Implementation of emis software to undertake cross practice searches and reports.

@middevonhealth

Mid Devon Healthcare is a federation of 6 GP practices in a rural area of Mid Devon around the Crediton and Okehampton areas covering 46,000 patients.

Mindful of the NHS England Five Year Forward View and the changing landscape in primary care five of our practices (Bow Medical Practice, Chiddenbook Practice, Mid Devon Medical Practice, New Valley Practice and Wallingbrook Medical Practice) we started meeting in November 2015 on an informal basis. 

Initially we met with one GP partner and the practice manager from each practice to explore whether there were any common issues and to ascertain whether there was an appetite for us to jointly address them. It was clear from these initial meetings that the key issues concerning all practices were: GP workload, staffing/recruitment, resilience and how the Five Year Forward View would impact on patients, primary care and the wider system in our geographical area.

Feedback from the team was that patients’ needs weren’t being met; people were unable to book appointments to see a GP or Nurse for several days/ weeks.   The staff were displaying symptoms of stress and anxiety.  The feedback from the clinical team; GP and nurses was frustration. They were complaining that they were working late and felt overburdened.  GPs felt that many appointments weren’t being used appropriately with people who would most benefit from their clinical skills and expertise, and that patients needed to be directed to the right person with the right skills for their problem/s.  The patient survey at this time showed that patient satisfactory on the service provided by the reception staff could be improved, and that patients wanted the receptionists to provide them with help about the healthcare service.

The managing partner realised that the current systems and processes weren’t optimising the potential that could be provided, and that the current situation was not sustainable, and therefore action was required.
A swot analysis was conducted and the list of ideas and innovation were discussed with the staff both informally and formally at meetings. A plan of action was agreed and implemented.
 

The Barnstaple Alliance is a group of five GP practices: Litchdon Medical Centre; Boutport Medical Centre; Brannam Medical Centre; Queens Medical Centre and Fremington Medical Centre with shared geography, all based in Barnstaple, North Devon who have formed an alliance.

The ethos of which is to stay independent but join together to do what is right for practices and patients and to create better links with other organisations such as NEW Devon CCG, Public Health and the Voluntary Sector.

Following a successful merger in June 2016, we were able to start looking at the services we collectively provide to our patients in order to: Improve access for patients with long term conditions Maximise the way we use our workforce Enable each of our sites to develop services

Improve access for patients with long term conditions.

Maximise the way we use our workforce.

Enable each of our sites to develop services.

Pressure was mounting on the practices in Torquay with a growing demand combining with an unprecedented number of GP vacancies meaning of course, it was getting more difficult to accommodate patient appointments.
 
 

A federation of initially four South Devon practices serving 34,000 patients, developing a single site, single team ‘On The Day Treatment’ (OTDT) model.

The model has been successfully implemented.We are now re-evaluating it and making changes to optimise the service.This includes advanced health navigator training and clinician records training.The phased merger of the practices has started.

Livewell Southwest have been appointed as the lead service partner to lead and manage numerous NHS England Pharmacist in General Practice programmes across numerous practices in Cornwall and Devon.

The Challenge -

To reduce GP appointment by working with train physiotherapist to delivering a one stop approach to common joint injections.
 

 To provide continuity of care to patients but not just by the Usual GP therefore reducing GP workload.

 Enhancing the role of a practice based Patient Care Coordinator.

 Enabling the staff to support the GP in signposting, referral chasing, rolling appointment booking and fast tracked care if required.

 The Challenge -

1.       Notifying our entire patient list of their usual GP as per contractual requirements
2.       Ensuring we offer flu/shingles/pneumococcal vaccinations to all eligible patients who make any contact with the practice.
3.       To reduce environmental impact and cost of sending letters.
 

Like many other practices in Plymouth and throughout the UK, both Stirling Health Group and Chard Road Surgery had recruitment problems as GP partners either retired or relocated. Both practices were under considerable pressure and the workload for the remaining partners was becoming unsustainable.

We recognise the challenges of the modern health service and wanted to bring a new approach to the problems we were facing. We needed to work in a new way if we were to continue to provide effective and sustainable services to our patients in the long term.

Before the merge Chard Road Surgery had changed their appointment system to ‘complete telephone triage’. It was soon recognised that the majority of children needed to be seen for a face-to-face review by a clinician and that telephone triage was not the best way to assess them. Under the complete telephone triage system parents had to call, wait for a clinician to call them back and in most cases were then asked to bring their child to the surgery.

We obtained funding from the Friends of Wyndham House to employ an Outreach Nurse.  Initially this was for three sessions per week to visit patients at home to provide a health check and signpost them or their carers to services that might be helpful.  We initially had difficulty identifying patients who would benefit most from this intervention.  As a result we have evaluated and now target patients > 90 years or those identified by GP's as being suitable candidates.  

• Timely and consistent follow up for those with anxiety and depression

• We have a large number of patients with common mental health conditions such as anxiety and depression who can benefit from social prescribing, empowerment to self care as well as continuity and consistency of relationship in managing their condition.

www.barnfieldhillsurgery.co.uk    @BarnfieldHill

The surgery identified a need to engage with those potentially suffering from loneliness and isolation, to show patients what whilst their needs were non-medical they were still valued and could be supported.