GPIP Case study: Chasing the Tail


  

Over 450 general practices across the UK have carried out the improvement programme and continue to talk positively about their experiences. We have captured some of the feedback in our case studies, so if you’re interested in finding out more about some of the modules within the programme, visit the case studies page.

Chasing the tail is one of the six modules that practices can choose to do; this particular medium-sized practice based in England has a list size of 8000+ patients and selected this module to help improve the service they deliver to patients and put them in a better place to meet increasing demands. Using a structured problem solving approach, the practice quickly identified two patients that required further examination.

The main objective of this module is to find what we call the ‘frequent flyers’ – those patients that visit the surgery frequently and demand a disproportional amount of time. This module is great for helping practices release capacity.

Upon completion of the module the multi-disciplinary team identified a total of 24 patients, 80% of whom now had the opportunity to be managed differently and receive a greater holistic nature to their care. The practice now have a great understanding of their patient population and where their capacity is utilised across the practice.

“We did have one patient who was our highest user, who we spoke to nearly every day, we did manage nearly 10 days without management. They are not contacting us as much through the Chasing the Tail work. They had 102 doctor contacts in the last year. We now have a plan for the patient, which everyone understands and we can put into action what we have collectively agreed.” 

– Practice Manager

You can find the full case study including the results here

GPIP - here to improve general practice

Working in General Practice is tough – we’ve worked with over 450 and very few, if any at all, are finding things easy at the moment. The increasing pressure of an ageing population, more complex health issues and increasing public expectations are only adding to the mix. 

Couple this with the general expectation of General Practice to ease the load on Accident and Emergency departments across the country and you start to see that things need to improve for practices. 

That’s where General Practice Improvement Programme (GPIP) comes in.

    

Using our experience of creating programmes that deliver change and truly empower people, as well as our experience of Primary care - we've worked with practices to find a way to create headspace – quickly and sustainably.

There’s no homework, no finding time – its 12 sessions of support that follow a Teach, Simulate, Do process that yields results on the day.

Feedback from the practices that have completed the programme has been great, see for yourself in the case studies. It’s no silver bullet, but GPIP helps a lot and in the current environment the need for practice headspace is paramount.Curious to know how it works? Find out here

  

 

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