Building GP Capacity and Resilience: The Productive GP Programme from NHS England  


  

As one of the coaches on the Productive GP Programme run by NHS England, I work with GP practices to improve their processes, strengthen their resilience and expand their capacity in a number of ways. One of these is to look at frequently attending patients.

The process is fairly simple:

1) Identify those patients who consume the most appointments in the practice

2) Review their patient records to determine if other clinical or support services could be used to ease pressure on appointments and improve patient care.

The systems that GP practices run make it easy to identify those patients that attend frequently. Doctors and practice nurses then get together to review patient information to see if other approaches might help to reduce the demands that these patients place on the practice to release space for other patients. These alternative pathways might include interventions from mental health specialists and other clinical professionals; alternative therapies; as well as voluntary and community groups and services.

In my experience, many of the patients who consume the most GP appointments have mental health or addiction issues. The extent to which other services can help reduce dependency on the GP practice will depend on the provision in the local area. Nevertheless it may be possible to reduce the burden on the GPs alone by taking a more proactive approach to scheduling appointments – sharing appointments between a nurse and GP for example – and being clearer about how often the patient needs to be seen.

Some practices are lucky enough to have the space to arrange clinics specifically for mental health issues; for counselling; and even for advisers to come in to try and address the social issues that lie behind stress and anxiety.

Let me give some examples:

In many surgeries, it is the time of the practice nurses that is under most pressure. In one small practice, with only 2 part-time nurses, training Health Care Assistants to change dressings freed up approximately 150 nurse appointments per year.

In another small practice, frequently attending patients were not much of a problem – there were only 22 patients who had had more than 10 GP appointments each in the past year. However, even there alternative interventions for six of the patients helped reduce the pressure, and gave the patients a more comprehensive care plan.

By contrast, a large urban practice had nearly 800 patients who had 20 or more appointments (GP and nurse) each in the previous year. This equated to 7,900 consulting hours. Nearly 300 of those patients had over 30 appointments in the previous year (nearly 2,000 consulting hours). Here the ongoing work to reduce the impact on resources of patients who, medically, don’t need to be seen so frequently has the potential to release considerable capacity, so that patients trying to get an appointment can be seen more quickly.

With another mid-sized suburban practice, only 15 patients had had 30 or more appointments in the previous year. A review by the GPs identified that 7 of them could be referred to recently enhanced mental health provision in the area.

Of course many patients who attend surgery frequently do need to be there. But taking the time to review records, particularly in a multi-disciplinary meeting, can help identify new approaches and ease some of the pressures. Even a reduction of 10% or 15% in the number of appointments generated by frequent attenders can make an important difference.

And it is not all just about frequently attending patients. “Zero attenders” also represent a golden opportunity for practices to focus on preventative work. Among the patients on the list who have not requested an appointment at all in the last year (the “zero attenders”) many will have conditions where some proactive preventative work will reduce costs for the health service should those conditions worsen. Such groups include those with diabetes, asthma, hypertension, and so on.

For example, one small practice identified 150 patients in the eligible group who had not attended a smear test in the last five years. These patients had had all the usual reminder letters but, rather than let it lie at that, the practice took a proactive approach to telephoning the patients to explain the importance of the test. A reasonable proportion of that group (about 20% at the time of writing) subsequently attended for the test.

Another practice targeted patients in the eligible group who had not undertaken the available bowel cancer screening, as well as those missing their smear tests. Another small practice focused on high blood pressure, asthma and patients with a BMI over 35+ and, with a coordinated approach, successfully got many of them to attend for health advice and a review of their prescription drugs.

This is the sort of work that GP practices should be doing. It is good for patients and it saves the NHS money in the longer term. Often, however, practices do not get to do as much of this work as they would like because they are dealing with other workload pressures. The Productive GP Programme can help focus on some of these issues to improve processes and develop better plans. Of course this requires a time investment to review processes and activities, but the benefits far outweigh this input.

Addressing the medical needs of patients who request and attend many appointments enables a practice to improve the care it provides and, at the same time, free some capacity to undertake more preventative work with patients who would rather not attend their GP clinic. The data is relatively easy to extract. Time is then needed to review records and develop appropriate plans. The time spent on this valuable work will reap benefits for the practice and help improve the care it provides to its whole community.

Those working in GP practices can click here to find out more or they can talk to their CCG. 

Guest blog, Healthcare - Ross Maynard, Productive General Practice Coach

 

General Practice Improvement: Frequently Asked Questions  


Over the last 6 weeks, The General Practice Improvement Programme has been exhibiting across the country at the UK’s largest healthcare events to front line GPs, Practice Mangers and CCGs. The feedback has been outstanding with delegates keen to find out the benefits of the programme which seems so relevant in today’s healthcare market. 

