What is a Primary Care Network?
A primary care network is a group of practices who work together to focus on local patient care. They’ve been around since 2019 and 99 per cent of practices across England now work as part of one.
With increased demand and a shortage of clinical staff, practices find they can provide greater, more personalised care for patients when they can work together on certain services or issues.
Take a look at this short animation from NHS England which explains how they work.
Who We Are
We are two PCNs covering some 65,000 patients:
Chessington & Surbiton PCN with five practices:
Surbiton Health Centre PCN with three practices:
The two PCNs work very closely together with common management aiming to provide a broader range of extended services. Our vision is to continue to improve the quality of care that we provide in alignment with the needs of our patient population. Because we are part of a PCN we can take advantage of additional staff roles that are now available to support all our patients. These additional roles help us to provide the right care at the right time from the right professional. You can also find further details on our services page.
In case you are wondering, Orchard Practice and Berrylands Surgery are part of another PCN (Churchill, Canbury, Orchard & Berrylands PCN).
Our Team
Dr Phil Moore
Clinical Director
Phil Chapman
PCN Manager
Physiotherapists
A First Contact Practitioner (FCP) is a physiotherapist professionally qualified to assess patients with soft tissue, muscle and joint pain without a referral from a GP and to decide on the most appropriate management pathway.
The role of an FCP is to work within GP surgeries and offer physiotherapy appointments for patients with MSK conditions. FCPs are highly experienced and able to assess, diagnose, and manage patients with MSK issues. In addition, the FCP Physio can order further examinations and refer to a range of different services.
Clinical Pharmacists
Clinical pharmacists work as part of general practice teams. They are highly qualified experts in medicines and can help people to manage long-term conditions, offer advice for those on multiple medicines and give better access to health checks. 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.
Pharmacy Technicians
Our Pharmacy technicians play an important role, complementing clinical pharmacists,
and other members of the PCN multi-disciplinary team.
Pharmacy technicians are different to clinical pharmacists and while they are not able to prescribe or make clinical decisions, they do work under supervision to ensure the effective and efficient use of medicines.
In the PCN, their core responsibilities cover clinical, technical, and administrative roles.
Care Coordinators
Our care coordinators work with patients and other healthcare professionals to make sure the patients receive organised and effective care.
They review patients’ needs, establish their healthcare goals and help patients access services and any support they need so they can understand and manage their own health and well-being. Our care coordinators focus on patients that are frail and elderly and with long-term conditions. The role involves significant communication with patients, their family members and various healthcare professionals.
Our care coordinators centre their attention on individual patients, meaning they can spend more time with a patient face-to-face in the practice, over the phone, or doing home visits where necessary.
Social Prescribers
The role of social prescribers is to help patients with social concerns to access a wide range of support services to help them with social, emotional and practical needs focusing on improving their mental and physical wellbeing and general health.
Social Prescribers can support patients to access help around:
- Housing, Finance, and Benefits
- Long Term Conditions
- General and Emotional Wellbeing
- Social Isolation and Integration
- Volunteering, Employment, and Learning
Social prescribers look at goal planning over a maximum of six sessions/contacts (phone, clinic appointment or, if indicated, home visit) and support patients in accessing suitable help where this is indicated. Social prescribers are ‘community connectors’ who help people out of their difficult social situations.
Our social prescribers receive referrals predominantly by email, but patients can also contact them via the Staywell website https://www.staywellservices.org.uk/ or by phone at 0208 942 8256.
Health and Wellbeing Coaches
Our MH Practitioners assist the PCN by providing advice and support within GP surgeries. They review patients presenting with mental health issues, consider a range of options regarding treatment interventions, provide patients with highly specialised advice concerning care when appropriate, and liaise with GPs and MH teams. The MHP offer brief interventions, e.g. problem-solving, decision-making, building resilience, building on personal strengths, risk de-escalation, medication advice and prescribing. If necessary, the MHP will refer or signpost the patients to more specialist services.
SMI (HCA) Team
The role of a Severe Mental Illness Health Care Assistant (SMI HCA) is to contact housebound or hard-to-engage patients and arrange a home visit suitable for the patient. The aim of the visits is to ensure that these patients are having an Annual Physical Health Check (APHC), in the comfort and familiarity of their own homes, ensuring the patients are compliant with medicine, and have no issues with medication or concerns with their overall health.
When the SMI HCA visits the patients, they are accompanied by either a Care Co-Ordinator or a Mental Health Practitioner, who is linked to the patient’s Surgery. If possible, the SMI HCA works closely with other teams and groups within the PCN to assist with meeting these additional needs.
PCN Administrators
As part of the broader team in general practice, GP Assistants (GPA) provide a support role, carrying out administrative tasks combined in some areas with basic clinical duties. They can help to free up GPs’ time and contribute to the smooth running of appointments, improving patients’ experience in the surgery and enabling the GP to focus on the patient.