The CCG frailty team is continuing its work to integrate services across the borough for all frail and elderly people.
- Add patients at high risk of unplanned admission to the practice frailty register for co-ordinated case management.
- The locality MDTs now run regularly (see below). It's envisaged that the Locality meetings will soon transform into Neighbourhood-based meetings. GPs or practice nurses encouraged to visit and discuss patients.
- North Locality – every 4th Wed morning or lunchtime
- West Locality – every 4th Wed morning or lunchtime
- South Locality – every 3rd Wed lunchtime
- All referrals to the MDT should be sent before 4pm on the Tuesday before the meeting each week to firstname.lastname@example.org.
- Care navigators are available in practices, supporting vulnerable older people to get the right care.
- There are 4 education modules that can be completed – GP Education Frail & Elderly. Upon completion, a certificate will be issued.
For more information about prevention of falls, please refer to the Camden Integrated Network Checklist.
View the Presentations from the Frail & Elderly session on 22 September 2016.