Over the course of these events, the GPIP development team have been flooded with questions about the programme and have taken the time to identify key questions which seemed to stand out:

How can GPIP help with CQC inspections?

We should start by saying that GPIP hasn’t been designed to specifically meet the needs of a CQC inspection. Its primary function is to quickly help practices improve – but of course there’s an overlap – it does help in many areas, and we have written a specific piece on this here: http://gpip.co.uk/GeneralpracticeCQC

Are CCG’s willing to fund the programme?

With the majority of previous practices we have worked with, their CCG’s have been willing to fund and support the programme. However we understand that each CCG is different and have found the best approach is for the GPIP team to present back directly to the CCG from your recommendation and interest. 

What are the main work areas of the Programme?

The programme focuses on 7 high impact areas which in the short term can make the most practical and suitable changes.  These are: 

  • Chasing the Tail 
  • Workforce Planning
  • Consistency of Approach
  • Workplace Organisation
  • Effective Email & Meeting Management
  • Minimum Job Requirements
  • Failure Demand

Is there any Homework involved?

Unlike other productive programmes, GPIP is delivered through half day, once a week sessions over a 12 week period to ensure visible changes can be made on the day of implementation. There is no homework for the practice and when we leave, we continue to offer one year’s telephone support and the GPIP box set to assist you in maintaining those changes. 

How can GPIP deal with our high attending patients?

The Chasing the Tail module focuses on high attending patients, by using  data from your systems we identify a select cohort of patients whose care is most likely to be costly of time due to their high attendance. We then work with all levels of staff to look to better manage their care in order to free up a considerable amount of time for the practice. Time, which you have the freedom to invest elsewhere in your practice. 

How does GPIP differ from other Improvement Programmes?

Many other improvement programmes offer a long process of development which requires practices to complete a considerable amount of solo homework in order to create long term changes. The issue with this is that practices don’t see direct changes and usually don’t have the headspace to complete the homework individually.  The General Practice Improvement Programme is designed to tackle this by offering the interventions across 12 weeks with no homework so the Practice can see sustainable changes on the day of delivery. 

What ROI is expected form the Programme?

As the programme is designed to release efficiencies and time, it is how the Practice re-invests that time to determine ROI. For example one practice was able to increase their list size by 1200 patients due to the considerable amount of time they were able to save, generating an additional £75,000 in revenue. 

Can GPIP help support the Quality and Outcome Framework?

Although GPIP was not designed to directly support the QOF framework many of the outcomes help practices achieve higher points through the 6 main scoring areas.  If this is something your practice is looking to achieve, the programme can be tailored specifically to help improve support and develop each scoring area resulting in a more efficient practice. 

 

If you have questions of your own, get in touch at This email address is being protected from spambots. You need JavaScript enabled to view it.

 

 

 

How can GPIP help with CQC inspections?                      


General Practice Improvement Programme

The pressures facing General Practice have never been greater. With an increasingly elderly population, a higher prevalence of lifestyle related illnesses and growing expectations from the wider public for a prompt, highly efficient service – practices face challenges like never before. 

Add into this mix the increasing scrutiny from central and regulatory bodies such as CQC as well as the rising costs and falling income for practices and we start to see a very difficult picture. 

One question we’re often asked is, how can the General Practice Improvement Programme help my CQC inspection?

We should start by saying that GPIP hasn’t been designed to specifically meet the needs of a CQC inspection. Its primary function is to quickly help practices improve – but of course there’s an overlap. 

CQC’s 5 Key Questions

• Are they safe?

Many things affect the practice safety. In GPIP we cover key areas such as workforce planning, to ensure your practice has the right skill mix in the practice every day. We also work with the practice to ensure doctors provide a consistent approach to patient care through our ‘consistency of approach’ module. 

• Are they effective?

A focus on the right care for the patient and ensuring their care is effective is the foundation of any practice. Through the ‘Chasing the Tail’ module, GPIP works to look at the most frequently attending patients with an MDT to ensure each of these patients is receiving the right level of care for their condition. Often we find that many of these patients can be better and more effectively managed, ensuring their care is improved and the practice’s time released. 

• Are they Caring?

Practice staff are some of the most caring and dedicated anywhere in the health service, but stress and pressure can sometimes mean that staff don’t spend enough time with patients. The primary focus of GPIP is to help reduce practice pressure and release time for practice staff. 

• Are they Responsive?

A practice need to be able to meet the needs of it’s patients – so effective organisation of the practice is essential. Through the ‘Workplace Organisation’ module, the GPIP team work with practice staff to help improve efficiency using key organisational techniques. 

• Are they well-led?

Having a strong management and governance team within a practice is essential. Whilst GPIP won’t change the character of your team, it will help to define, set and embrace a set of standard operating procedures which have been developed with the whole practice team. 

More information on the expectations of CQC can be found here: http://goo.gl/iv0Na9 

 

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