Our Primary Care Network builds on the current primary care services and enables a greater provision of proactive, personalised and more integrated health and social care. We are supported by practitioners in additional roles who allow us to build bespoke multi-disciplinary teams based on the needs of our local population. By working together with local community services, this allows us to make support available to people where it is most needed.
Our multi-disciplinary team
Care co-ordinators provide extra time, capacity, and expertise to support patients in preparing for clinical conversations or in follow-up discussions with primary care professionals. They work closely with the GPs and other primary care colleagues within the PCN to identify and manage a caseload of identified patients, making sure that appropriate support is made available to them and their carers, and ensuring that their changing needs are addressed. They focus on the delivery of personalised care to reflect local PCN priorities, health inequalities or at-risk groups of patients. They can also support PCNs in the delivery of Enhanced Health in Care Homes.
Our care co-ordinators are: Denisa Marc, Emma Watts, Jenny Velasco, Lynn Chandler, Rajal Parekh and Sarah Callaghan.
Clinical pharmacists work in primary care as part of a multi-disciplinary team in a patient-facing role to clinically assess and treat patients using expert knowledge of medicines for specific disease areas. They work with and alongside the general practice team, taking responsibility for patients with chronic diseases and undertaking clinical medication reviews to proactively manage people with complex medication use, especially for the elderly, people in care homes and those with multiple conditions.
Our clinical pharmacists are: Aleeza Khan and Fabio Macedo.
Find out more about clinical pharmacists in general practice.
Dietitians are healthcare professionals that diagnose and treat diet and nutritional problems, both at an individual patient-level and wider public health-level. They work with adults in a variety of settings, including primary care, to support changes to food intake to address diabetes, food allergies, coeliac disease, and metabolic diseases. Dietitians also translate public health and scientific research on food, health, and disease into practical guidance to enable people to make appropriate lifestyle and food choices.
Our dietitians are: Cleverly Fong and Sarah Heuten.
To find out more about the role of a dietitian in primary care, visit the Health Education England website.
First contact physiotherapists (FCP) are qualified independent clinical practitioners who can assess, diagnose, treat, and manage musculoskeletal (MSK) problems and undifferentiated conditions and, where appropriate, discharge a person without a medical referral. FCPs working in this role can be accessed directly by patients, or staff in GP practices can refer patients to them to establish a rapid and accurate diagnosis and management plan to streamline pathways of care.
Our first contact physiotherapists are: Areeba Qureshi, Deborah Milne and Lisa Marshall.
Find out more about first contact physiotherapists.
Health coaches will predominantly use health coaching skills to support people to develop the knowledge, skills, and confidence to become active participants in their care so that they can reach their own health and wellbeing goals. They may also provide access to self-management education, peer support and social prescribing.
Health coaches will support people to self-identify existing issues and encourage proactive prevention of new and existing illnesses. This approach is based on using strong communication and negotiation skills and supports personal choice and positive risk taking.
They will work alongside people to coach and motivate them through multiple sessions, supporting them to identify their needs, set goals, and help them to implement their personalised health and care plan.
Our health coach is: Alison Warner (Leacroft Medical Practice).
Find our more about health and wellbeing coaches.
Our mental health support co-ordinators work with patients who are experiencing depression, anxiety, low self-esteem, stress or low-level mental health problems. Over the course of up to six one-to-one sessions, they will work on creating a personalised support plan, catering to the care needed for each patient and advise on appropriate signposting to local organisations in the community.
Our mental health support co-ordinators are: Ambar Hussain and Savi Jayaweera, supported by the mental health practitioner Jaroslaw Kochan.
A paramedic in primary care can recognise and manage the deteriorating patient and can manage patients with long-term conditions, minor injuries, and minor illness. They can also support patients who require wound care, have fallen, have MSK problems, and have urinary tract or respiratory infections. Paramedics can supply a range of medicines through PGDs, including antibiotics and analgesics.
Paramedics can support PCNs in responding to on-the-day demand by offering telephone triage or undertaking home visiting. They can also support PCNs to improve access to care by seeing minor ailments and injuries in surgery. Paramedics can support PCNs with the delivery of Enhanced Health in Care Homes and overall their intervention should reduce the need for admission to hospital.
Our paramedics are: Amealia Burridge and Vicky Keats
Social prescribing link workers give people time and focus on what matters to the person as identified in their care and support plan. They connect people to community groups and agencies for practical and emotional support and offer a holistic approach to health and wellbeing, hence the name ‘social prescribing’.
Social prescribing enables patients referred by general practice, pharmacies, multi-disciplinary teams, hospital discharge teams, allied health professionals, fire service, police, job centres, social care services, housing associations and voluntary, community and social enterprise (VCSE) organisations to get the right care.
Link workers typically work with people over 6-12 contacts (including phone calls and face-to-face meetings) over a three-month period with a typical caseload of up to 250 people, depending on the complexity of people’s needs.
Our social prescribing link workers are: Anna Pooley and Jenny Glen, led by Tracy Olckers.