Helping people with COPD stay well at home through proactive neighbourhood care in Lambeth
Lambeth Together partners have expanded support for residents with chronic obstructive pulmonary disease (COPD) as part of their shared commitment to bring more care closer to home.
The North Lambeth Primary Care Network (PCN), in partnership with Guy’s and St Thomas’ NHS Foundation Trust, has launched a new proactive care service for people in north Lambeth living with COPD.
The service can support up to 150 patients at a time and is designed to help identify problems early, provide support at home, and reduce the risk of avoidable flare ups and hospital visits. The service is delivered in partnership with Doccla, who support NHS proactive and virtual care services.
This model of care reflects our ambition to shift more specialist support into neighbourhood and community settings, enabling people to stay well for longer and maintain their independence, in line with the NHS 10‑Year Health and Care Plan.
About the service
The remote monitoring service is for north Lambeth residents with COPD who would benefit from extra support to stay well at home. Eligible patients will be contacted directly by their GP practice and invited to join, in line with national NHS guidance on proactive and virtual care. This service works alongside existing NHS support and does not replace usual care.
The offer includes regular check‑ins, at‑home monitoring devices and tailored advice to help people manage their condition confidently and avoid unnecessary hospital visits. Anyone invited to take part will receive clear information from their GP and the service team on how to enroll. More about how proactive care works across the NHS is available on the NHS website. If urgent medical help is needed at any time, patients should continue to use NHS 111 or emergency services as usual.