Severe Mental Illness (SMI) Outreach SDF Funding Plan in Northamptonshire

Description

NHS Northamptonshire Integrated Care Board (ICB) have awarded services under a Pilot arrangement for a period of 12months as part of the Severe Mental Illness (SMI) Outreach model. This contract is awarded as a grant agreement.

The SMI Outreach model includes the following:

o A dedicated team, comprising physical health nurses, smoking cessation advisors and health & wellbeing coaches.
o Engaging with GP practices to identify the top 20% of non-responding SMI patients (this equates to c.960 SMI patients in Northamptonshire, per year).
o Mobile testing equipment to allow a comprehensive physical health check in any location across the system.
o Smoking cessation advice, where applicable, including awareness-raising around smoking risks for SMI patients and access to Nicotine Replacement Therapies or local authority smoking cessation services.
o Adapted de-briefing sessions to explain the result of the health check including lifestyle and behaviour recommendations.
o Up to 6-week health and wellbeing coaching delivered by Peer Support Worker - to include community navigation, resolve access barriers and support new habit formation.

The provider will support:
o formation and mobilisation of a peripatetic team, including a clinical/ non-clinical skill mix that support the delivery of a comprehensive physical health check
o support relationships with GP practices in Northamptonshire or the East Midlands region
o work closely with Primary Care to ensure the Ardens SMI Health Check template is completed (in full) on both System 1 and EMIS clinical records, and in a way that ensure the health check is visibly completed on the Ardens Manager Platform
o mobilise equipment and facilities to deliver all aspects of the health check across a range of community locations, including within the patient's home.
o enable access to dedicated awareness-raising, advice, guidance and support for smoking cessation.
o enable access to focused debriefing, in which patients who receive a health check can be given opportunities to discuss the outcomes, clarify their understanding, and fully comprehend the recommendations for follow-up intervention.
o enable access to person-centred, needs-led guided support and intervention to bring about lifestyle and behaviour change
o work within the financial envelope of £202,000 per annum