Multi-agency Primary Care collaborative working

What is a Multi-agency Primary Care collaborative working

This model enables professionals from a range of health, social care and third sector organisations to work together proactively to meet the complex needs of individuals registered at a specific GP surgery.  The clinical care co-ordinator is based in the GP surgery.  Any patient identified by any member of the team can be discussed either proactively if identified as being at risk or following an event such as unscheduled attendance at a hospital. By understanding their local population needs and taking a person-centred approach, the team have enabled the services to focus on what is important to that individual and ensure the different agencies work together in a collaborative, prudent way to meet those needs.