WSIC - Kilburn

To ensure continuity of the service, a short-term contract (12 months) has been awarded to Kilburn Primary Care Co-op Limited whilst undergoing a procurement exercise for the service. Market Engagement has been undertaken in advance.

One of the main focus areas is to dissolve the divide between primary and community + secondary based health services, delivering new service models in which patients get more options, better support, and joined-up care at the right time in the optimal place, through Primary Care Networks (PCNs).

The service will provide high-quality of care and improve people's experience by:

• Providing holistic, person-centred care, rooted in individual needs, goals and aspirations rather than solely 'treating the symptoms'. The emphasis is on diagnosis care planning and proactive care + care for dying, health education, and reaching out to health inequalities vulnerable groups and other non-aligned disadvantaged people.
• Support early identification and intervention through population health management.
• Supporting people to live independently in their own homes and minimising the amount of time they spend in hospital.
• Coordinate the care of individual patients and work collaboratively with the patients, their family, GPs, services in the community, local authorities and voluntary services.
• Provide expertise and support for GPs, community services and other service providers.
• To improve the provision of coordinated care and to reduce NEL admissions and A&E. attendances where appropriate.
• To get NEL admission services to identify their Cost and manage patients appropriately.
• To improve access to diagnostic facilities by GPs thereby reducing the demand for unnecessary outpatient services.
• To increase virtual consultation rates by primary and secondary care.
• To increase self-care by individuals.
• To disencumber unnecessary processes.
• To recognise diagnostic uncertainty by clinicians.
• To provide meaningful support to patient-facing teams by realignment of office-based personnel.
• To mandate office-based roles have to incorporate at least 1 day a month in patient-facing direct contact services within their job plans.