Annual conference - Primary care networks in action

Primary care networks in action

Wednesday 9 October 2019

9.50 – 9.55 Welcome from morning theatre chair Professor James Kingsland OBE, NAPC National Primary Care Home Clinical Director

9.55 – 10.35 Eden Primary Care Home – an integrated care hub with primary care, community and adult social care services on one site

This session will explore how Eden Primary Care Home in Cumbria, one of NAPC’s initial primary care home rapid test sites, has broken down traditional professional boundaries and worked with patients and local communities to overcome challenges specific to the area. Eden covers the most sparsely populated area of the country, with the highest level of fuel poverty in England. Local hospitals are about one hour’s drive away for most patients. Covering a population of around 52,000 patients, Eden established an integrated care hub where community health teams, adult social care, Eden District Council and most local voluntary organisations are co-located within a local community hospital site. All these services are working effectively together for the first time to achieve the best possible outcomes for patients and local people


  • Dr Ashley Liston, GP Lead, Eden Primary Care Home (Integrated Care Community)
  • Vanessa Connor, Senior Integrated Care Community Manager, North Cumbria
  • Angie Reynolds, Integrated Community Care Manager/Clinical Nurse Lead, Cumbria Partnership NHS Foundation Trust
  • Gordon Barwick, Team Manager, Eden West Social Work Team, Cumbria County Council


Click here to download the slides from this session or here to listen to a recording.

10.45 – 11.25 Children’s rapid response service in Luton – reducing A&E admissions

This session will focus on a dedicated children’s rapid response team which was set up in Luton to reduce A&E admissions, minimise the length of time children spend in hospital and improve out of hospital care. The service was set up after a review found that six common acute conditions accounted for 85% of emergency activity involving children – respiratory problems, fever, diarrhoea and vomiting, accidental injuries (including head injury), abdominal pain and fits and fainting. Urgent care pathways for these conditions have been designed to guide local GPs and patients are now able to call NHS 111 and be referred directly to the team. During the session, data will be shared demonstrating how the service has led to improved patient care and reduced pressure on A&E, hospital paediatric teams and GPs.


  • Dr Uzma Sarwar, GP and Clinical Lead, Children’s Rapid Response Team, Luton CCG
  • Lynn Fanning, Children’s Community Nurse Practitioner, Cambridgeshire Community Services NHS Trust


Click here to download the slides from this session or here to listen to a recording.

11.35 – 12.15 Integrating community pharmacy services with primary care networks

This session will explore the challenges and opportunities around integrating community pharmacy with primary care networks. NAPC’ guide to community pharmacy integration within primary care homes shows what is possible for greater integration making greater use of pharmacists’ skills and taking a population management approach. We have seen primary care homes join forces with their community pharmacies on flu vaccination campaigns, develop an integrated approach to managing patients with long-term conditions and work together to reduce polypharmacy. The session will discuss how this learning can be applied across primary care networks and the NAPC’s next steps in supporting the drive for further community pharmacy integration in light of both the NHS Long Term Plan and the new community pharmacy contractual framework. Join the session to hear the approach being taken in Newham including their award winning pre-TB extended primary care service – a general practice and community pharmacy partnership with shared IT system to reduce rates of tuberculosis.

Panel includes:

  • Professor Ash Soni OBE, Vice President, International Pharmacy Federation (FIP), Assembly and English Pharmacy Board Member, Royal Pharmaceutical Society, NAPC Council Member
  • Dr Farzana Hussain, Clinical Director, Newham Central 1 PCN
  • Jignesh Patel, Pharmacist Independent Prescriber, Rohpharm Pharmacy


Click here to download the slides from this session or here to listen to a recording.

13.25 – 13.25 Welcome from afternoon theatre chair, Dr Johnny Marshall OBE, President, NAPC

13.30 – 14.10 Harmony and Health Singers (Healthier Fleetwood Primary Care Home)

The first Harmony and Health Singing Group started in 2017 with 10 people getting together to sing for fun as part of the Healthier Fleetwood community movement in Lancashire that was born a year earlier. Since then it’s taken off – there are now more than 200 members with four singing groups across four venues. The group is not a choir, it is all about having fun, making friends and feeling healthier and happier. Many members who felt isolated before and didn’t go out now attend regularly and new relationships and social groups have formed. Come and join the more than a dozen singers who’ve travelled to the conference to sing and tell their stories of how Healthier Fleetwood has empowered them to take control of their health and their lives. Warning this is an immersive session – you will be asked to join in!

