Neighbourhood Multi-Disciplinary Groups

A neighbourhood Multi-disciplinary Group, or MDG, is a group of health care workers and social care professionals who unite as a team to ensure the planning and implementation of person-centred care and its delivery for individuals who require support.

The groups include:

  • A GP
  • Practice Nurse/Advanced Nurse Practitioner
  • Social Work Advanced Practitioner
  • Community Nurse
  • Mental Health Professionals
  • Administrator
  • Consultant Geriatrician

The focus of an MDG is to review and problem solve complex cases, provide plans and anticipate care needs for those using health and social care services.

Each person discussed will be allocated a named Care Coordinator. For those patients classed at level two – needs some help – this is likely to be their GP or Practice Nurse. This will be the person responsible for coordinating their care and ensuring their discussion at the MDGs as required.

However, for those people who are level three – needs some more help – the Care Coordinator is more likely to be a District Nurse or Social Care representative.

Adults discussed at the MDGs will be those who are using some form of health and social care services or registered with a GP. There may be some adults within the ‘able’ level who will not fall into either of these categories and therefore may not be allocated a Care Coordinator.

At the point where they enter the health and social care system, they may then be taken forward to MDG meetings and a Care Coordinator will be allocated.

There are set triggers that may activate an MDG discussion or the completion of a shared care plan. This plan will be stored electronically so each person involved in the individual’s health and social care, will be able to easily access the plan as needed. A copy will also be kept at the individual’s home so they can easily view and share with others as required.

The triggers include:

  • Those who live alone
  • People showing signs of a low mood, anxiety or depression, or those who are socially isolated
  • People who suffer from multiple long term conditions, for example asthma, diabetes, heart disease
  • Anyone who begins to use health and social care services more often
  • Those who are providing or receiving care

The Multi-disciplinary Groups goal is to help older people in Salford achieve greater independence and improved wellbeing, by integrating care within communities.

This will allow adults to receive coordinated, high-quality care from an increased range of services when they are needed and help to make sure that people will be seen by the right person, at the right time, in the right place.