Being in the vanguard of NHS change

An initial support package for the 29 New Care Model Vanguards was announced on 31 July. The package has been developed to help the vanguards – who are leading the redesign of health and social care in England – make the changes as quickly and effectively as possible.

In the first of a series of blogs giving insight into what it means to be at the forefront of change for the NHS, Dr Donal Collins, reveals the ambitions of the Better Local Care (Southern Hampshire) Vanguard:

Our message is clear: Better. Local. Care.

The Better Local Care (Southern Hampshire) multi-specialty community provider (MCP) vanguard is the most exciting project I have been involved with during my 22 years as a GP.

It gives me great hope for primary care.

The last four to five years have been challenging, with continued struggles to recruit and fewer trainees wanting to do the jobs myself and others have done for decades.

During that time it became increasingly difficult to see a way forward.

But Better Local Care – a partnership between GPs, Southern Health NHS Foundation Trust, three clinical commissioning groups (Fareham and Gosport, West Hampshire and South Eastern Hampshire), the voluntary sector and others – gives us that way forward.

It enables collaboration and integration in ways we have never had before.

What’s totally different about this is it is a “bottom up” transformation. It is clinicians on the ground working in partnership, in conjunction with patient and voluntary groups to develop this model.

This gives us more ownership locally and it genuinely does break down barriers between organisations for the benefit of patients.

Colleagues from the Five Year Forward View new care models team recently visited Southern Hampshire to learn more about progress with the MCP locally. Plans for the first three localities in southern Hampshire developing the model – Gosport, South West New Forest and East Hampshire – were presented during the visit.

The team visited Fareham and Gosport Clinical Commissioning Group’s headquarters at Commissioning House, near Portsmouth, Lymington New Forest Hospital, and the Arnewood Practice at New Milton, in the New Forest.

It was a very positive experience and it was encouraging to learn from the feedback we received that we are advancing rapidly in absolutely the right direction.

Progress has been swift since that milestone.

In Gosport we’re developing a same-day appointment service which will separate urgent care from care for long-term conditions. Calls to the service will be triaged by doctors and nurse practitioners so the patient gets to see the right professional at the first point of contact, or receives appropriate advice over the phone without necessarily needing to attend a clinical setting.

In time, the aim is to include a range of health professionals in the service. For example physiotherapists, community psychiatric nurses and pharmacists and will be expanded to include specialisms as well, such as paediatrics, ear, nose and throat and respiratory services. It will be available to all 85,000 patients in Gosport. This will then allow us to scale up GP cover, in terms of opening from 8am to 8pm and seven-day working.

The surgeries will continue with the monitoring of long-term conditions. This urgent care service, by relieving pressure from day-to-day working at the surgery, will increase the surgeries’ capacity to be able to deal with more patients with shorter waiting times and longer appointments.

The benefit to patients will be improved access: if a patient needs to be seen, they will be seen. If they need an alternative service they will be signposted to that appropriate service in a timely fashion.

As an example, if you rang to see your GP with back pain and you needed to see a physiotherapist, the system will get you straight to see the physiotherapist, without the delay of seeing a GP and a referral form being filled out.

A similar scheme is in place at the Arnewood Practice in the New Forest, where a musculoskeletal (MSK) practitioner has been employed as part of the practice team. Patients who call the surgery with knee or shoulder problems, for example, can be booked in directly with the MSK practitioner where appropriate.

Meanwhile, in East Hampshire, GPs are looking at same-day access by working to understand the issues and variations across practices. This will lead to developing tailored solutions for the locality. If appropriate, this may include piloting same-day appointment hubs operating from 8am to 8pm.

In Gosport we are introducing a new group of volunteers known as “surgery signposters” in partnership with Gosport Voluntary Action. These volunteers assist people who are frequent attenders at GP surgeries, who might have a non-medical problem, for example loneliness, and could receive the support they need from a local voluntary group or service.

They will work with patients to identify appropriate support available.

A team of pharmacists, nurse practitioners and GPs with specialist interests will visit every nursing home in Gosport. They will stop inappropriate medication that may have been prescribed some years ago. We aim to set up the specialist nursing home service to review all patients on a regular basis.

This is an exciting time and enables us to work closely to change systems to benefit a large number of patients in one fell swoop.

Dr Donal Collins qualified in Cork, Ireland in 1989 and worked for five years in a busy district general hospital in Limerick.

He finished his GP training in Gosport, Hampshire, before taking on a full- time job at The Highlands Practice in Fareham.

Dr Collins developed his special interest in Ear, Nose and Throat (ENT) conditions and finished his postgraduate diploma in ENT in 2007.

Following this Dr Collins was part of a group who set up Fareham Area Clinical Enterprise (FACE) Ltd in Fareham and Gosport.

He is now chairman of FACE, which runs ENT, gynaecology and cardiology clinics in the community, at GP surgeries in the area. He is also lead for the community ENT service.

Dr Collins is Clinical Lead for the Multi-Specialty Community Provider in Gosport and Chairman of Fareham and Gosport Primary Care Alliance.