- Blood Pressure @Home
- Care Coordinator Services
- Clinical Pharmacists services
- CVD Prevention Programme
- Enhanced Access
- First Contact Physiotherapy (FCP) Service
- GP Assistant services
- GP Services
- Holly Health
- Mental Health Services
- Severe Mental Illness Health Care Assistant (SMI HCA) services
- Sleepstation
- Social Prescribing
A blood pressure test is a simple way of checking if someone’s blood pressure is too high or too low. Home blood pressure monitoring enables patients with hypertension to measure and share their blood pressure readings with their GP from their home.
Our service called Blood Pressure @Home, provides active support to patients with high blood pressure and helps them manage their condition from the comfort of their own home.
We invite you to contact your GP practice to get your free blood pressure monitor, which will enable you to monitor your blood pressure regularly. This will help you keep track of your readings more accurately, and allow your clinician to make better informed decisions about the management of your condition.
Take control of your health by using this new service, and help us to support you better in managing your high blood pressure.
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.
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.
Heart and circulatory disease, also known as cardiovascular disease or CVD can often largely be prevented by leading a healthy lifestyle, for example stopping smoking, reducing alcohol intake, maintaining a healthy diet and exercising regularly. Spotting risk factors early reduces the chance of developing potentially life-threatening conditions, including heart attacks, stroke and dementia.
We are actively trying to support our patients who may be at risk of developing CVD; therefore, these patients will be contacted by text by their practices and invited to take part in a free CVD Prevention Programme called the “Prevention Decathlon”.
Surbiton and Chessington PCNS offers extended hours from Monday to Friday, 6:30-8:00 pm, and on Saturdays from 9:00 am to 5:00 pm.
During Monday to Friday, appointments with GPs are available either face-to-face or by phone.
Every Saturday, we provide blood tests, smears, dressings, and stitch removal appointments.
The Enhanced Access service is designed to better support our patients by increasing access to primary care services throughout the week.
Our First Contact Physiotherapy (FCP) Service will allow patients to receive input from an expert in the first instance. First contact physiotherapists are advanced physiotherapists who are clinically competent to manage and treat musculoskeletal problems which means you may not need to see a GP.
The specialist physiotherapist can assess you and suggest the most appropriate way to help you. They can also give you advice about any further investigations or treatment you may need and refer you to other services.
Our First Contact Physiotherapy Service will be able to see people with the following conditions:
- Joint pain
- Shoulder pain
- Tendon problems
- Muscle pain
- Sports injuries
- Knee problems
- Neck pain
- Soft tissue injuries
- Tennis elbow
- Back pain
- Osteoarthritis
- Trapped nerve
- Sciatica
Our First Contact Physiotherapy Service will be available for patients of all practices within our PCN.
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.
Our PCN has recruited additional GPs who work across all our practices, helping to increase the number of GP appointments available. This ensures patients have better access to timely and accessible healthcare.
Surbiton and Chessington PCNs are introducing Holly Health, an app designed for health and habit coaching, to adult patients diagnosed with severe mental illness (SMI) who are managed under primary care, meaning their SMI conditions do not require hospital support.
Our PCN has collaborated with Holly Health to provide our patients with a complimentary 12-month habit coaching program, designed to enhance sleep, exercise, nutrition, and mental well-being. This app can be an additional resource to help improve your physical and mental health. To learn more about your eligibility for the Holly Health App, please contact your GP Practice, or contact us directly, and a member of our team will respond promptly.
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.
The role of a 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, 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.
Do you have problems sleeping?
If restless nights are becoming a regular thing, you’re not alone — and you don’t have to manage it on your own.
Sleepstation is a new NHS-approved service now offered to our patients, providing expert support for those experiencing sleep issues, including insomnia. You’ll be paired with a dedicated sleep coach who will guide you with personalised advice, all from the comfort of your own home.
And there is no need to see a GP, you can self-refer! To begin, please visit:
https://app.sleepstation.org.uk/nhs/register
To get started, make sure you select your registered surgery by searching for its postcode.
The role of social prescribers is to help patients with social concerns explore suitable opportunities for support that may help them with their particular queries.
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