Supporting Primary Care Networks and Local Integration

 Our teams work with the Clinical Directors of our 5 Primary Care Networks (PCNs) and local partners and patients to support and develop initiatives to transform and integrate services to improve the health and wellbeing of the local population.

What have we done so far?

• My Care My Way is a local West London initiative that supports the health and wellbeing of those aged over 65. Developed in partnership with patients, it is a pioneering collaboration of services, and the result is better-co-ordinated care that meets the individual needs of older people

• The local multidisciplinary team are in place across West London for people with complex needs. These aim to develop clever solutions and improve care between patients and carers, NHS, third sector and social care services. We have multidisciplinary teams for:

  • Frail older people

  • People living with mental health problems

  • Children

•  We have an expert team of “social prescribers” working in West London who link patients to non-clinical services designed to support people with a wide range of social, emotional, or practical needs.

Where now?

• Data and research to truly understand the needs of our local populations and the areas of focus for our local health and care organisations.

• Tackling health inequalities locally and employing additional staff to support practices and to improve the well-being of our patients, e.g., mental health hubs

• Expanding local services to support patients living with Diabetes and Cardiovascular conditions

• A new integrated care centre at Violet Melchett clinic focussing on health and wellbeing will bring together a range of clinical and non-clinical services to benefit residents and patients

• Expand the St Charles Centre development for health and wellbeing as a resource for the local community