Who works for the team?

The Community Health and Wellbeing Team is a community based team consisting of:

  • district nurses
  • advanced care planning nurse specialists
  • mental health workers
  • occupational therapists
  • physiotherapists
  • GPs
  • pharmacists
  • social workers
  • Care and Repair
  • Wellbeing Coordinators based at Interlink

The team operates across Merthyr Tydfil and RCT in the following clusters:

  • Rhondda
  • Cynon Valley
  • Merthyr Tydfil
  • Taff Ely

 

How does the service work?

Referral
The patient will be referred to the service by their GP or another trained professional, who will notify the Community Health and Wellbeing team on their behalf. Sometimes members of the Community Health and Wellbeing team will also refer a patient they may be working with who they think may benefit from the service. 

First contact
A member of the Community Health and Wellbeing Team will then contact the patient  by telephone to arrange an appointment or simply to discuss their health and social care needs over the phone. There may be a short waiting time, which the patient will be informed about when they are referred. 

If we identify a health need that sits outside our team, such as speech and language support, we will also refer to the right person.

Care plan
The team will work with the patient to develop an individual care plan which aims to best meet their needs.

Questionnaires
During their care, the patient may be asked to answer some simple questions about their health and wellbeing, or even about their experience of the services. This is really important as it helps the team to measure how effective their service is at helping the patient to meet their goals and will help the team to improve their services in future.

Mrs Jones, Merthyr:

"The team are delightful and provided me with marvellous results. I remain in pain but the zimmer frame and caddy enable me to move within my property with the items that I need. Thank you so much for your input. "

Mr Davies, Taff Ely:

‘We couldn’t have asked for better help and advice. All support is greatly appreciated. We developed an excellent rapport with the Occupational Therapist."

Dr Lucy Downing, GP Lead, Rhondda & Taff Ely:

"Patients' lives have been transformed by regaining their independence following support from the team.

They receive help to improve their mobility, are provided with equipment to make living at home easier, offered assistance with managing their medicines, given advice on what financial support may be available and much more."

Share your experiences of the Community Health and Wellbeing team with us

We strive to improve quality through continuous listening, learning and improvement from patient feedback. Therefore, we would love to hear from you about your experiences. Please tell us how the Community Health and Wellbeing Team helped you or someone you know. Additionally, if you have any concerns, It is important that you tell us as soon as possible so that we can look into this and work to improve our services in the future.