Our Support

The purpose of the Primary Care Network is to facilitate close working between a group of practices to provide integrated services to the local population. This is achieved across the following roles (click the titles to read more):

  • Co-ordinates the work of the PCN and provides leadership.

  • Carry out a wide range of activities including, medication reviews, leading on changes on prescribing across the patient population, offering prescribing advice to prescribers in the practice, ensuring patient safety when they are transferred between care providers through reconciliation of prescribed medicine.

    https://www.youtube.com/watch?v=mtPlTyV5YsE

  • Undertake patient reviews to ensure effective medicines use, through shared decision-making conversations with patients. Carry out medicine optimisation tasks including effective medicine administration, e.g. checking inhaler technique, supporting medication reviews and medicines reconciliation. Take a central role in the clinical aspects of shared care protocols and liaising with specialist pharmacists for more complex patients.

  • Undertake patient-centred interviews and provide a range of evidence-based psychological interventions including guided self-help based on cognitive behavioural therapy, counselling for depression, couple therapy for depression, brief dynamic interpersonal therapy, interpersonal psychotherapy for depression, online psychological treatment programmes and psychoeducational groups and workshops.

    https://www.youtube.com/watch?v=-itZrsCkT0w

  • Assess, diagnose, triage, and manage patients, taking responsibility for the management of a complex caseload.

  • Proactively identify and work with a cohort of people to support their personalised care requirements, using the available decision support aids. Bring together all a person’s identified care and support needs and explore their options to meet these into a single personalised care and support plan.

  • Carry out a wide range of activities, including identifying unmet needs; especially for the frail and vulnerable, those at risk of hospital admission, loss of independence or those coming toward the end of their lives. Referring patients to appropriate VCS (voluntary, community and social enterprise) services.

    https://www.youtube.com/watch?v=Iyr5FRdiKv8

  • A GP assistant is a support role in primary care that helps doctors with administrative and basic clinical tasks. GP assistants work as part of a multi-disciplinary team and contribute to the smooth running of the surgery and the patient experience. Some of the tasks that GP assistants may perform include:

    • Booking appointments

    • Taking blood samples

    • Measuring blood pressure

    • Updating patient records

    • Ordering prescriptions

Early Cancer Diagnosis

We are seeking to improve referrals to specialists and screening uptake by:

  • Improving referral processes for suspected cancers, with a focus on safety processes, ensuring that all patients receive information on their referral

  • Contributing to improving local uptake of National Cancer Screening Programmes

  • Supporting the delivery of these through engagement with the hospital and community services

Medication Review and Optimisation

Structured Medicine Reviews (SMRs) are an evidence-based and comprehensive review of a patient’s medication, taking into consideration all aspects of their health. In a structured medication review, clinicians and patients work as equal partners to understand the balance between the benefits and risks of and alternatives of taking medicines.

Enhanced Access

From 1st October 2022 the PCN will be facilitating the provision of enhanced access appointments between 6:30am and 8:00pm Monday to Friday and 9:00am to 5:00pm on a Saturday. A range of clinic types will be offered covering chronic disease and routine health care, delivered through face to face, telephone and video.

Care Homes Focus

We deliver weekly ward round to Care Homes within the PCN and using the Multi-Disciplinary Team arrangements, we develop and refresh personalised care plans.

PCN Training Coordinator

We have recently appointed a Training coordinator to support the training and development of the staff across all the practices within the PCN.

AskMyGP

This digital first triage solution launched at Ranworth Surgery. 78% of patients saying this system is better than our previous triage system. Around 80% of all requests coming in via online platform. Some quotes from patients:

  • I like the new system as it suits me and I like the ease of using the technology

  • Much better than sitting on hold on the phone and risking possibly not getting appointment. Very good

  • So much better than hanging around on the phone for ages trying to get an appointment!! Well done Ranworth for putting an effective system in place!

Respiratory Consultant

We are being supported by a consultant working on site 1 day a month to see complex patients and support clinicians with the aim to reduce hospital admissions over winter. 

Frailty Project

We are working with the Hospital Trust on a frailty outreach project to see patients in the community. This is done with the aim of bringing secondary care into primary care and savings unnecessary trips to the hospital.

PCN Diabetes Lead

Our PCN Diabetes lead is overseeing and managing diabetes care across a PCN as we have one of the highest prevalence in the area.

CYP Counsellor

Based on site our Childrens and Young person’s Counsellor is providing additional support to complex patients who would otherwise have to wait for external support e.g. CAMHS/Community Paediatrics

GP Assistants

We have employed a team of General Practice Assistants (GPAs) reducing practice workload and freeing up GP capacity.

Reducing Inequalities Project

We have been working with Tendring Community Voluntary Services on outreach clinics for baby immunisations in areas of poor uptake and deprivation.

Appt Health

We have implemented software to enable automated text messaging booking for flu clinics, saving several admin hours and modernising general practice through technology.

Heart Failure Audit

We have engaged with a GP Cardiology specialist to review and improve our Heart Failure registers, increasing the level of care these patients.