Aim and Purposes
Frome Market Health Hub (FMHH) is partnered with Somerset NHS Foundation Trust (SFT) to facilitate the provision of health screening clinics for farmers, their families and agricultural workers who visit Frome Livestock Market, with the broad aim of improving patient’s health. In addition to the services provided by NHS partnership, FMHH also provides regular podiatry care, free of charge to visitors to the Livestock Market and other health services when appropriate (e.g. as a pop-up COVID vaccinations centre).
It makes sense to locate the health hub at the livestock market which is both an important social and business centre for the farming community. Through FMHH, the NHS is able to reach a group of rural patients who find it most difficult to access traditional health services.
Objectives and Activities
The chief objective of health screening is to detect potential serious mental and physical illness, before it becomes burdensome for either patients or the NHS. While NHS nurses and mental health nurses are funded by Somerset NHS Foundation Trust (SFT), FMHH organisation provides two treatment rooms and a dedicated reception area at the market, has purchased special items of equipment, and organised all marketing and communications materials to promote the health hub to the public. Having received a grant from Somerset Community Foundation, FMHH has funded the services and equipment to run twice-monthly podiatry clinics, also free of charge to patients.
Achievements and Performance
After a year in planning from March 2020 to 2021, during which the COVID 19 pandemic prevented the FMHH clinics from moving forward, in May 2021 the provision of NHS funded nurses and mental health nurses was approved by Somerset NHS Care Commissioning Group (CCG), on a one-year pilot basis. This approval ignited the operational organisation of the health service provision for the health hub, a process that took the NHS five months to complete and which included the successful recruitment of nursing, receptionists and mental health professionals to run FMHH clinics at the market. Staff availability, as the country came out of lockdown, was sometimes patchy resulting in occasional cancellations of Wednesday clinics and perhaps this lack of continuity and the fact the NHS clinic was only open one morning each month at the beginning, meant that farmers took a while to take advantage of the services offered. The first FMHH clinic took place on October 13[th] 2021. At the same
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time, starting from October 2021, FMHH set up and has been running very successful podiatry clinics, twice monthly.
Following launch of the clinics at the livestock market in October 2021 up to the 30[th] March 22 year end, approximately 35 patients (men and women of mixed ages) have been seen by nurses and the mental health team and a further 17 podiatry patients have been seen and had repeat follow up treatments. NHS clinics were operating just once a month during the period and the clinic was cancelled altogether in two months due to staff shortages and illness. The pandemic’s effect was still in evidence and furthermore, the livestock market’s restaurant – the social hub of the market – was also closed. For this reason, the numbers visiting the health hub clinics in this period, were higher than we, the organisers, had expected. The nursing role is to provide basic health screening tests which can be referred to the patient’s own GP with patients’ approval. These tests include blood checks for raised blood pressure, raised glucose levels and raised cholesterol, weight and smoking and alcohol consumption advice and nurses can provide or change dressings. A questionnaire tool is used for prostate cancer initial screening and other areas of concern, such as skin conditions are also referred on. Nursing staff are not providing a diagnostic service but if a patient presents with a particular concern then nurses can often offer reassurances that ease anxiety or refer them to their GPs. Essentially, nurses play a critical role in listening to their patients, frequently referring them to the mental health practitioners at the Health Hub for further conversation with Talking Therapists.
The podiatry clinic has done much to draw in farmers who can be reluctant to visit a nurse. Patients in the podiatry clinic are very often referred to the NHS clinic for blood tests when the podiatrist recognises from her patients’ feet, symptoms of broader underlying health issues such as high blood pressure, diabetes, ulcers, rheumatoid arthritis, atrial fibrillation, plantar fasciitis – etc. Patients wishing to see the podiatrist are advised to book an appointment – as opposed to the drop-in availability of the nursing clinics. This is because podiatry treatments usually take longer and many patients need repeat treatments, and there are only 5 treatment sessions in the time available.
Financial Overview
In the founding year (2020-21) the organisation received a grant from Somerset Community Foundation of £5000, which at the start of the period April 2021 to year end March 2022 had gained £1.25 in bank interest. This opening balance of £5001.25 remained untouched until the health clinics were able to open in October 2021. Further donations have been received adding £731.98 during the year and a small amount of bank interest of £1.37 received in the period.
There was one extraordinary expense for the purchase of a special reclining podiatry chair costing £207.98 and from October 2021 to the year end, bank charges of £1.30 were subtracted from the organisation’s account.
From October 2021 to the year end, the organisation made regular payments to our freelance podiatrist who charges a set fee of £160 for a morning’s clinic. The podiatrist invoices the organisation monthly and the total usually, but not always, covers two morning sessions each month, i.e. £320.00 per month.
At the year end, after payment of a podiatry invoice dated 30th March 2022 but paid in early April, the organisation has £3925.41, in the bank.
