under 18 years of age.
5. Special Care dental services for individuals with learning disabilities, autism, sensory impairment, physical or mental disabilities.

Pharmacy first

I’m really proud that all 96% pharmacies are now live with Pharmacy First. This is an initiative to improve access to care for people with seven common acute conditions. The service enables patients to either walk in or be formally referred from both general practice and 111/ out of hour providers for the following conditions:

• sinusitis
• sore throat
• earache
• infected insect bites
• impetigo
• shingles
• uncomplicated urinary tract infections in women

This builds on existing work of our pharmacies to support the management of people with hypertension and contraceptive needs, and I hope it will also help reduce the massive demand in general practice.

General Practice

There continues to be huge pressure on general practice with increasing demand across the board. As we all know, this has also been made more difficult due to the increasingly complex needs of patients spending longer on waiting lists than in the past.

General practices are also facing a huge financial challenge with the implementation of the new contract so it is more important than ever for us to work together to support each other across the whole of our health and care system.

With this in mind, we are keen to find new ways of bringing primary care and in particular general practice together so that as a system we have an agreed place to go to seek general practice input to ensure their voice is heard and can influence our decision making as early as possible when planning services. This way we won’t inadvertently make extra work for primary care, or base our decisions on incorrect assumptions. It will also provide a forum for support and for primary care to share ideas, and innovations. This is a work in progress but I hope this will be in place over the next few months.

Mental health

I was in Aylsham at a fantastic face to face primary care engagement event last month and our new children and young people (CYP) specialty advisor Dr Sarah-Jane Lang, gave such a great update on mental health I’d like to share that too.

For children and young people, we encourage a stepwise approach, with a focus on family, friends and school first, and so we now have 10 mental health support teams in schools to help CYP outside of formal health settings.

The Just One Norfolk website is also a fantastic resource for families, parents and carers. The newer FYI Norfolk website has been coproduced with young people, and that is designed for young people aged 11-24 to use themselves – please encourage families and CYP to use these free resources.

The youth charity MAP also provides support to young people aged 11-25 with staff, young people and supporters working together. Or, for those who prefer to keep it virtual Kooth online provides a free, safe anonymous place for young people aged 11-25 to find online support and counselling.

Families can also access support through seven family hubs where parents and carers of children from conception to 19 (25 for young people with special educational needs and/or disabilities) can get information, advice and guidance for the whole family including financial and mental health, parenting, feeding, infant relationship and parental wellbeing. You can find out more about these hubs here.

This range of support is available to all and it’s really important to encourage people to use these free resources for general support. But, they won’t suit everyone, and some people will clearly need more help. GPs are probably the very best placed people at providing the holistic, and whole family approach for a child or young person who is struggling. They can also make use of multiple additional roles depending on what is best for that individual. These do vary across our patch, but could include youth workers, enhanced recovery workers, mental health practitioners, social prescribers, health and wellbeing coaches, care coordinators, multidisciplinary and safeguarding meetings.

But, when further support is required beyond this, anybody can now submit a request for support, for children and young people aged 0-25 by using this link  https://www.justonenorfolk.nhs.uk/mhsupport. We’re keen to move away from this being a traditional “referral” and move instead to the national i-THRIVE model of shared decision making, needs led and proactive prevention and promotion.

So how does this work? The person will create an account and will then be able to fill out a request for support . Where possible our preference is for young people and/or their families to be empowered to complete the form themselves as this tends to provide the richest detail on what the current needs are, the impact this has on their life, any related risk and the young person’s voice in what support they would prefer.

The form for GPs is available via Ardens and integrated into the primary care systems – labelled Mental Health 0-25. The most up to date form, for GPs only, can also be found here:   Mental Health and LD. 

I’m afraid it is quite long, but remember that ideally the child or young person should be doing it themselves and if not, then the most important bit is the risk section, which the team need in order to prioritise the request. Such referral forms are definitely NOT compulsory, but they are particularly useful to help requests to be prioritised as accurately and as quickly as possible.  

The mental health triage team is hosted by Just One Norfolk. They will review the submitted information, gather any further information required, eg. by looking at clinical systems and or contacting the referrer or the child or young person or the family directly.

They will then match the young person to the offer that best meets their mental health need. This could include immediate advice and guidance, or connection with a specialist provider such as MAP, Ormiston Families or NSFT for example.

A notification should come out within five days so the child or young person, their family and their GP surgery all know what is happening, whoever it was that first filled in the form.

This is not a pathway for crisis – clinicians should call the relevant crisis number and families should call 111. This is also not a pathway for diagnosis of neurodiversity such as ADHD or Autism. But, I hope this service will make a huge difference for a lot of CYP and families across Norfolk and Waveney. Please do feedback on the service, as this is still quite new, and will continue to evolve over time.

While I was in Aylsham, I also popped into one of our five wellbeing hubs. The hubs provide a safe space for adults to get support for mental health and wellbeing. With a focus on wellness, not illness, there will always be a warm welcome and supportive staff to offer help, a listening ear or a route into more formal support programmes.

Veteran Health

Finally, a little on veterans. According to the 2021 census and council data, there are approximately 49,000 veterans living in Norfolk and Waveney, (5.2% of our population against a UK mean of 3.8%) with approximately 3000 currently serving. Many will have family and school-aged children also living on our patch, who may have particular challenges accessing healthcare, in particular when they are relocated around the country.

So, I am delighted to confirm that the ICB, our mental health trust, community trust and all three of our acute hospital trusts all have accredited veteran aware status.

The Royal College of General Practitioners (RCGP) also runs a Veteran Friendly Practice Accreditation Programme, launched in 2019. It aims to help practices to better identify, treat, and refer veterans, where appropriate, to dedicated NHS services. We are one of only four integrated care systems (ICSs) nationally to have a veteran friendly practice in every primary care network (PCN), and currently 80% of our surgeries have achieved this status which is great.

Take a look at this webpage for more information: https://improvinglivesnw.org.uk/our-work/working-better-together/supporting-armed-forces-and-veteran-healthcare/

Please do also signpost veterans, their families and carers to this link, which carries lots of additional information and links to support available.

But, if yours is one of the 25 practices which haven’t signed up yet, please use this link to apply and understand more about the benefits of this programme: https://elearning.rcgp.org.uk/course/view.php?id=803 or address informal queries to andy.griffiths3@nhs.net or andrew.hayward@doctors.org.uk. The sign-up process is usually undertaken by practice managers and takes just 20 minutes. This entitles practices to an information pack, with supplementary learning shared in a short newsletter on a quarterly basis. A clinical lead must be named for each practice, but the learning and support can be shared across the whole practice team – with social prescribing link workers ideally placed to play a key role in running this initiative.

A bumper issue this month – so thank you for staying with me, and reading to the end, and thank you as ever for all that you do.

Frankie