Tuesday, 17 January 2017

Potential of GP Surgeries

This week it has been the turn of GPs to be at the receiving end of the government blame game... no doubt us patient leader types will be in line one day soon, so before my morale is flattened like May has flattened every other type of person within the NHS, allow me a few paragraphs of positivity and hope! 

I've been wondering for a while about the real potential within primary care for person-centred care and self-management support, and various conversations recently, not to mention tweets in response to May's comments, have finally made me finish off this blog and press publish...

One of the arguments I hear about federated GP surgeries is about the economies of scale. I get that in terms of procurements, and have heard many examples of the benefits of economies of scale meaning they can bring in specialists such as in house physio’s and diagnostic equipment etc. I also think economies of scale in primary care mean there are great opportunities for person-centred and community centred approaches in federated GP surgeries. Think what a large Trust can do - patient experience team, engagement teams, information teams, support workers.... If large services in NHS Trusts (community/pathway specific) can do it, a la David Gilburt model of patient director in Sussex, so can primary care in the federated models. Let me share my optimistic vision for person-centred federated GP practices, facilitated by a specific job role... I know no-one in primary care has any time for this 'nice to have' stuff, but it is important, so lets gets someone to really focus on it. I'm not asking GPs to do this - god knows they have enough to do already. 

There are so many different aspects of primary care that could be supported by someone with a specific role and remit in person- and community-centred care. Apart from in the largest practices, my experience so far is that these important aspects are done by people with a million and one other more pressing things to do. But as part of a portfolio of a specific person working for a federation of practices, they could have a really significant impact on patient and carer experience, by having the time to explore and improve all these elements. Thinking along a patient’s journey…

The reception and waiting areas: as part of some work I did with People First Dorset on behalf of NHS England, we found that patients have to process over 40 pieces of information, and much of the information is out of date, inaccessible and not used. Rethinking the presentation of information, through themed information boards, ensuring key information is easily accessible can make a big different here. 

Being part of the team for those unavoidable 'inappropriate' appointments: I've had a few people who have rung me as a self-management coach saying they weren't sure to call me or the GP, but needed a specific bit of information. They rang me first, and I was able to give them the information (simple signposting). If dedicated non-clinical support workers are seen by patients as an equal member of the team (and importantly, easily accessibly like that), receptionists and GPs can easily triage patients to see the non-clinical worker (with rapid access to GP following to manage risk perhaps). 

Training of staff: while clinical training and updates are essential, so are person-centred skills and approaches. This could be coordinated by someone who works with patients and carers to enable them to deliver and co-facilitate training sessions on any aspects of person-centred care or awareness around specific conditions or topics (such as carers or dementia). Even clinical training topics can be delivered in a person-centred way with people with lived experience of the conditions in question, and that requires support for those patients and carers as well. The economies of scale of federations mean I am expecting more training to be in house, making this even more relevant. I know of a GP surgery in Dorset that had training topics for staff suggested by the PPG, and this could be expanded on! 

Meaningful and effective PPG: In Dorset, there is great variation of quality among PPGs, and in my opinion, the highest quality correlates to those with the most support. Support might mean training for members in being active partners for change, and facilitating the group's links with the practice so they can be impactful. 

Care and support planning, and the conversations downstream from that...: General practice is the best location for care and support planning, but it doesn't have to be done entirely by general practitioners. Non-clinical professionals can make great contributions to care and support planning conversations, and importantly help implement plans by following up with social prescribing, green prescribing, self-management support and care navigation support. These roles have a million names, but its the same underpinning principles. the sort of person-centred non-clinical 'intervention' that this 'role in federated practices can drive, develop and deliver. 

Driving other agenda's in primary care: With variation in progress vast, patient access to online records is important, and needs facilitation. The Dorset Care Record is making progress locally, but other surgeries like Haughton Thornley Medical Centres, under the leadership of @amirhannan are lightyears ahead. Amir and his team have had dedication to this cause that is hard to find in other places, yet could be supported by a patient director role in a federation. 

Patient Feedback: during conversations at the @InquireUK we discussed the differences in feedback mechanisms in trusts and primary care organisations, and the issue of small team capacity in primary care was a big factor limiting the engagement with feedback mechanisms other than the standard surveys. The much-hyped 'economies of scale' can surely help with the Patient Opinion programmes and other initiatives larger surgeries can sustain? 

Being part of the local networks: with the focus of the role, this individual could really strengthen relationships with local third sector organisations and other statutory services, such as Fire and Rescue services, HealthWatch along with CAB, housing, public health, education and parish networks. I hear so often that these organisations are craving meaningful relationships with GP surgeries that are so hard with the current clinical staff and limited capacity of the small business model they embody. Even linking up and supporting local community transport schemes so patients can get to the surgery - surgeries benefit from these, but rarely input in any meaningful way.

Innovation around primary care with a person-centred focus: the potential to explore supporting gardening groups (green therapy, such as Thrive) to maintain the surgery grounds, or going as far as the inspirational Lambeth GP Food Co-op. The sky is the limit... especially if we coproduce innovation with local people! 

Perhaps this GP centre could be at the end of a beautiful yellow brick road, behind an old wardrobe door...!! ; ) 


  1. What a lovely idea, as a clinician dealing with people with complex co morbidities, complex issues and lack of time with GP I can see how a clinical pathway / patient experience manager position would be very useful in all PCTs. I don't believe there is one person in each CCG that truly understands ALL of the funded pathways, exclusion and exclusion criteria and how to assist patients / clinicians to access these. Great idea, I would apply!

    1. Thanks! We just need a forward thinking CCG to commission this!

  2. "If dedicated non-clinical support workers are seen by patients as an equal member of the team (and importantly, easily accessibly like that), receptionists and GPs can easily triage patients to see the non-clinical worker (with rapid access to GP following to manage risk perhaps)."

    I would go one better on this, have the non-clinical team member directly contactable so that patients go there first with their queries. One of the bottle necks in many GP practices are their telephone systems. Have an appointment line, but then have separate lines for the non-clinical patient manager. I believe this is how they are doing it at Healthy Prestatyn Iach http://healthyprestatyniach.co.uk/the-service/our-teams

    " I know of a GP surgery in Dorset that had training topics for staff suggested by the PPG, and this could be expanded on! "

    I know of PPGs that could not only suggest topics but also deliver the training! PPG members don't leave their brains at the door, they can also be highly trained and experienced people who are experts themselves in not just their own conditions, but also in business, system change and improvement and many other areas.

    But the PPGs need the support from the surgeries, and until PPGs have similar statutory guidance like School Governors do in education, that is only going to happen in isolated situations.

    One of the things that appears to happen when surgeries merge and work at scale is that the PPG voice gets lost.