Click here to listen to a recording.

14.20 – 15.00 Building resilience in mental health

Click here to listen to a recording.


15.10 – 15.50 Working with schools to improve young people’s mental health and well being

This session will explore the different ways in which two primary care homes are working in close partnership with their local community trusts and schools to support pupils with mental health problems. The South Coast Medical Group in Dorset runs GP sessions in local schools to help combat high levels of mental health problems among young people. Team Winsford (Winsford Care Community) in Cheshire funds a project which involves training education staff to spot mental health problems and make appropriate referrals.


  • Dr Shelley Carter, GP, South Coast Medical Group Primary Care Home
  • Dr Isi Sosa, GP and Safeguarding Lead, Dorset CCG
  • Tina Cookson, Clinical Lead, Team Winsford Primary Care Home (Winsford Care Community)
  • Ian Roberts, Team Manager, Winsford Child and Adolescent Mental Health Services
  • Nic Curran, Assistant Principal, Winsford Academy


Click here to download the slides from this session or here to listen to a recording.

16.00-16.40 Frome Primary Care Home – the story of a maturing PCN

This is the story of Frome Medical Practice which has pioneered an enhanced model of primary care. In 2013 it set out to improve patient care and improve the working lives of those working in health and social care. Recognising that many vulnerable and socially isolated people would benefit from support other than medical interventions, the Frome practice established a care coordination hub to provide a more holistic approach to care. Based in the practice’s state-of-the-art building, the hub houses more than 130 permanent health professionals, including 30 GPs, district nurses, health visitors, a pharmacy, opticians and operating theatre. Working in a collaborative holistic way and supporting patients to make their life worthwhile, Frome Medical Practice has seen a sharp drop in emergency admission and staff have been empowered to deliver healthcare they are proud of. Working with Health Connections Mendip and Frome Town Council, there are now 1,000 connectors encouraging patients to take control of their lives. Join the session to learn from one of the most mature primary care networks.

  • Dr Helen Kingston, GP and Senior Partner, Frome Medical Practice
  • Dr Rob Taylor, GP Partner, Frome Medical Practice
  • Dr Andy Millar, GP Partner, Frome Medical Practice
  • Jenny Hartnoll, Service Lead, Health Connections Mendip
  • Jo Fordham, link worker, Health Connections Mendip
  • Kathy Clark, Patient, East Mendip Primary Care Home


Click here to download the slides from this session and here to listen to a recording.

Thursday 10 October 2019

09.25 – 09.30 Welcome from morning theatre chair Dr Minesh Patel, NAPC Chair

Click here to listen this welcome.

09.30 – 10.10 Macmillan Cancer Support and NAPC – PCN’s role in delivering personalised care for people living with cancer

NAPC and Macmillan Cancer Support are working with a number of primary care home sites to enhance care and support for people living with cancer. The primary care home model has been seen to be particularly effective in providing enhanced and personalised cancer care because of its focus on team-based and integrated working across primary, community and secondary care. Primary care homes involved in this project have received specialist training from Macmillan and implemented Macmillan’s Quality Toolkit for Cancer Care in Primary Care and the ‘Right By You’ model – both of which aim to provide seamless and personalised care to cancer patients at primary care level. This session will provide an overview of the project from Macmillan and will include updates from St Austell Healthcare and Granta Primary Care Homes on how they introduced the project, the challenges they faced and lessons learnt.

  • Dr Rosie Loftus, Joint Chief Medical Officer, Macmillan Cancer Support
  • Sophia Nicola, Primary Care Advisor, Macmillan Cancer Support
  • Dr James McClure, GP, St Austell Healthcare Primary Care Home
  • Kelly Austin, Social Navigator, Granta Primary Care Home


Click here to download the slides from this session or here to listen to a recording.

10.20 – 11.00 Working with community trusts to improve the care of older patients

This session will explore how two primary care homes and networks are working in close partnership with their local community trusts and other organisations to improve the care of older people. Team BDP Primary Care Home works with the Cheshire and Wirral Partnership NHS Foundation Trust to reduce the length of hospital stays for older patients and provide rehabilitation in a local care home. Lakeside Stamford Primary Care Home works with a wide range of statutory and voluntary organisations in Lincolnshire to reduce the number of falls among older people. Falls resulting in serious injury are the most common cause of hospital admission in its catchment area.

