Easing the pressure in primary care

GP practices in Bedford, Luton and Milton Keynes (BLMK) are coming together as primary care networks to help relieve pressure on frontline services. Here the GP lead for the BLMK integrated care system explains how this new way of working benefits both patients and staff:

The working model for general practice has been the same for a long time, with individual practices each covering their own catchment area.

However, with primary care services under so much pressure in recent years, the need for change is inevitable.

Here in Luton, practices have been working together in networks covering 30,000 to 70,000 patients for about four years, with community services, social care and mental health all aligned around those networks. With the formation of the BLMK integrated care system (ICS) we’re now supporting practices to push forward with their network initiatives, and the practices themselves are looking more closely at how they can work differently.

There’s now a national driver for this kind of coordinated working across primary care, and established relationships between practices can support the formation of networks. Across our patch, we now have 20 primary care networks (PCNs) covering 100 per cent of practices.

How practices decide to come together can vary.  For example, a small town and its surrounding countryside may have an obviously defined community; however in bigger towns and cities the drivers can be based more around established relationships rather than geography..

Most important to the development of a PCN is the willingness to work together to address issues of concern, coupled with a certain pragmatism given that other services will need to wrap around the network.

We know that a population base of around 30,000 -50,000 is the optimum for such networks. They need to be small enough for the clinical and administrative teams to get to know each other well, but also cover large enough populations so that they can deliver initiatives at scale, such as recruitment drives or new interventions for patients.

In BLMK the drive to create PCNs has acted as a catalyst for practices to look at what local population data they have to find either the groups of people causing most concern or the services that most need improvement – areas that they couldn’t address alone.

Some practices, such as Lea Vale where I’m a partner, are well along the way as they were already working as networks of practices. Others just starting the journey are finding the possibility of doing something different very energising.

Once the networks have identified which population group they want to focus on and their needs, they are looking at the skills and recruitment required to address that need. For example, practices may identify a need for a home visiting service where emergency care practitioners or specialist nurses take calls from a number of practices, reducing the need for home visits by GPs and improving response times for patients across the network.

Not all networks share the same focus – some are targeting the needs of the frail elderly or people with multiple conditions, while others are focusing on the mental health needs of young people or people of working age.

For example, a PCN in Luton is focusing on children with very complex health problems such as a genetic or metabolic disease, who represent a very high-risk group with complex issues around medication and coordination of medical services.

In Newport Pagnell, local sports centre sessions supporting wellbeing and exercise and looking after yourself are being funded through Sport England, and in Bedford, PCNs are looking at working age mental health and working with community groups that offer support for isolation and anxiety.

PCNs are all about integrating health professionals and the voluntary sector, to reduce the handoffs and improve coordination. It’s not about adding extra resources, but using the skills of everyone already working with these groups in a more efficient way, reducing the pressure on primary care.

Speaking for my own practice, since working as a network that makes the most of everyone’s skills, we together see more people and there are fewer DNAs because a lot of what GPs do is on the day or the next day rather than booking ahead.

If I was to advise others looking at building PCNs, I would say that relationships are important. You also need to look at what data you have now, even if it’s not perfect, and to really make a difference for your populations you need to address the issues where there is a shared energy – even though there will be a lot more to do, these initial projects are an important starting point.

In BLMK we now have a workforce that can see a possibility of working differently. I would encourage everyone to start working together with your neighbouring practices and really work as a team to deliver the needs of that population. It’s very satisfying and, for me, it has absolutely brought back the joy of working in general practice.

To find out more about how GP practices in Luton are working together in new ways and providing life-changing support to patients, watch the video below.

Thinking creatively about primary care

Dr Nina Pearson

Dr Nina Pearson has been a GP for 31 years and is currently a part-time partner with Lea Vale Medical Group, a practice of 24,000 patients over three sites in Luton.

Nina has held a number of clinical leadership roles throughout her career and has been Chair of Luton Clinical Commissioning Group since April 2013. During this time she has led Luton CCG to a position of maturity with a health and social care economy which is meeting the NHS constitutional standards but still facing a significant financial sustainability challenge.

Since June 2017 she has been the GP Lead for the Bedfordshire, Luton and Milton Keynes Shadow Integrated Care System, developing primary care as the cornerstone of population health using the primary care home model.

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