NEWS
21/06/2024
What is a Primary Care Network (PCN)?
Mendip Primary Care Network (PCN) is a collaboration between Beckington Family Practice, Mendip Country Practice, Grove House Surgery, Oakhill Surgery and Park Medical Practice who between them cover 38,115 registered patients. The PCN is not a legal entity but a collaboration between GP Surgeries that are working to provide proactive personalised, coordinated and more integrated health and social care for their community. PCN’s receive funding to expand the range and effectiveness of clinical and holistic patient centred service they offer.
How does this work in practice within Mendip PCN.
The Care Co-Ordination Hub is the best illustration of this within Mendip PCN. The Hub is a dedicated team of staff based in Shepton Mallet supporting our practices in their aim to provide personalised care to patients who need support. The Surgeries are however still the front line of Care and first point of contact for patients.
The Hub team consists of the following people:
| GP Complex Care Lead and GP Frailty Lead | • | 8 Care Coordinators |
| Complex Care Lead Nurse and Diabetes Lead nurse | • | 2 Home visiting Paramedics |
| Proactive Care Occupational Therapist and Proactive Care Nurse | • | 5 Health Coaches & Connectors |
| 3 Clinical Pharmacists and 2 Pharmacy Technicians | ||
The Hub expands the level and type of care and holistic support services on offer to our patients by linking with other agencies like Adult Social Care, District Nurses, Occupational Health and Physiotherapy. This helps promote and improve ongoing patient care and health while reducing the direct demand on GP Practices, preventing unnecessary admission to hospital. This releases capacity within the Surgeries for day to day, urgent and acute care needs of the community.
There are various aspects to the support the Hub provides as described below :
Hospital discharge follow up:
Adult patients recently discharged from hospital will be contacted by a Care Coordinator within 72hrs of returning home identifying any areas where they need additional support. This could be help with personal care or help in the home, needing equipment to support mobility and safety at home or social and financial support. They may need help to arrange transport to hospital appointments or have questions about their medication. The Hub can signpost or refer to people who can help.
The Proactive Care Team
This is a dedicated team involved in proactive and preventative care of the Frail and Elderly in our community and Care Homes. They identify and assess vulnerable and “at risk” patients and provide clinical and practical support to improve health and promote safety in the home environment thereby avoiding repeat hospital admissions and enhancing the patient’s quality of life.
Cancer Support
The Care Co-ordination Team provide a Cancer Support Pathway for patients referred for investigations and can provide further support if a cancer diagnosis is received. This can be practical help organising transport, referral to other organisations for financial advice or counselling support, or support with medications.
Pre-Diabetes and Diabetes Support
The Hub supports patients who are pre diabetic (HbA1c 42-47) by offering referral to the Diabetes Prevention Programme to inform and support those wishing to remain healthy and prevent progression to a Diabetes diagnosis. The Hub also runs new initiatives and support groups for those with Diabetes who are seeking to achieve remission of their condition through education, understanding and action. These groups are evolving and have proved highly successful and well attended so far. This work is also supported by the Health Connections Team who run various exercise and wellbeing groups.
The Pharmacy Team
In addition to supporting the Care Coordinators and the Proactive Care Team in their activities. The Pharmacy Team run other medication specific projects on behalf of the GP’s. The Team manages post discharge medicines reconciliation, checks medication is prescribed safely, monitors the effectiveness of medications and carries out monitoring of high-risk drugs. Our Clinical pharmacists carry out Medication Reviews with patients and work as part of the wider multi-disciplinary clinical team at Mendip PCN. The work of the Pharmacy Team frees time for more GP appointments and ensures safe and effective prescribing across our practices.
Health Connectors Team
The Health Connections team, the unsung heroes of Health and Wellbeing, work within the Care Coordination Hub.
