Enhanced Primary Care is for people who are deemed by their GP to need that little extra bit of support to stay well for longer. This may be because they have a long-term condition like diabetes or heart problems but could include other factors, such as they live with a carer who isn’t coping or they are isolated from friends and family. Most GPs and practices would like to offer this extra support as an ongoing service, but struggle because of the increasing day-to-day pressures they face.
Under Enhanced Primary Care, each ‘neighbourhood’ on the Fylde Coast benefits from a dedicated local team of professionals who keep in touch with patients and up-to-date on their condition. These ‘Neighbourhood care Teams’ also advise on how to access other proactive help in their local communities such as voluntary groups and services.
This community-based team consists of nurses, therapists, care co-coordinators and wellbeing support workers, plus other support staff, working together alongside local GPs to ensure that patients feel fully supported with their conditions and can stay as well as possible. The teams also form close links with existing mental health and social care services to make sure all of a patients’ needs are supported. However, the teams are not identical across all areas of the Fylde Coast as individual neighbourhoods require professionals with different skills to meet the needs of their local population.
People who would receive the support available from the Neighbourhood Care Teams include 42-year-old ‘Michael’. He has one major medical condition – diabetes – but also drinks too much alcohol which makes his condition more difficult to manage.
Rather than a ‘What is the matter?’ approach to treat Michael’s illness, the local team will instead proactively focus on ‘What matters most?’ to Michael for his wellbeing. By working very closely with him and his GP the team will make sure that Michael receives care that is personalised solely to him.
The local team will support Michael to self-care and effectively manage his condition so that he requires less contact with his GP and hospital care. The team will empower Michael to take more responsibility for his own health and wellbeing and understand the lifestyle choices which impact upon his health.
All of this should enable Michael to stay well for longer as he will be able to confidently manage his condition at home. When he does require specialist medical help it will ensure he does not need to see different professionals who he has to repeat his story to.