Doccla launches COPD Proactive Care service with Guy's and St Thomas' and North Lambeth PCN

We're pleased to announce the launch of the COPD Proactive Care service in north Lambeth, developed in partnership with the North Lambeth Primary Care Network and Guy's and St Thomas' NHS Foundation Trust The service is now live across six GP practices, supporting up to 150 patients at a time to stay well at home and reduce the risk of avoidable admissions.

For people living with COPD, earlier support makes a real difference - identifying problems before they escalate, and keeping people well in the community rather than in hospital. 

What the service delivers

Patients identified by their clinical team as likely to benefit are contacted directly by their GP surgery and invited to join the service. Once enrolled, they receive:

• Regular check-ins and symptom reviews
• Remote monitoring to track key health measures at home
• Personalised advice and guidance from their clinical team

The GP practices offering this service are Hurley Clinic and Riverside Medical Centre, Lambeth Walk Group Practice, Mawbey Group Practice, South Lambeth Road Group Practice, Waterloo Health Centre, and Vauxhall Surgery.

Proactively supporting patients in the community

This partnership reflects a deliberate shift in how we deliver care in the community – working across primary care, acute and specialist providers to proactively manage patients in the community – supported by real-time monitoring. 

Dr Shaheen Khan, Deputy Medical Director, Integrated and Specialist Medicine at Guy's and St Thomas', explained the ambition behind it:

"This new model of care reflects an ambition to shift more specialist support into neighbourhood and community settings, enabling people to stay well for longer and maintain their independence. We're excited by the opportunity to work in partnership to support the care of people in their own homes. By using a combination of senior clinical expertise and technology we can do even more to support our local population."

That combination - clinical expertise alongside real-time monitoring - is central to how Doccla operates. Technology surfaces the signals; clinicians act on them. The result is earlier intervention, fewer avoidable admissions, and patients who are more confident managing their condition at home.

What this means for the system

The NHS 10-Year Health Plan sets out a clear direction: shift care earlier, closer to home, and from sickness to prevention. Proactive Care is how that shift becomes operational - not as a pilot, but as a scalable, embedded service running alongside existing clinical teams.

North Lambeth is the latest system to take that step. We're proud to be part of it.

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