Integrating Primary and Community Care

Care Coordination believes that General Practice is at the centre of the health and social wellbeing for all community dwelling patients. Increasingly an effective partnership between primary care and the community sector is seen as key to strategies focused on:

• Keeping people well and maintaining independence for as long as possible
• Engaging informal supports and community based models of care to avoid admissions and shorten length of stay in acute hospitals and delay entry to residential care
• Enable ageing and dying in place

We aim to work closely with general practice teams to ensure referrals are smoothly managed and General Practice remains well informed of the services that have been initiated for their enrolled population. We are committed to working in partnership with Primary Care and other community providers to:

• Grow new services
• Transform the focus of some of the more traditional care services that are in place in the community
• Expand the role of the primary and community care sector (and in particular community nurses) overall

By identifying the priorities and goals of clients Care Coordination helps them achieve the best possible level of independence.

Our principles of coordinating care:

• Partnership: Providing client focused care and solutions with the client and their support network
• Collaboration: Working closely with health professionals and providers of health care and support services
• Excellence: Our staff committed to meeting the needs of our clients
• Solution focused: Developing innovative community focused solutions...nothing is too much trouble