Proactive Care

NHS Greater Manchester Integrated Care (NHSGM) and Greater Manchester Primary Care Provider Board (GMPCB) have partnered with the national CLEAR programme and Peak Health Coaching to provide a support package for twenty PCNs in Greater Manchester to develop proactive care for local populations.

The programme, which runs for six months from August 2023 to February 2024, includes targeted support for PCNs to develop new models of proactive care with the aim of improving patient outcomes and reducing demand on primary and secondary care.

Each PCN must choose one of three high impact patient cohorts – dementia, frailty or high intensity users – to focus on during the programme.

Learning is through a mix of virtual and face-to-face workshops, with the opportunity to participate in drop-in and network sessions, supporting PCNs to:

  • understand how to access, navigate and interpret clinical insight and service data based on population health needs to develop new models of proactive care
  • increase interest among healthcare professionals in data-driven service redesign leading to more personalised, proactive care
  • build innovation capability and empower colleagues to lead change
  • develop a person-centred culture
  • optimise personalised care ARRS roles and ensure they align to patient and workforce needs
  • identify system partners to collaborate with to optimise proactive care pathways and benefits to patients

Participants are also learning from real-life case studies, such as Healthy Hyde.

Further details can be found in the programme welcome pack.

Proactive care is an NHS Long-Term Plan commitment focused on the provision of care in the community for patients living with long term conditions such as frailty and comorbidities, who would benefit most from integrated, evidence-based care. The aim of this type of planned, co-ordinated and personalised care is to help people live well and independently for longer, especially those with multiple long-term conditions.

Proactive care places a strong emphasis on preventing health issues before they occur with pre-emptive measures to maintain and improve an individual’s wellbeing. It is also an opportunity to address health inequalities by using data that’s available to identify specific groups of patients. The transformative potential of this work on proactive primary care in Greater Manchester is significant.

For further information about the programme, contact Andrew Binnie, Programme Manager for Proactive Care: Andrew.binnie@nhs.net