Primary Care Network (PCN)

Southwest PCN Team:

We work together with other local surgery’s Westfield Road, Parkside and Bedford Street. This is called a Primary Care Network, by working together we hope to achieve health improvements for our patients at a larger scale. Our network currently employs a variety of staff which include:

Social Prescriber:

A social prescriber delivers a high standard of patient care, working collaboratively with the Primary Care Network members to meet the needs of patients and supporting the practices.

Social Prescribing helps people connect with services, support, and activities in the local community to improve their health and wellbeing

The service is open to adults over the age of 18 for whom non-medical interventions may be particularly effective in reducing demand for health services, generally where poor health is being caused by social isolation, lifestyle, or other underlying issues.

Pharmacist:

Pharmacists are qualified experts in medicines, and can help our patients in a range of ways. This includes carrying out structured medication reviews for patients with on-going health problems, advice for those on multiple medicines and improving patient safety and outcomes through a person-centred approach. Counselling patients to improve understanding of their medication and improve compliance. We develop and work on projects across the network; this means we can share best practice across the network, learn and develop better ways of working and pass on the knowledge.

Mental Health Worker:

This is a Primary Care led service for non-urgent wellbeing/mental health care for adults registered within the South West PCN.

The purpose is to offer assessment and support for patients with non-urgent mild to moderate mental health needs including signposting or referral on to other services.

Integrated Community Support Team (ICST) :

The Integrated Community Support Team (ICST) delivers personalised physical health and social care assessment to all over 18s from the PCN.

ICST assesses patients/families that have: Multiple unplanned hospital admissions; Frequent user of GP services; Frailty and Isolation; New medication education, compliance, sourcing medication; Recently discharged from hospital and not managing well; Support with promoting independence; Struggling carer/family: Struggling around the house with mobility, function, personal care.

The aim of the service is to promote independence, improve quality of life and reduce GP app and hospitalisations.

Under 18s, mental health and addictions is not covered by the service.

Physician Associate:

A Physician Associate can assess and manage certain acute and chronic conditions (e.g. BP, diabetes checks and NHS health checks).

Provide patients with advice and counselling on health promotion, disease prevention and analyse results of diagnostic tests. Able to take bloods, ECG, and interpretation of results. Evaluate the effectiveness of care management plans etc.

First Contact Physio:

To provide high level decision-making and clinical-reasoning skills to assess, diagnose and triage a multitude of patients. To provide a treatment care plan for the patient which is tailored to their individual needs. Educate the patient of their condition and set them exercises accordingly. Provide them with advice on how to manage their pain levels to help them function on a day-to-day basis and provide treatment if it is appropriate. In the event that the first contact physio can nothelp the patient they will signpost/refer them to the appropriate services.

Health & Wellbeing Coaches:

  • Reduce health inequalities.
  • Long term conditions
  • at risk of developing a long-term condition
  • providing support for issues such as weight management, managing chronic pain, or living with depression or anxiety.
  • Prescribing lifestyle support (movement, reducing blood pressure and falls prevention). The focus will be on providing group and one to one support to our patients.
  • Empower people with the knowledge to make positive lifestyle changes in their everyday lives to be happier, healthier and more balanced.
  • Health coaching, motivational interviewing and behaviour change skills to empower people to make positive changes.
  • Our health and wellbeing coaches also work together to do regular groups to help improve fitness and well-being.

Dietician

As a dietitian, the priority is to promote good dietary health and treat nutritional problems by providing practical advice about food choices and dietary pattern, based on scientific research.

Our dietitians experience encompasses nutrition support; dysphagia; diabetes; functional bowel disorder; allergy and intolerance; cardiovascular health; liver and renal; weight management and bariatric surgery; pregnancy; paediatrics.