What We Do


Please see our ‘Plan on a Page’ for an overview of our vision, principles, goals and programmes of work.


Our Principles of Working Together

  • Together we can provide excellent primary care services to our neighbourhood populations
  • Our ethos is based on co-operation not competition between all providers
  • We will be transparent and engaging both with the population we serve and our membership
  • We have a right to provide services and a responsibility to deliver high quality care
  • Together we are stronger – together we are Quay Health Solutions

Our goals

We have identified four goals for QHS that reflect both our members’ priorities and support NHS Southwark Clinical Commissioning Group’s Five Year Forward View. These are:

  • Develop and maintain a sustainable organisation
  • Deliver high quality clinical services across north Southwark
  • Lead the design of models of care in north Southwark by being the voice for primary care, representing members views and ideas
  • Develop primary care in north Southwark, supporting GP practices to manage change, and making it a good place to work and be a patient

Our programmes of work

To achieve our goals we have developed or support programmes of which include the following (click on heading for further information):


Our Primary Care Network

Joining up primary care services at a local level, focusing on the specific needs of local populations.


Our Extended Primary Care Service

Enhancing access to primary care in north Southwark and improving patient experience.


Care home service

Providing routine, proactive and urgent care and support treating patients in the homes and avoiding unnecessary hospital admissions.


Social prescribing

Supporting patients with a personalised route to improving their health utilising the rich and diverse range of community services and voluntary sector organisations in our area.


GP Pharmacists

Pharmacists working across GP practices to reduce the demand on GPs and improve quality and safety of prescribing medicines.


Clinical Effectiveness Southwark

Improving quality across general practice by delivering a package of clinical guides.


Care Navigators

Supporting patients with social needs (e.g. social isolation) to free up GP time.


Multidisciplinary team working

Health and care professionals working together to improve coordinated care.


Neighbourhood working

Working in geographical neighbourhoods; Borough, Walworth, Bermondsey and Rotherhite to ensure coordinated and improved care.


Call and Recall

‘Call and recall’ is a method we use to increase the participation of patients in different areas of their healthcare.


Our contracts

Quay Health Solutions (QHS) is a group of 17 GP practices (member practices) in north Southwark. QHS has been given funding by NHS Southwark Clinical Commissioning Group (CCG) to improve the quality of care in general practice and improve the health outcomes of local patients. As part of this, we support our member practices to deliver the Population Health Management Service contract, the Personal Medical Service contract, the Extended Primary Care Service and the Care Home Service.


Population Health Management Service (PHMS)

The PHMS contract began in April 2015. All member practices support the delivery of the PHMS contract. The services we offer as part of this contract include:

  • Coordinated care for people with three or more long term conditions
  • NHS Health Checks
  • Annually reviewing people who have pre-diabetes
  • Providing asthma and COPD inhaler reviews
  • Ambulatory blood pressure monitoring
Personal Medical Service (PMS)

The PMS is a locally agreed contract between the CCG and individual GP practices. The PMS contract includes: providing flu vaccinations, supporting people who; have suffered from a stroke, have hypertension, have chronic heart disease or have diabetes. It also includes supporting people who are at the end of their lives. In north Southwark, QHS support our member practices with the delivery of the PMS primary care services for our population.


Our case studies

Quality Improvement Programme

From 2016 to 2018 we implemented quality improvement projects in practices to reduce workload, free up time for GPs and improve care for patients.


Practice Nurses and Health Care Assistants (HCAs)

From 2016 to 2018 we implemented a programme of work to support  nurses and HCAs across our GP practices.


Local Care Networks

From 2017 to 2019 we worked to join up care between GP practices, hospitals, community services, social services and the voluntary sector via Local Care Networks.


Coordinated care

From 2017 to 2020 we delivered coordinated care for people with three or more long-term conditions in north Southwark.