Panel includes:

  • Dr Miles Langdon, Chief Medical Officer and GP partner at Lakeside Healthcare(Lakeside Stamford Primary Care Home)


Click here to download the slides from this session or here to listen to a recording.

11.10 – 11.50 Leadership in primary care networks

This session will outline how Northamptonshire Health and Care Partnership (STP) co-designed their 12-month leadership programme for clinical directors (CDs) including the approach they took and the importance they placed on it from the beginning. They will explain how they developed the programme alongside their key stakeholders including CDS, commissioners, the local medical committee (LMC) and the local community trust, and why investing early in the leadership development of CDs is vital to the success of PCNs and realising the vision of the NHS Long Term Plan


  • Catherine Wills, Workforce Programme Lead, Northamptonshire CCGs
  • Dr Sanjay Gadhia, GP and Chair of the Primary Care Workforce Group, Northamptonshire CCGs
  • Dr Naomi Caldwell, GP and Clinical Executive Director for Localities and Primary Care, Nene CCG


Click here to download the slides from this session or here to listen to a recording.

12.00 – 12.40 Beacon Medical Group Primary Care Home – multi-disciplinary team working in action

Bringing together new roles and scaling up an urgent care team for a primary care network can present a host of challenges. At Beacon Medical Group Primary Care Home, a practical multi-disciplinary team framework was developed by its advanced clinical practitioner – the first paramedic practitoner to work full time in primary care – to help the group tackle the high demand for appointments (more than 200 a day) and support its evolving and expanding urgent care team. As part of the framework, clear expectations were set for new emerging roles, the whole team (GPs, practice pharmacists, advanced paramedic practitioners, advanced nurse practitioners and a minor illness nurse) were involved in its development and time set aside for resilience, reflection and growth. The PCH championed its team members to patients and neighbouring practices. Additional training time enabled students including trainee pharmacists, paramedics and nurses to witness the team’s work and they now see the new model as offering a place to develop their careers in the future.


  • Simon Robinson, Advanced Paramedic Practitioner, Beacon Medical Group Primary Care Home
  • Robin Conibere, Practice Pharmacist, Beacon Medical Group Primary Care Home
  • Claire Oatway, Chief Operating Officer, Beacon Medical Group Primary Care Home

Click here to download the slides from this session or here to listen to a recording.

13.00 – 14.00  Diploma in Advanced Primary Care Management Presentation Ceremony

The ceremony celebrates the success of the latest primary care managers to complete the Diploma in Advanced Primary Care Management. They’re the third group to successfully complete the course and will receive their graduation certificates.The one-year diploma supports primary care managers within primary care networks to develop the skills and competencies for managing primary care at scale. The students have completed the course whilst working in demanding full time roles in primary care. Join us to help celebrate their achievements.

  • Hosted by Dr Minesh Patel, Chair, NAPC

Click here to listen to a recording.

14.10 – 14.50 Tackling the PCN estates’ challenge

As primary care networks (PCN) deliver the NHS Long Term Plan’s vision of more integrated care, local systems and PCNs are looking at the estate needed to deliver the these aims. Fully integrated community-based health care increasingly needs modern, customised and functional premises to provide extended ‘out-of-hospital’ services to meet the health needs of the local population. Current provision varies across areas and systems and there is a need to understand better how entire footprints can be used more effectively. The current primary care estate is often a block rather than an enabler to progress, as too many buildings are inadequate to allow PCNs to offer an increased number of services in a more accessible way for patients and improved communication between healthcare professionals and patients. Join this session to hear  how these challenges can be overcome and how a good estate strategy can have a positive impact and help realise the integrated care vision.


  • Dr Sue o’Connell, CEO, Community Health Partnerships
  • Simon Gould, Head of Development, Assura
  • Dr Miles Langdon, Lakeside Stamford Primary Care Home
  • John Pope, Chief Executive, NAPC (session chair)


Click here to download the slides from this session or here to listen to a recording.

1500 Replay of video address of Secretary of State for Health and Social Care Matt Hancock (pre-recorded)

Click here to view.