During the PHMDP PHM was used to identify the severely and moderately  frail to provide personal plans by frailty practitioners – this was for around 12 months before Covid hit and showed improvements to quality of life for those patients as was successful (Sara would expand on this)

 

During the worst of the pandemic the team then used a PHM approach to identify the clinically vulnerable and those that are shielding to links with volunteers that could help with food and medication and made links with Health Champions

 

Post lockdown the approach was then used to identify those coming out of shielding frail and at risk of falls to intervene before any unplanned admissions and provide proactive support. They have introduced falls buddies and a carousel clinic and links to social prescribers