South Staffordshire Staying Well Pathway Pilot

Descriptions

NHS South East Staffordshire and Seisdon Peninsula, NHS Cannock Chase and NHS Stafford and Surrounds CCGs wish to commission the delivery, coordination and operational management of a staying well pathway extended pilot.This service will be offered on the basis of direct referral of patients with mild to moderate frailty registered with a participating practice the above CCGs. The aims and objectives of the staying well services extended pilot project is to deliver a safe and effective pathway and a multi-disciplinary team (MDT) based service which enables service users to avoid hospital admissions.The overarching aims, and objectives are to:— enhance the patient pathway by effectively assessing, referring and managing patients within the most appropriate setting,— provide fast, timely access to assessment, treatment and care,— prevent avoidable hospital attendance and admission,— contribute appropriate data to monitor impact of the service.