Integrated Care

Changes to the way health and care services are planned and delivered

Over recent years, the way health and care services are planned and delivered has been changing to better meet our health and care needs. On 1 July 2022, the new ways of working will be formally established with the creation of 42 statutory integrated care systems.

Integrated care systems are local partnerships made up of all the public services that provide health and care in your local area - the NHS, GPs, local councils and the community, voluntary and social enterprise sector.

Each includes an integrated care board and an integrated care partnership. Together they plan how best to deliver these services to meet the needs of local people. Clinical commissioning groups (CCGs) will be closed down and their relevant legal functions will transfer to integrated care boards.

These new ways of working will help deliver important priorities including addressing the COVID backlogs, improving access to primary and urgent care and tackling health inequalities. You can find out more by visiting the integrated care section of NHS England's website.

Updated:  29/12/2022

Integrated care logo

Social Prescribing and Care Coordination

Social Prescribing    

Each Practice within the PCN, has their own Social Prescriber who will work with patients who have social problems and issues.  These can include debt, benefits advice, housing, social isolation, domestic abuse, employment or any other social issues which may be affecting their quality of life.

Social prescribers will speak with the patient either at the GP practice or in their own home and support them to identify and prioritise any issues.  They will then work with them to ensure they receive the correct level of support and ensure this is put into place.

What is Social Prescribing

Care Coordination      

Each Practice within the PCN, has their own assigned Care Coordinator who can work closely with staff to identify and support patients.

Care Coordinators will work with patients with complex or long term health conditions.  These patients may need assistance to coordinate their care e.g.; if they have multiple appointments and are struggling to manage them or to find transport to attend.

Your Care Coordinator will carry out a personalised holistic assessment of the patient and can assist with identifying care needs.  The patient may need a care needs assessment from social services or they may be struggling to manage around the house.  They may have concerns around their memory or be having problems with incontinence.  The care coordinator can assist in integrating health and social care and ensure the right care is provided at the right time.

Your Care Coordinator can also work with unpaid carers and family members of patients with Long Term Conditions (LTC) or complex needs.  Carers are often not aware of the support that is available to them and benefit greatly from the Care Coordinator service.


  • Under the age of 18
  • Recent self-harm or suicidal ideas or intent (within last 3 months)
  • Severe mental health problems or those under secondary care mental health services. (dementia patients accepted)

If you feel you would benefit from the support we can offer, please ask at or telephone Reception and request a referral. 

Added:  08/12/2021

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