Case study summary
An Urgent Care Team was introduced to help the medical group cope with the number of GP vacancies and therefore limited GP appointments available. An effective triage system was set up, made up of medical professionals, directing routine patients through the usual and appropriate channels to make an appointment, and promoting self care and accessing community services.
Beacon Medical Group became faced with a number of GP vacancies and a recruitment issue due to the national shortage of GPs, along with a challenge around provision of same day access and availability of routine advanced appointments. The board and partners took the decision to convert the vacant GP sessions into Urgent Care Team slots and to recruit a range of skilled clinicians to form an Urgent Care Team (UCT), which includes a paramedic, and pharmacist and a nurse practitioner as well as a GP. This new way of working began in June 2015.
The ‘No Waiting Room’ campaign introduced the concept of an UCT and plans to educate patients as to what it was and who it was for. It recognised that some patients might find it hard to adapt to seeing other clinicians when they are unwell. It was an eye catching physical message which quickly gave patients insight and knowledge regarding the new services available.
The ‘No Waiting Room’ campaign was designed to convey the message that instead of spending time sitting in the doctor’s waiting room, patients could now access an alternative service that could meet their needs in a more timely manner – essentially, the right care, at the right time, with the right person.
Beacon Medical Group (BMG) recruited nurse practitioners, clinical pharmacists and an advanced paramedic practitioner to form a UCT in place of recruiting additional GPs.
The team work Monday to Friday and provide a service between 8am and 6pm each day. The UCT sit together in a hub, alongside the duty doctor who triages the majority of the urgent on the day work and distributes it to the team.
Previously the reception team would undertake the initial triage of calls and each GP would have their own list of urgent on the day calls to make and patients to see. This work now sits solely with the UCT however they still ensure that each GP has at least two ‘on the day’ slots that the UCT can book into if necessary and/or appropriate, for example to ensure continuity of care.
All the UCT make calls to patients, are able to take patients from the duty list that are appropriate to be seen by them and have appointments that they are able to book patients in to if they need to be seen that day. Our Advanced Paramedic Practitioner also undertakes home visits as necessary.
The reception teams were key in promoting the UCT to patients and explaining its function and purpose. They have also instilled confidence in patients that they are not receiving a lesser service but in fact a better service.
The introduction of the UCT and subsequent review and refinement of the triaging process has had significant impact for GPs and patients and generated positive outcomes across the board including:
- Capacity to manage the on the day demand for urgent care
- Ability for GPs to focus largely on long term conditions management and routine patients when they are not on duty
- Smoother running duty days and more manageable workloads for duty doctors
- Faster access to urgent on the day advice and care for patients for whom it is appropriate and necessary
- Increased patient education and awareness in regard to who they can be seen by and the clinicians within their communities who are able to provide services to them
- A greater understanding that not everyone and everything needs to be seen by a GP
- Increased availability of advanced appointments enabling people to book in with their clinician of choice and for continuity of care for long term conditions management.
The UCT has been successful because they not only possess the right skill-mix but also the right personality mix. They work as a team, learn as a team and share best practice and experience in order to up-skill and enhance their practice. The team receive regular tutorials and are given the time and opportunity to develop as practitioners. The team receive both operational and clinical support.
It was thought that having an Urgent Care Team might increase inappropriate access to primary care services in offering another way for patients to be seen. BMG have ensured that this has not been the case through the effective use of their triage system, directing routine patients through the usual and appropriate channels to make an appointment and promoting self care and the accessing of community services via our telephone triage.
Tips for adoption
- Engagement, and buy-in from all staff
- Strike a balance between routine and urgent provision that meets the demands on your service and provides a positive patient experience: monitor, adjust and adapt
- Regular review and revision of the service as necessary
- Ongoing support and training for team members
Dr Jonathan Cope GP said: “At Beacon we recognise that our core role is to provide the best possible service for our patients. We aren’t afraid to work with others and to use new approaches in finding ways to improve our services. We feel it’s our duty to find sustainable ways of working, use our resources wisely and to look for improvements at every opportunity.”