Neighbourhood Teams Excellence award for Spen Valley programme supporting frail patients
A new programme to support frail patients has claimed a national award.
The Spen Primary Care Network (PCN) has been announced as the winner of the Neighbourhood Teams Excellence award at the SystmOne GP Excellence Awards.
The prestigious award, voted by SystmOne users, follows a presentation on the PCN’s work with GPs, patients and service providers.
One in eight of the patients in the PCN has a frailty diagnosis, with the network engaging with patients to understand more about what affects their health.
The PCN then collaborated with each of its seven practices to create a tailored patient list and a multidisciplinary team to look holistically at how they can improve the health and care of patients who would benefit most from this approach.
The engagement process found mental health and social care issues were central to improving the quality of life for these patients in addition to GP-led support, physiotherapy, rehabilitation, personalised care plans and medication reviews.
Dr Danielle Nimmons, academic GP at Liversedge Medical Centre, PCN clinical director and the lead clinician behind the project, said: “Everyone is so happy. It is validation that what we are doing is good. It’s beneficial seeing the providers working well together. We all feel equal in what we bring to this work, and we all have a voice.
“Each partner is an expert in their field, and it is empowering them to improve the lives of our patients.
“We’ve seen positive results within just six months, and we are looking to roll this out across all the PCNs in North Kirklees. I can even see this approach being adopted in other areas of West Yorkshire or maybe even further afield.”