Primary Care Network

Leicester City South Primary Care Network (PCN)

Quote / Testimonial:


“Supporting our communities, strengthening General Practice and working with our health care system partners to improve population health, personalise care and reduce health inequalities”

Leicester City South Primary Care Network are a collaboration of 5 GP practices in Leicester City:

Saffron Health
The Hedges Medical Centre
Sturdee Road Health and Wellbeing Centre
Inclusion Healthcare
Leicester City Assist Practice

We are working collaboratively with other local organisations to provide clear information about a range of health-related services available in the area.
Our surgery teams are working closely with each other, enjoying the ability to share expertise and resources, to develop new services.

Our vision is to continue to improve the quality of care that we provide in alignment with the need of our patient population.

What is a Primary Care Network?

Primary Care Networks are groups of GP practices working closely together – along with other healthcare staff and organisations – providing integrated services to the local population.

From the 1st of July 2019, all patients in England are covered by a Primary Care Network (PCN). A PCN is made up of neighbouring GP Practices who have decided to work together to provide and improve healthcare services in the local area.  The video to the left details what a Primary Care Network (PCN) has been designed to achieve.

Leicester City South PCN is a network of practices covering parts of Leicester city. The PCN consist of 5 GP practices in the South of the city who are working collaboratively with other local organisations to provide clear information about a range of health-related services available in the area, as well as providing national resources to enable you to learn more about your diagnosis.

We are working on delivering these key elements using a diverse team of health professionals:

  • Structured medicines review and optimisation
  • Enhanced health in care homes
  • Anticipatory care
  • Personalised care
  • Supporting early cancer diagnosis
  • Cardiovascular disease prevention and diagnosis
  • Tackling neighbourhood inequalities
  • Enhanced access

The video on the right details what a Primary Care Network has been designed to achieve.

PCN Roles

Expanding our workforce

The needs of our communities, in particular in areas where there are health inequalities, are greater than ever before. Our population is being impacted more and more by complex, long term conditions. There is a growing concern about areas of longstanding unmet health need and the social determinants of health are playing a bigger role than ever before. These new challenges are increasing the pressure on the system to deliver for those in our communities and there is more that we can do to shift our focus from treating those who are unwell to preventing ill health and tackling health inequalities.

The creation of Primary Care Networks (PCNs) builds on the core of current primary care services and enables a greater provision of proactive, personalised and more integrated health and social care. To support PCNs, the Additional Roles Reimbursement Scheme (ARRS) provides funding for 26,000 additional roles to create bespoke multi-disciplinary teams. Primary Care Networks assess the needs of their local population and, working with local community services, make support available to people where it is most needed.

Find out more on each of the ARRS roles provided through Leicester City South PCN below.

Clinical pharmacists work in primary care as part of a multidisciplinary 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.
Pharmacy technicians play an important role within general practice and complement the more clinical work of clinical pharmacists, through utilisation of their technical skillset. Working within primary care settings allows the pharmacy technician to apply their acquired pharmaceutical knowledge in tasks such as audits, discharge management, prescription issuing, and where appropriate, informing patients and other members of the Primary Care Network (PCN) workforce. Work is often under the direction of clinical pharmacists as part of the PCN pharmacy team.
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.
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 get the right care for them.

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.

Click here for more information on Social Prescribing
Mental Health Practitioners working in PCNs take on a ‘first contact’ role. The role involves liaison with practice clinicians, as well as liaison with secondary care, social workers and voluntary sector staff, where appropriate, and making best use of third sector and other community opportunities for promotion of patient wellbeing and maintenance of mental health.

Click here for more information on Mental Health
Care coordinators provide extra time, capacity, and expertise to support patients in preparing for clinical conversations or in following up discussions with primary care professionals. They work closely with the GPs and other primary care colleagues within the Primary Care Network (PCN) to identify and manage a caseload of identified patients, making sure that appropriate support is made available to them and their carers (if appropriate), 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.
The nursing associate is a new support role in England that bridges the gap between healthcare support workers and registered nurses to deliver hands-on, person-centred care. Nursing associates work with people of all ages in a variety of settings in health and social care, including general practice.
The paramedic is employed to support GPs to support and provide care for patients across the PCN. As they have a pre-hospital background, our paramedic is able to work with people with a variety of health conditions. They assist in managing patients coming out of hospital, working with our care homes to support patient care.

