Patients Benefit from New Ways of Working in Dudley

People in Dudley are benefiting from a new and unique service from a team called Integrated Plus.

Integrated Plus is a service delivered by Dudley Council Voluntary Service (DCVS) as part of a new way of working in Dudley CCG under the banner ‘All Together Better Partnership’.

All Together Better brings together health and social staff to work together in teams led by local GPs to offer a whole range of care and support wrapped around the people who need it the most. Integrated Plus, Locality Link Officers form a vital part of these collaborative teams called a Multi-Disciplinary Team (MDT).

The most vulnerable people in Dudley are being helped by Locality Link Officers to address underlying reasons for their health and wellbeing problems and to help them connect back to their communities.

Integrated Plus works with people aged 16 and over who frequently present at their GP practice or other medical service, and people at high risk of hospital admission.

Ivan Carter is one of the first people in the area to benefit from a referral to this team.

After losing his wife to cancer Ivan required regular appointments with his GP. Ivan was experiencing stress, depression, anxiety and frequent falls due to his disability, and also felt unsafe in his own home. Unable to solve some of these issues Ivan was referred to Integrated Plus. After being allocated a Locality Link Officer Ivan was given support to address his health problems and gain access to local support and activities in order to improve his daily life and reduce the effects of loneliness and isolation.


The team explored a multitude of ways to help Ivan that resulted in securing new housing accommodation and linking him into community activities and services like Age UK’s Springboard Project and The Whitehouse Cancer Support.

Ivan is now an active member of his new community and can be described as someone who has moved from being dependant and isolated to someone who is activated in his own community and able to give support to others, Ivan says;

“I feel safer now, really secure. The Integrated Plus service is fantastic – although my GP had tried to help I was getting nowhere. They is someone to turn to when you feel you have no one and I can’t thank the Link Officer enough. Since he came on the scene it’s all gone one way, and that’s up. He made me aware of places I didn’t even know existed and I dread to think what my situation would be if he hadn’t helped me. If I can give a mark to represent his support it would be 10 out of 10, he has given me a lot of backing. I’m really chuffed”.

Terry Gee, Locality Link Officer, Dudley Council Voluntary Service (DCVS), said; “Ivan is a patient that fell through the net and wasn’t sure who to turn to for the help he needed. He was regularly having falls in his home and having to see a mental health practitioner due to quite serious low mood and depression. With just a few phone calls it was quite simple to ensure he felt safe in his own home and get him on his way to living in accommodation that is more suitable and appropriate to his physical and mental health needs.

Many more people in Dudley have benefited from this service. The Link Officers are representing the voluntary sector at all 46 practice Multi-Disciplinary Team meetings across the borough and have received over 1000 referrals so far.

You can find out more about All Together Better Dudley and how you get involved at

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