What We Have Done


The Belper 5 Integrated Community Care project continues to progress. The GP practices now have Advanced Clinical Practitioners and Clinical Pharmacists in post. These new staff are at various stages of an induction programme and are becoming integrated members of the practice team. The Belper Project Board are undertaking a leadership development programme which has been extremely valuable supporting the group to continue to work positively together and seek new opportunities to develop collaboratively. These include health promotion and proactively managing patients who have a dementia diagnosis within the Belper area.


  • Belper 5 practices asked by CCG to test collaborative working

  • To work with each other, DCHS, the CCG and other partners as needed

  • To improve community healthcare services and integration between care providers

  • To improve equality of service provision to mobile, housebound and care home patients

  • To test the process of collaboration 


  • Regular meetings attended by a GP from each practice, and a DCHS and CCG representative

  • Project manager funded by CCG

  • Considered health needs of our population

  • Reviewed the strengths and differences between the 5 practices to identify areas to improve services

  • Build trust 


  • Agreed objectives and terms of reference

  • Enhanced Community Support Team

  • Change of Community Matron role

  • Additional Advanced Care Practitioners

  • Practice-based pharmacists

  • 12 months needed to evaluate impact?


  • Finding time

  • Building relationships

  • Agreeing shared goals

  • Understanding constraints

  • Managing change

  • Providers making spending decisions

What Have We Learned?

  • Collaboration is hard, even for willing participants

  • Collaboration takes a lot of time

  • Only collaborate to achieve something you cannot achieve alone

  • Honesty and openness are essential

  • Adequate resources are essential

  • It is ok to disagree

  • It is ok to change your mind