Mental Health

Leicester City South Primary Care Network is pleased to be able to offer a Mental Health Practitioner (MHP) service to the patients registered to one of our five network practices. We aim to build on the work our MHP is providing and look to increase the offer in the future.

Our MHP works across all five of the network practices and we would like to provide you with some information as to how this service may be able to support you. We have also included some useful links to other services available.

Who are Mental Health Practitioners (MHPs) and how can they help?

The MHP is a mental health professional who works within GP practices. They offer assessment and provide guidance and signposting for adults who are experiencing mental health difficulties.

Aim

The aim is to ensure that people who may be struggling with a change/deterioration in their mental health, receive a prompt, specialist mental health assessment. This is carried out locally within your own GP surgery. MHPs also provide guidance to learn how to self-manage difficulties or signpost/refer to appropriate support.

Who is this service for?

The service is available to anyone aged 18 years and older with a mental health concern who are not currently receiving treatment from NHS mental health services or are looking to step down from mental health services.

How can I make an appointment with the MHP at my GP surgery?

Please contact your surgery and ask how you can make an appointment with your MHP as appointments are offered on particular days depending on your registered surgery.

What can I expect from the MHP?

You will be offered an appointment with your MHP. It is preferred that this is face to face but we understand this is not always possible and alternative arrangements can be made.

At your appointment the MHP will assess your mental health needs. This appointment can last up to 30 minutes.

What next?

Following assessment, your MHP will offer appropriate further support. This can range from:

  • Signposting/referral to potentially useful online/self-help resources.
  • Referral or signpost to the most appropriate service, such as: NHS Adult Community Mental Health Services or a relevant third sector or voluntary organisation.
  • The MHP may ask you to return for a review appointment. This will be to further assess your needs and help you to manage your difficulties more effectively.

Should you wish to contact your allocated MHP between your appointments, please contact your GP surgery and leave a message.

Other sources of help

Leicester Partnership NHS Trust

Leicester Partnership NHS Trust also have a 24/7 Mental Health Centralised Access Point who can be contacted on 0808 800 3302.

They accept self-referrals. Your relatives and GP can also make referrals on your behalf if there are urgent concerns about your mental health.

Samaritans

Samaritans can be contacted 24/7 – Tel: 116 123.

Social services

Social services are available to help with social support.

They can be contacted on the following numbers:

  • Leicester City Social Services – 0116 454 1004
  • Leicestershire County Social Services – 0116 305 0004

Outside of normal working hours, the emergency duty team for both Leicester City and Leicestershire County social services is available on – 0116 255 1606.

Non-urgent advice: Emergencies

In any emergency, please remember to ring NHS 11 in the first instance or 999.

Social Prescribing

Social Prescribing connects people to community groups, activities and local services for practical and emotional support, information, and advice.

Social Prescribers give people time to focus on what matters to them and support you by looking at non-medical factors that are having an impact on your health and wellbeing, such as loneliness, isolation, financial concerns, housing issues, exercise/weight loss and life events (such as bereavement). They will listen to you and your circumstances and work together to find activities, organisations and opportunities that allow you to take control and improve your situation. These can include:

  • Social activities or groups
  • Learning a new skill or finding a new hobby
  • Help to cope with long-term conditions by getting involved with community activities
  • Finding advice and support with practical problems such as housing, benefits, or finances
  • Exploring volunteering or employment options
  • Being linked up to befriending schemes or support groups
  • Trying out activities that help improve physical and mental wellbeing, such as Community Gardens

The Social Prescribing service is available at all five of the network practices and is available to any registered patient aged 18 or over. You can be referred by your GP, nurse, a member of admin staff or you can refer yourself by contacting your practice reception. It can work for a wide range of people, including those:

  • With one or more long-term health condition(s)
  • Who need support with their mental health
  • Who are lonely or isolated
  • Who have complex social needs which affect their wellbeing

Your Social Prescriber will initially get in contact with you by telephone to arrange an appointment and will work with you at your own pace, usually up to 6 sessions.

What is social prescribing? | YouTube