Hereford Medical Group Primary Care Network

 

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Primary Care Networks

Since the NHS was created in 1948, the population has grown and people are living longer. Many people are living with long term conditions such as diabetes and heart disease or suffer with mental health issues and may need to access their local health services more often.

To meet these needs, GP practices are working together with community, mental health, social care, pharmacy, hospital and voluntary services in their local areas in groups of practices known as primary care networks (PCNs).

PCNs build on existing primary care services and enable greater provision of proactive, personalised, coordinated and more integrated health and social care for people close to home. Clinicians describe this as a change from reactively providing appointments to proactively caring for the people and communities they serve.

PCNs build on existing primary care services and enable greater provision of proactive, personalised, coordinated and more integrated health and social care for people close to home. Clinicians describe this as a change from reactively providing appointments to proactively caring for the people and communities they serve.

Due to HMG’s size we were able to form a Primary Care Network.

Each of the 1,250 PCNs across England are based on GP registered patient lists, typically serving natural communities of between 30,000 to 50,000 people (with some flexibility). They are small enough to provide the personal care valued by both people and GPs, but large enough to have impact and economies of scale through better collaboration between GP practices and others in the local health and social care system.

PCNs are led by clinical directors who may be a GP, general practice nurse, clinical pharmacist or other clinical profession working in general practice.

 

Achievements in 2020/2021

  • Worked closely with Wargrave, Belmont and Cantilupe PCN and Herefordshire Council and Vennture to reach homeless and extremely vulnerable city residents.
  • Set up dedicated Covid-19 vaccination service. Provision of this service for 26,000 patients. Working in partnership with Herefordshire PCNs to respond to the challenges of delivering this unprecedented vaccination programme.
  • Moved into a new purpose-built premises during a global pandemic, and using the space in creative and unplanned ways to ensure our patients continue to receive the highest level of care that we are able to provide.
  • Successful recruitment to multiple Additional Roles (ARRS), eg care coordinators, pharmacy technician, social prescriber and and Advanced Practitioner to lead our Enhancing Health in Care Homes work.
  • New ways of working more collaboratively with PCN partners to provide a more joined up service for our patients, including in areas of mental health, First Contact Physiotherapy and Community Pharmacy.
  • Closer working with the 16 care homes with HMG PCN.
 

Focus for the next year

  • Improving continuity of care
  • Restoring services following the pandemic and vaccination programme delivery
  • Building on our use of IT systems and data to improve patient pathways and professional communication
  • Proactive identification of further vulnerable groups of patients and working with partners to care for them with a personalised care approach
 

Key roles within the PCN

  • PCN clinical directors: Dr Erica Sibley and Advanced Nurse Practitioner Kerry Mills
  • PCN Development Manager: Currently out to advert 

Physiotherapy and First Contact Practioners (FCP) in General Practice. This video feature Claire Strickland, a Physiotherapist who works with HMG in a FCP role

 

Sources