West Leeds Primary Care Network (PCN) has been introducing new roles into a multidisciplinary team that covers the whole PCN, pooling capacity, experience, knowledge and skills to deliver a seamless primary care service to patients.
The primary care team now includes pharmacists, pharmacy technicians, care coordinators, occupational therapists, dietitians, a paramedic, health and wellbeing coaches, social prescribers, physiotherapists, and physician associates.
Most of these roles are designed to work across the entire PCN on a pro rata basis rather than within individual practices, so that the team’s time is spent in the areas where they are most needed. The exception to this is the physician associate roles where the PCN beds individuals into their own allocated practices for continuity and to build relationships. The positions are being funded through the Additional Roles Reimbursement Scheme (ARRS).
Alleviating pressure in the practices
PCN Manager Lisa Francis explained: “One of the aims of widening the skills and clinical disciplines available across the team is to alleviate pressure on the GPs and practices as a whole.” Patients can get the care they need from an appropriate healthcare professional, often much more quickly than was previously possible. “The new roles also allow patients easier access to services in their own community, potentially saving them unnecessary trips to hospital and time spent waiting for a referral”.
The physician associates in the team provide direct support to GPs. They work with the on-call GP each day, helping to triage and treat patients, and carry out home visits as needed. There are three physician associates covering the seven practices in the PCN, with the prospect of more to be recruited imminently.
The other team members create rotas to cover all the practices. All patients within the PCN are placed on one federated clinical system and appointments are allocated to practices on a pro rata basis according to their list size. However, the team ethos means that slots left un-booked after a certain time are opened out to other practices to book, ensuring there is no wasted capacity.
As well as using additional staff to provide care for all patients, the PCN was also considering how best to deliver a joint frailty team service together with the local community NHS trust. “We decided to take on four health and wellbeing coaches who are able to make home visits to support patients with a severe frailty score and an acute condition.” Lisa explained.
Another important role has been the social prescribing link workers who are “worth their weight in gold” according to Lisa. These link workers can see patients for 45-minute appointments, to listen and understand where people need support, then signpost them to services that can help. They can carry a short-term caseload as needed, so they are able to give patients the time they need. Their role also includes community development work with the third sector and others working in the community.
Focus on pharmacy
One area the PCN has focused on is the pharmacy team, which is now well developed with a range of different grades including an apprentice pharmacy technician.
“We have extraordinary staff in our pharmacy team, who complete the tasks that practices need every day, such as prescription requests and medication reviews,” said Lisa. “They aim to balance alleviating practice pressure while ensuring our PCN meets its contractual obligations such as the Impact and Investment Fund targets including taking a lead on the CVD indicators, and medication reviews for people with learning disabilities and serious mental illness. Some practices have their own pharmacists, and the PCN team has built relationships so they can support them as needed”.
The PCN multidisciplinary team (MDT) meets in full once a month, with individual team meetings also taking place regularly. For example, the frailty team has a weekly MDT meeting and monthly meeting together with the Leeds Community Healthcare NHS Trust (LCH) and a geriatric consultant.
“This is a key element of PCNs,” said Lisa. “In the past there has been a degree of separation between stakeholders and GPs and the PCNs are here to fill that. For example, one of the frailty team is employed by LCH and they have access into the virtual frailty ward, which helps the PCN team eliminate unnecessary admissions”.
The monthly MDT meetings bring staff together in such a way that they can wrap care around individual patients. All the services are offered via the patient’s own GP surgery, and they have instant access to all the services without needing a referral to the local trusts. The teams all know each other and can make things happen quickly.
Key relationships for success
The PCN team has almost 40 members, 35 of which are funded by ARRS and the rest through the Leadership Fund. It is still recruiting so this number is likely to grow again. The leadership team is always keen to apply for any and all funding available to support their vision of how the PCN can work. The ethos of West Leeds PCN is to ensure it spends every penny of its ARRS allocation.
“As a social enterprise we keep a firm eye on finances,” added Lisa. “We make sure we don’t miss out on any non-recurrent options, and we’re also a training PCN”.
Lisa concludes that cohesion in the leadership team and the relationships between the separate GP practices is integral to the success of any PCN. Each practice has to “pull in the same direction” in order to be a success.