At Granta and Shelford primary care home, our team has managed to weather the winter storm without being bowled over by a tidal wave of increased demand from patients.
Our routine work, including the care of patients with long term conditions, has carried on as normal, we’ve continued to see some 45% of patients asking for appointments on the same day…and we do our best to make sure all our staff take lunch and coffee breaks, even in our busiest times.
So how did we do it? In a nutshell: through vision, collaboration, co-operation and by working at scale within the primary care home model.
The winter pressures and Christmas holidays didn’t come as a surprise to us. We didn’t do anything different this year and we didn’t receive any extra resources beyond those offered to all General Medical Services practices locally. But what we did do was ramp up a system we put in place several years ago.
After talking to patients, we realised we weren’t meeting their expectations in terms of ease and speed of access to clinicians for urgent problems. We set up rapid access clinics staffed by senior clinicians who focus solely on urgent cases during surgery opening hours.
We use a telephone triage system and give patients the option of either talking to a GP on the phone or coming into the clinic. It’s all about what language you use so people don’t feel as if they’re being fobbed off. Our care navigators and receptionists will say something like: “Would it be helpful for you to talk to one of our GPs on the phone?” We never turn anyone in need away. Those who opt for a phone conversation will receive a call back in under 20 minutes on average. On Mondays and in peak periods we may have up to 10 clinicians in the rapid access clinics – seven or eight doctors and advanced nurse practitioners, as well as two emergency care paramedics who make home visits if needed.
We’ve created an attractive and viable alternative to A&E and while we’re still in the process of collating the data to evaluate the effect on our local hospital, I believe our clinics have resulted in a significant reduction in emergency department attendances.
I know clinicians elsewhere feel as though they’ve been fighting against the tide – running faster, working harder and buckling under the pressure. It’s very difficult for smaller practices to stay afloat because they’re working in a system which is broken and no longer viable. They simply don’t have the time or resources they need to take a step back and re-engineer the system.
We’ve been reaping the benefits of working at scale which is vital for sustainability. We’ve merged three practices into one and will soon be joined by a fourth – this means we’re big enough to be flexible with our workforce, scaling up or down to meet demand. We have a system in place which is robust enough to manage a surge in demand without any detriment to staff or patients.
We’ve done all this without any external support or funding. We’ve managed but that’s not to say we’re not looking for extra resources. In terms of improving health care for the local population, it’s primary care which delivers the biggest bang for your buck. There’s inequity in the current system of resource allocation which sees general practice receiving around £136 per patient per year compared with £145 on average going to the acute sector for each A&E attendance. We’re calling on our sustainability and transformation partnership to double the proportion of its investment in primary care over the next five years.
If that happened we wouldn’t just be managing, we’d be flying. Our aim is to become one of a handful of PCHs delivering all health services which can reasonably provided in a community setting – including district nurses, physio, mental health and advanced diagnostics – within a single primary care hub. We want to work with our local emergency department to co-design services and share skills and knowledge. I’ve had a meeting with them this month to start the ball rolling.
This is our vision and with the right support and funding the things we could achieve would be phenomenal.
Dr James Morrow, GP and partner, Granta and Shelford primary care home