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Reserve Policy
As the NHS clinics are subject to CCG funding renewal after the first year of clinics (i.e. October 2021 to September 2022), it does not seem sensible, or necessary to apply for further grant donations until such time as there is confirmation that the NHS partnership will continue. The payment of podiatry fees (not more that £3,840 p.a) is the organisation’s single outgoing and the practitioner is not under contract but self-employed. The organisation’s policy therefore is not to hold a reserve but to seek further funds from grants or donations when there is confirmation from the CCG that the NHS clinics will continue into 2023.
When required FMHH has been assured of a further grant allowance from SCF and other donors have been identified. An application will be made in good time, before funds are needed.
The first outgoings in the year 2021 – 22 are to the podiatrist and one or two small expenses as above and detailed in the accounts. The organisation has reported back to SCF, thanking them for their support and has received back a promise of further funds being available to the organisation if and when needed. Other donations have been received, as detailed in the accounts.
Volunteers
Throughout the, year the organisation has been supported by NHS Mendips Health Connectors who have sent representatives to the livestock market, regularly, to help build awareness of the health hub clinics and encourage potential patients to visit. The Health Hub is also greatly assisted by the very welcome presence at the market of the Market Chaplain and Farming Community Network (FCN) volunteers, all of whom are known by our target audience.
The organisation is extremely grateful to all our trustees who have been generous with their time and skills. In particular, the organisation has benefited greatly from the advice and production of marketing and communications materials supplied free of charge by Mole Valley Farmers Ltd, all free of charge. The organisation could not function without the livestock market’s space set aside to facilitate two treatment rooms in a reception area withing their office suite and the weekly advertisements for the health hub on their own website. Financial accounts and advice are given freely by Old Mill Accountants, for which the organisation is most grateful.
Structure Governance and Management
The partnership of NHS with FMHH is a fine example of a public body working alongside the voluntary sector for public benefit. The founding trustees were approached, on the basis of individual skill sets. Our Chairman is a retired farmer with extensive farming knowledge and excellent ‘soft’ skills in relating to farmers’ lifestyles and stresses. A Deputy Lieutenant of Somerset with extensive experience in mental health in the county, accepted the invitation to become a trustee and has been a driving force in outlining the key areas where the organisation can have most impact. We asked the partner who heads the rural side of a large accountancy firm to be our finance advisor; the livestock market manager, who is on site and both willing and able to manage the site requirements of the health hub staff, is a trustee and key day-to-day contact with the administrator; a senior member of Mole Valley Farmers Ltd who understands the needs of farmers and is able to communicate through the MVF newsletters; a livestock auctioneer who is in touch with Young Farmers and who communicates well with them, served as a trustee for the first year but has since moved away and is no longer listed; a senior partner of Cooper & Tanner (Land Agents) based at the market
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and is a specialist in estate management and the affairs of farmers in general is a founding trustee; and the Chairman of Frome Livestock Auctioneers (FLA) and retired senior partner of Cooper & Tanner, who’s wide experience in voluntary service and who’s great source of common sense guidance was greatly valued, sadly died in December 2021. Finally, the writer is trustee administrator for the organisation. The board works extremely well together and has been supportive and constructive throughout the process of bringing the health hub to life. The governing document outlines a rotational arrangement at 2-, 3- and 5-year intervals. Having lost two of the founding trustees during the second year of the organisation, there is no need to rotate this year.
Administrative Information
Frome Market Health Hub is situated at Frome Livestock Market, Standerwick, BA11 2QB. The administrative contact for all correspondence is: Mrs Diana Bourne, of Yarnfield Cottage, Maiden Bradley, Warminster, BA12 7HY.
Finance Officer: Mr Andrew Vickery, Head of Rural, Old Mill Accountants, Malltravers House, Petters Way, Yeovil, BA20 1SH
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Financial Statement forthe Yearended 31x March 2022 Frome Market Health Hub Financial Statements for the year ended 31 March 2022 Totsl Total 2021 2022 RECEIPTS AND PAYMENTS ACCOUNT Receipts Receipts from donors Bank interest received 731.98 1.37 5,000.00 1.25 Totsl receipts 733.35 5,001.25 Payments Podiatry chair Podiatrist Bank charges 207.89 1.280. 1.30 Total payments 1,489.19 Net surplusl{deficitl for year (755.841 5,001.25 83nk current and deposit accounts at l April 2021 Bank current and deposit accounts at 31 March 2022 5.C(11.25 4,245.41 S,1.25 STATEMENT OF ASSEfs AND UABILMES Assets Cash Funds Bank current account 4,245.41 5,(KJl.25 Liabilities Podiatrist Bank charges Net Assets at 31 March 2022 320.00 o.io 3.925.31 5,001.25 The financial statements for the year were approved by the trustees on Zi signed on their behalf by- Martin Brown Chaimian and Trustee Andrew Wickery Finance Officer and Trustee