Our integrated community teams (ICTs) bring together community nurses, occupational therapists, physiotherapists, social workers and reablement workers to work as one team to serve a local area.
These teams work alongside GPs to provide care for people in their place of residence or in the community.
They also work with the ward teams based in our seven community hospitals across Gloucestershire, and with our countywide specialist services, voluntary organisations and other care providers to provide assessments, treatment and support for people within the community. We have teams based in Gloucester, Stroud, Cheltenham, north and south Cotswolds, Tewkesbury and the Forest of Dean.
Who do we support?
Our integrated community teams combine services provided by the NHS and Gloucestershire County Council. We provide support for over-18s who are eligible for social care through the county council or who are registered with a Gloucestershire GP. Services are also provided to younger people in “transition” to adult services (16-18 yrs).
The type and range of support provided by the teams is targeted to meet the individual needs, of patients and carers/family.
What sort of support do we provide?
Support generally falls into one of the following categories:
- Services that can be provided quickly and safely in a person’s own home
- A short period of intensive support - such as reablement - to maximise independence. This is provided in an integrated way using the relevant skills of the team as well as, where appropriate, additional support through external care teams
- Support and encouragement to enable self-management and maintenance of long term health and social care needs
- Support and care for people nearing the end of their lives
Communication Journal Information Sheet
The communication journal is a paper record kept in your home while you receive care. The journal is a way for you, your family, your carers and other agencies providing support can keep up-to-date.
Even with the move to electronic records, it is important to provide information in your home so that all involved in your care are kept informed. Not all care providers will be able to access the same electronic record and will need to be aware of certain things, such as medication changes. It also means that you and your family can record questions or concerns that can then be dealt with by your carers.
What to expect from a home visit
All team members visiting your home should:
- Wear identification badges which confirm who they are and where they are from
- Introduce themselves to you and provide details of how to get in contact when you first meet
- Ensure that when and how often they come to see you is based on your care needs, the times of your treatments and how much support you need
- Regularly assess and review your goal plan with you and/or your carers
Working in partnership with Gloucestershire County Council
Having worked closely with colleagues in social care for many years, we have now integrated adult health and social care services and manage approximately 800 staff - social workers and re-ablement workers - on behalf of Gloucestershire County Council.
So although your reablement worker or social worker will be employed by Gloucestershire County Council, their role is managed by Gloucestershire Care Services NHS Trust within our integrated community teams.
How referrals are made
Referrals are accepted from:
- All health & social care professionals in primary care, community care and hospitals
- Voluntary organisations
- Out of hours GPs
- Ambulance Service
- Single Point of Clinical Access (for health professionals)
- Specialist services
- Family or carer
If you have a first enquiry about an Integrated Community Team for yourself or a member of your family, your GP is often the best person to advise you.
You can also contact the Adult Social Care Helpdesk, which is run by Gloucestershire County Council and advises on a range of issues. The Helpdesk is open 8am - 5pm, Monday - Friday and can be contacted on 01452 426868
When you are visited for the first time you will be provided with the name and contact details of your local integrated community team who will coordinate your care.
If you are a health professional with an enquiry about an Integrated Community Team, please contact the Single Point of Clinical Access (SPCA) for information.