They will accept referrals from Care Coordinators and GPs for holistic, practical and emotional help to support a patient’s health and wellbeing from trained health Coaches and importantly you can also self-refer into this service. You can see a Health Coach for one-to-one appointments, join one of their groups or find out about training and getting involved in your community. There is also a fantastic resource in the Online Directory for support and information in your area: Welcome to Health Connections Mendip - Health Connections
For more information and support in any of these areas you can contact The Care Co-ordination Hub on:
Tel: 01749 600379 Option 1
Email: somicb.mendipcomplexcarehub@nhs.net
12/06/2024
Dr. Henk Bruggers Introduces the NHS Type 2 Pathway to Remission Programme
Marie from Frome on achieving Type 2 diabetes remission with the NHS pathway programme
How to use the NHS App - YouTube
Click Here - How to use the NHS App
Research
Healthy Living Education Programme
Healthy Living is a free online NHS service for people living with type 2 diabetes. It provides knowledge and information that will support you to manage your condition.
It includes:
- Information about type 2 diabetes and its treatments;
- Advice on emotional and mental wellbeing;
- Advice with adopting and maintaining healthy behaviours with food and exercise.
For further information please visit: Healthy Living
Child Weight Management Service
NHS Low Calorie Diet
Health Connections Mendip
Health Connections Mendip supports the practice and our patients by providing free social prescribing and health coaching support. For more details and information about the groups they run and services they provide, please see the Health Connections website.
Domestic Abuse
Domestic abuse is much more common than people think and can affect anyone, presenting in a variety of ways. For help please visit Somerset Survivors or contact the practice.
Contact Us Online
The Park Medical Practice is embracing technology to improve patient care. Following our recent change to ask all patients to ‘contact us online’ where possible, we have received an overwhelming positive patient response, with some constructive feedback. Thank you for continuing to work with us in improving the service.
You will have noticed in the press the very high levels of demand across the NHS and reduced clinical staff levels nationally. We are in a very similar position to many parts of the country and have needed to review ways of trying to provide you with the best service we can despite the challenges the NHS is facing across the whole system. We are using a process that has worked very well in a lot of other parts of the country. Our aim is to improve our service to patients, ensuring patient care is delivered by the right person at the right time wherever possible. To make it easier and faster for patients to get help and to improve the efficiency of the practice.
The ‘contact us online’ service allows patients to outline their concern quickly and in their own words, uploading images if required.
When an admin query is completed, a member of the reception or administration team will review this.
When a medical request/query is completed, a doctor will review this.
When a patient has an urgent query or is unable to use the service online, please call the reception team who will be happy to assist to complete this over the phone.
Following a request form being submitted, the patient will be contacted by the practice to advise on the most suitable way we can help them.
As a practice we know that some of our patients do not have access to the internet or online options, and they are a very important group, so we need to ensure we can still support their needs and health. We recently communicated the above change by a text message, and we are very sorry to learn that in some cases this has been interpreted that patients could only ‘contact us online’. We sincerely apologise for any unnecessary anxiety that this has caused. We would like to make it very clear that this is not the case and whilst we encourage all our patient to ‘contact us online’, if this is not possible, please call us and we will assist you in the best way that we can. Our priority is to provide utmost care to all our patients no matter their health and care needs.
The Partners of the Park Medical Practice.
Getting the right care at the right time
We are committed to providing care from the best healthcare professional to our patients as quickly as possible.
To achieve this, our reception team will ask you a few questions about your health concern and may direct you to an alternative service if that gives you access to an appropriate healthcare professional in a quicker time.
See our Local Support Groups page for more details
Click here to see the Somerset Choose Well poster
NHS Waiting Times
Since the start of the Pandemic, the number of people waiting for NHS treatment in England has grown to 6.1 million – the highest level since comparable records began – and is expected to rise further as those who have missed out on care come forward.
The website www.myplannedcare.nhs.uk supports people waiting for a hospital appointment, operation, or treatment, and gives them advice and support while they wait. This includes access to average waiting times at their hospital.
All requests for NHS hospital treatment are graded by the relevant consultant team based on clinical need. If your symptoms have changed or if you are very concerned, please let us know and we will update your referral.
Patient Participation Group
If you are interested in joining the PPG or want to find out more information about what the Practice and the PPG are currently involved in please see the dedicated section of our website here: PPG
HANDi Mobile Applications:
Click for Apple Appstore or Google Playstore.
