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.

Our PCN staff work and share their time between ourselves, The White Horse Medical Practice, and our Primary Care Network site, Botley Medical Practice.

Physician associates are healthcare professionals with a generalist medical education, who work alongside doctors providing medical care as an integral part of the multidisciplinary team. Physician associates are dependent practitioners who can work autonomously, but always under the supervision of a fully trained and experienced doctor. They bring new talent add to the skill mix within teams, providing a stable, generalist section of the workforce which can help ease the workforce pressures that the NHS currently faces.

Clinical pharmacists are increasingly working as part of general practice teams. They are highly qualified experts in medicines and can help people in a range of ways. This includes carrying out structured medication reviews for patients with ongoing health problems and improving patient safety, outcomes and value through a person-centred approach. Clinical pharmacists work as part of the general practice team to improve value and outcomes from medicines and consult with and treat patients directly. This includes providing extra help to manage long-term conditions, advice for those on multiple medicines and better access to health checks. The role is pivotal to improving the quality of care and ensuring patient safety.

The role of a Social Prescriber is non-medical. Social Prescribers can connect people to community groups and statutory services for practical and emotional support and are able to give people time, focusing on 'what matters to me' and taking a holistic approach to people's health and wellbeing.

The reasons a person might be referred to a Social Prescriber are many and varied; ranging from low mood to thinking about stopping smoking, queries about benefits to food bank vouchers, loneliness, bereavement, social isolation, losing weight, carer stress – and many more besides.

In her spare time Sarah really enjoys spending time with her family and friends. She also loves running, walking and baking and going out in her campervan.

Primary Care Wellbeing Workers take a person-centred approach in the delivery of one-to-one sessions for people who are experiencing mental health issues or other social or lifestyle issues that are impacting on their wellbeing. The support provided aims to encourage and enable people to link in with existing support services, use the support available in their local community, and develop tools to increase their ability to manage their own wellbeing.

The role of a Mental Health Nurse is to build effective relationships with patients who use mental health services and also their relatives or carers, whether that's helping them to take their medication correctly, or advising about relevant therapies or social activities.

A Care Coordinator assists patients with navigating the health and care system and making the appropriate connections with the right teams at the right time. 

In addition to supporting people in becoming more involved in their own care and health, they are skilled at assessing people's changing needs. 

In particular, they are effective for patients with chronic conditions, multiple chronic conditions, and those with frailty or those at risk of frailty. These patients need support to stay well. However, they are not limited to those groups of patients.

A care coordinator can also bring together multidisciplinary teams to support people with complex health and care needs.

HN’s Clinical Coaches are all experienced registered healthcare professionals who help patients to develop knowledge about their conditions, medications and the confidence to safely self-manage where appropriate. This is designed to increase patients’ independence, reduce their anxieties and enhance health outcomes. The coaching takes place over the phone, daily to start with, or at a frequency the patient prefers. Some patients have experienced life-changing impacts as a result of clinical coaching. More information about HN's Clinical Coaching can be found on the Health Navigator website (www.hn-company.co.uk).