1. Care navigation A new service for Camden’s frail and elderly population Sharleen Rudolf, Care Navigation Manager

2. Trained professionals who work within health and social care to make sure that patients get the care and support they need. In Camden, navigators will be focussed on supporting people to access community and voluntary sector services that help them to remain independent and well. Care navigators operate across a network of service providers. Who are care navigators?

3. Referral service for patients to non-traditional providers above the level of signposting volunteers. Dedicated support for practice and locality level multidisciplinary teams, providing advice, information and coordination across clinicians and voluntary sector / community services. Care coordination support for frail elderly and patients with long term conditions who are at risk of ‘did not attend’ (DNA) including escorting and/or use of inappropriate services. The functions of the service

4. Bloomsbury An example of the Hub and Spokes Model: Zone 2 GP practices St Phillips Holborn Medical Centre Museum Gray’s Inn Brunswick

5. Referrals from GP Care navigator Dedicated support and access to volunteers Improving the quality and coordination of care

6. Referrals from GP Care navigator Complex case management Dedicated support and access to volunteers Improving the quality and coordination of care

7. Referrals from GP Care navigator Complex case management Dedicated support and access to volunteers Home visits and follow up Improving the quality and coordination of care

8. Provision of a person-centred approach Identifying problems Setting individual goals Developing a personalised action plan

9. Working towards the improvement of outcomes Ability to look after myself My general confidence Keeping safe Managing my money Meeting people and doing things Ability to manage my home

10. Onwards referrals and follow up into voluntary and community services Housing and home safety (e.g. cleaning, handyman). Financial and legal advice. General advice and advocacy. Social and wellbeing. Preventative and health improvement (e.g. falls prevention classes). Mental health support. Carer support and assessment. Befriending. Transport.