High Peak Neighbourhood and Team Up welcome Dr Kathy McLean visit

TEAMS working together to deliver community care in the High Peak welcomed Integrated Care Board Chair Dr Kathy McLean to the Cavendish Hospital in Buxton to explain how they have been bringing care for patients closer to home.

The High Peak Neighbourhood Alliance and the Team Up Home Visiting team hosted Dr McLean’s latest visit to see frontline NHS work in Derby and Derbyshire. The Alliance told Dr McLean how local relationships meant they were able to reduce pressure on the hospitals by developing routes to deliver more care in the community.

The challenges discussed include transport problems for people living two hours away from the hospitals, working across boundaries, and pockets of deprivation such as the issues in Gamesley.

They also have higher rates for specific cancers in some areas. The opportunities included how the well-formed relationships in the area could solve many problems, reduce duplication and help people stay at home for care.

She then visited the Team Up Home Visiting Team, which is co-located on site, and helps older people who are often housebound, to get timely care without going into hospital. Doctors, nurses, social prescribers and pharmacists sit together and discuss cases referred to them from health and care professionals across the High Peak.

Dr McLean said: “It’s always fascinating to get into communities and see the work going on at the heart of the NHS and its partners. Witnessing the co-located hub in Buxton at the Cavendish Hospital just shows that when teams have the right conditions to work together it doesn’t matter which organisation they come from. The nurses, doctors, social prescribers and many more at the Cavendish have found a way to understand their patients, identify those who need care at home and get them what they need in a timely way.

“This neighbourhood model of working is the future vision described in the Government’s Ten Year Plan. We are a trail blazer in Derby and Derbyshire and I look forward to seeing what continues to develop over the next few years. “

Representatives from High Peak CVS, Blythe House Hospice, Connex Community Support, the County Council adult social care team, Derbyshire Community Health Services, the Active Partners Trust, the public health locality lead and the Integrated Care Board Place team attended the visit as part of the Alliance.

Dr Debbie Austin, High Peak GP and Chair of the Alliance said: “We are here to create a platform that allows us to work in a more integrated way alongside our communities to improve the High Peak population’s health and well-being. Our aim is to respect each other as equal partners and to work with the collective belief that we are stronger together.

“It was a delight to welcome Dr McLean and describe our local work as we are an area of innovation always trying to find the next way to improve care using our local relationships. This is why we have been able to go further faster on some of the key areas for neighbourhoods including the local navigation hubs and Team Up.

Team Up Derbyshire is a programme to integrate neighbourhood teams from General Practice (Home Visiting), Community Health and Social Care, Mental Health, Local Authority and Voluntary and Charity organisations across Derby and Derbyshire. The programme uses additional capacity to enable this integration and to build the infrastructure for ongoing and increasing integration. 

A core offer of Team Up is the Home visiting service (also known as the urgent community response service). This provides crisis response care within two hours of referral and reablement care (support to help people live at home) within two days of referral.

There are four components of this urgent community response service. These are:

• Home visiting services – whereby people are being visited at home by a range of different health and care professionals – overseen by the primary care networks
• Rapid response nursing and therapy services – provided by Derbyshire Community Health Services
• Adult social care rapid response services – provided by local authorities and increasingly being integrated with NHS services
• Falls prevention and falls recovery services – which are being expanded across the city and county under Team Up.

In 2025/26 the service has been asked to support those with broader complex needs whether they are housebound or not, as part of the national journey towards Integrated Neighbourhood Teams, and alongside further development of Local Navigation Hubs.

Dr McLean is attending a series of visits to ensure community work is understood by the Integrated Care Board and factored into commissioning decision-making.