Ageing Well Team

The team consists of, occupational therapists, community matron, physiotherapist, and care coordinators. They aim to provide a multidisciplinary team approach for patients with mild/moderate frailty, dementia, and those experiencing mental health decline. They will provide a comprehensive assessment for patients who are housebound or would benefit from a home visit to identify their health and social care needs.

The service aims to keep people with frailty needs, as well as possible in their own homes, and maximising quality of life. By providing a reactive and proactive approach to care, they aim to reduce GP pressure.  We anticipate that between 1-3 visits will be required which will allow time to carry out a detailed assessment, deliver interventions, make onward referrals, and signpost to appropriate services.

Patients will be referred into the team by a Doctor or Practice Nurse.

Service provided in association with Woodsley & Holt Park Primary Care Network