Health Support Team

The Tame Valley Practices have identified areas across the PCN area where additional support is required for patients. We have developed a team of Health Coaches specialising in different areas including:

• Frailty Health Coaches
• Employment Support
• Cancer Health Team
• Mental Health Support
• Pain Management and Addiction 

Scroll down to find out more about the role our Health Coaches.

Care Home Frailty Health Coach

• Liaises and communicates with each care home linked with Tame Valley Practices
• Develops personal management plans for patients and uses decision making tools for their care
• Liaises between the home and GP Practice to co-ordinate weekly ward round lists, urgent visit requests, and medication requests outside of the ward round times
• Works with Multi-Disciplinary Team (MDT) members to organise direct referrals to their services where beneficial to the patient
• Co-ordinates Stockport Pharmacist (SIPS) team/medicines optimisation in Care Homes and co-ordinates Structured Medication Reviews (SMR) to be carried out for patients.
• Assists with validation of and communication with people registered under a lasting power of attorney

Staff Member:

Eleanor McCabe - Covers Brinnington Surgery, Heaton Norris Medical Centre, Alvanley Family Practice, Bredbury Medical Centre and Woodley Village Surgery.

Frailty and End of Life Health Coach 

• Liaises between patients, carers and GPs.
• Develops personal management plans and uses decision-making tools for their care.
• Reviews frailty registers, identifying patients that should be on the end-of-life pathway to ensure they are receiving the care they need. 
• Assists with validation of and communication with people registered under a lasting power of attorney.
• Arranges, chairs, and minutes Gold Standard Framework (GSF) meetings. These are multi-disciplinary team meetings for healthcare professionals involved with individuals who require specialist care towards end of life. 

Staff Member:

Cheryl Wilson - Covers all practices.

Frailty and Dementia Health Coach 

• Liaises between patients, carers and GPs.
• Carries out Dementia reviews and develops personal management plans for patients.
• Carries out Dementia assessments for high-risk patients
• Assists with validation of and communication with people registered under a lasting power of attorney.

Staff Members:

Louise Breen - Covers all practices

• Reviews patients requesting fit note extensions
• Makes referrals to appropriate services to assist patients to return to work
• Supports patients with CV writing and interview technique training

Staff members:

Feisal Butt - Covers Park View Group Practice, Bredbury Medical Centre, Alvanley Family Practice, Brinnington Surgery

Ed Finn- Covers Heaton Norris Medical Centre, The Reddish Family Practice, Vernon Park Surgery and Woodley Village Surgery

• Works with the practice GPs to support patients who have been diagnosed with cancer. (Recent or in the past)
• Completes Cancer Care Reviews to support patients health and signposts to other services available. 
• Works towards Cancer screening uptake improvements across the practices

Staff members:

Samantha Mcasey (Lead Coach) – Covers Park View Group Practice, Brinnington Surgery, Heaton Norris Medical Centre

Diane Axford (Cancer Care Co-Ordinator) – Alvanley, Bredbury, Vernon Park, The Reddish Family Practice

PCN Cancer Lead : Dr Karen McEwan (Park View Group Practice) 

• Supports patients on medication reduction plans
• Carries out joint Structured Medication Review (SMR) clinics with Practice pharmacists
• Improves patients’ knowledge, confidence and skills
• Empowers patients to improve their health outcomes and sense of wellbeing
• Prevents unnecessary reliance on clinical services
• Provides interventions such as self-management education and peer support
• Supports people to establish and attain goals

Staff member:

Jean Smith – Covers all practices.