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Monmouthshire South

 
Cluster Lead Dr Annabelle Holtam 

 

There are two Neighborhood Care Networks (NCNs) in Monmouthshire (North & South) with registered populations of 53,701 and 47,353 respectively.

General Practices in Monmouthshire South
There are five practices operating in the Monmouthshire South (NCN) Cluster area.

Gray Hill Surgery  (Caldicot Medical Group) 
Mount Pleasant Practice 
Town Gate Practice 
Vauxhall Surgery 
Wyedean Practice 

Individual Cluster Plans and Reports

Monmouthshire South NCN IMTP 2020-2023
Monmouthshire South NCN Plan on a Page 2020 / 2023
Monmouthshire South NCN Plan on a Page 2018-19
Monmouthshire South NCN Action Plan 2017 -20 Year 3
Monmouthshire South NCN Annual Report 2018 - 19 (Year 2) 

Cluster Profile

Monmouthshire as a whole has a total population of approximately 100,000 people residing across 850km2, divided into two Neighborhood Care Networks (NCNs), South and North. South Monmouthshire has a population of 47,353 (01.01.20 capitation report), a 0.2% upward shift since 2015. There are 5 GP Practices, 4 branch surgeries & an Integrated Health and Social Care team serving the populations of Chepstow, Caldicot and surrounding areas. The NCN borders Newport to the East and England to the West and as of 1st April 2019, there was a total of 6,206 people living in England registered with a South Monmouthshire GP.

The NCN has seen a 2.3% increase in population since 2017/18 and by 2036, it is projected that the number of people in Monmouthshire as a whole, aged 85 and over in Monmouthshire will increase by 147%, from approximately 13,000 in 2011, to 32,0002. Further population growth is anticipated with new housing developments planned in Monmouthshire and the Forest of Dean, enhanced by the removal of the Severn Bridge toll in December 2018.

Monmouthshire has for many years had perceived affluence, which can mask differences within and between communities. Wages in 2017/18 were some 10% below the UK average and only marginally above the Wales average. Some 34% of our working population were commuting out of county to earn a living1. We face many challenges as highlighted previously, especially around building resilient and sustainable community and primary care services. Our Health and Social Care system is stretched with new challenges in terms of difficulties in recruiting staff. We rely on Third Sector services to offer a range of support and these relationships are key when trying to deliver our three key priorities.

In terms of organisational structure, local governance and strategic links, the NCN is aligned to Aneurin Bevan University Health Board’s Clinical Futures and Care Closer to Home strategies, Monmouthshire Integrated Services Partnership Board (ISPB), the Greater Gwent Regional Partnership Board (GGRPB), and also The Well-being of Future Generations (Wales) and Health & Social Services Well-Being (Wales) Acts.
Sources: 1The Well-Being of Future Generations (Wales) Act – Monmouthshire County Council Well-Being Assessment 2017/ 2Monmouthshire SS&WBA Needs Assessment
https://www.monmouthshire.gov.uk/app/uploads/2017/10/Population_Needs_Assessment_Final.pdf

What we are working on?

The NCN has agreed 3 key priorities which underpins its 2020-23 Integrated Medium Term Plan (IMTP):

  • Delivering Care Closer to Home
  • Tackling loneliness and social isolation
  • Building sustainable Primary care in the face of a growing population
What we have already done

​Undertaken a comprehensive needs assessment to inform our IMTP priorities over the next 3 years.

Future Priorities
  • Continue to ensure NCN development plans reflect local need;
  • Continue to work in partnership with Primary & Secondary Care, Third Sector and local populations to support the delivery of the Care Closer to Home strategy;
  • Continue to work with GP Practices to understand issues with sustainability and identify & maximise areas for cross-practice working;
  • Continue to commit NCN funding to test new schemes/ services linked to NCN Plan priorities.