Healthier Fleetwood Primary Care Home: Resident empowerment and service integration

In 2014, GP services in Fleetwood were at risk of falling over with a shortage of GPs and a high proportion of people with long-term conditions in the town, creating high demand for services.

This has changed due to the PCH which has aimed to bring services together, crucially building relationships between those involved. It also looked at residents as part of the solution, rather than the problem, and aimed to empower them.

The 20 families whose children were at highest risk of hospital admission were targeted for support. Integrated services for patients with mental health issues, liver disease, and COPD were developed.

Residents have developed their own social prescribing pathway with more than 24 activities available. Accident and emergency attendance fell by 16.7 per cent in 2017-18.

The town now has a full complement of GPs and has increased skill mixing in practices with new roles. The governance structure – which includes residents in its leadership group – is now being copied elsewhere.

Read a detailed case study about this project at HSJ Solutions


  • Devon Doctors: 111 Step-In Service for Over 75’s – Somerset HIGHLY COMMENDED
  • Enable East - Part of Essex Partnership University Foundation Trust: HeadsUp
  • Merton Clinical Commissioning Group: Merton Social Prescribing Project
  • Newcastle Gateshead CCG: Primary Care Demand Management [Practice Engagement Programme (PEP)]
  • North Staffordshire GP Federation: Staffordshire Physician Associate Primary Care Internship
  • One Health Lewisham: Development of Integrated Patient Triage App to Reduce Demand on Practices
  • Stratford Village Surgery: Online Triage
  • Sunderland CCG: New Consultation Types Programme