Case study summary
In Wessex, a wide range of stakeholders worked together to accomplish a liaison scheme for GPs and Consultants. Designed to reconnect individuals and foster deeper partnerships between clinicians, the scheme resulted in a number of short and long term outcomes. It is a simple, cost neutral concept driven by passion, determination and meticulous planning. It exemplifies a method of influencing innovation and change in order to improve patient care and safety. The pivotal themes are clinical leadership, partnership and behaviour.
“an outstanding way for professionals to come together to discover how to ensure high quality, continually improving and compassionate care for patients…..” Professor Michael West, Kings Fund.
It became apparent to teams in Portsmouth that the barriers between primary and secondary care often led to frustration on multiple levels and affected patient care and safety. The GP-Consultant scheme was born from an appreciation that better interprofessional relationships drive improved patient care and outcomes and ignite opportunities for innovation and quality improvement.
Following the success of the Portsmouth scheme in 2015, similar schemes were initiated in Southampton (2017) and Basingstoke (2017).
The initiative was designed to develop compassionate leadership and better working relationships that would encourage co-owned, local solutions and the seamless care of patients.
Key to this was developing a better understanding of the barriers faced at the primary and secondary care interface; whether relational, reputational, historical, invisible or infrastructural between primary and secondary care.
How it worked
Secondary care consultants from University Hospitals Southampton and local GPs volunteered to host and visit each other’s workplaces for half a day, to appreciate the challenges they each face within their work settings. 59 self-volunteered secondary care doctors were paired with 59 general practice counterparts; and as far as possible this was tactically planned in order to enhance working relationships e.g. pairing a locality GP with a geriatrician working within locality. Each pair spent half a day in each other’s environments from September – December 2017.
All clinicians completed an anonymous reflection template of their experiences, submitting voluntarily to the project lead. The reflection templates were categorised and analysed for common themes to determine if practical and pragmatic changes could be implemented to improve the local delivery of care.
Specific feedback was obtained from 71(60%) individuals. Responses were scaled from 1 (least likely) to 6 (most likely) and given a weighted average score. The results demonstrated that a number of barriers had been broken down and that scheme participants:
- were in support of a regular primary-secondary care forum (5.25);
- found the scheme useful (4.59);
- were likely to take part again (4.83);
- were willing to consider new ways of working as a consequence of building better relationships (3.85).
Themes that emerged from the scheme:
‘How do we make ourselves more accessible to colleagues and improve the flow of communication?’
‘Small acts of kindness make such a difference’
“…. impressed by the time management as a 10-minute appointment is clearly not a ‘one size fits all”
“… the computer system was not as easy to navigate, as the systems we have in place in primary care”
“GPs are highly trained clinicians with extraordinary communication skills navigating complex patients”
MDT (Multidisciplinary Team)
“…. amazing camaraderie in a very difficult working environment that provides support for the staff”
Training and appraisal
“Sheer lack of juniors in clinic”
It was vital to the success of the scheme that communication continued following the exchanges. A celebration of the shared learning from the liaison took place in January 2018, where the emphasis was on compassionate leadership and next steps. The ‘so what, now what’ plan was central to the discussions. The evening was CPD accredited and all reflections contributed to participants appraisals under quality improvement activity. The following affiliated NHS organisations joined the event:
- University Hospitals Southampton Staff Committee
- Thames Valley Wessex Leadership Academy
- Wessex Faculty RCGP
- Wessex LMC
- University of Southampton
- Southampton City CCG
- Fourteen fish
- Wessex Heartbeat charity
- Wessex Deanery
The event was graphically captured by a local student artist and the artwork is on display at the CCG, Wessex deanery and University Hospitals Southampton. It was also captured on video, and this was used to promote the scheme, and to teach leadership and professional development within the local medical school. It has been presented to Specialist Trainees as part of their ‘Work Smart’ day, Acute Medical training day – secondary care, primary care TARGET GP education event and the Southampton City CCG governing board.
The initiative and event were also widely published in:
- The local press
- University of Southampton, Faculty of Medicine
- CCG website
- TVWLA website
- Wessex faculty RCGP weekly e-news nationwide to 50000 GPs
- Support from the Chief Executives from UHS and SCCCG was instrumental in allowing both consultant and GP engagement.
- Networking with multiple influential agencies e.g. University of Southampton, RCGP, Southampton City CCG and University Hospitals Southampton allowed broader advertisement of the scheme, through a number digital channels, and contributed to the schemes favourable outcome.
- Engaging local affiliated NHS services maximised the impact and allowed for the spread of quality improvement activities.
- Primary and secondary care input in co-designing the celebratory evening as well as the feedback templates ensured there was equity in spread of clinicians as facilitators that contributed to its success.
The following quality changes have been observed:
Development of a template for hospital OPD letters
Dr G spent a morning in general practice with Dr G and observed how many templates were being used to code and structure the consultation. Dr G reflected on the experience and consequently has piloted a template structure for their OPD letters.
The result was the standardising of structure and time efficiency, as originally each letter could take up to 30 mins dictating. It also led to a framework for junior doctors to know how to structure their own OPD letters, resulting in training efficiency.
Production of leaflets on psychological support for patients whilst in hospital
Dr A realised that their patients, whilst in secondary care, were unseen and unsupported psychologically by primary care, although going through potentially the most traumatic experiences of their entire life. Dr A discussed their thoughts with Dr H as a result and explored options on how patients can be better sign posted to primary care psychological support whilst in secondary care.
Production and sharing of primary care secretary contacts
Dr D observed in primary care the direct urgent lines that the community teams had to access in general practice in an urgent situation that didn’t require 999. Dr B observed in secondary care, secretaries struggling to get through to primary care. In response direct dials for all GP secretaries in Southampton City CCG have been identified to share with University Hospitals Southampton.
Restructuring outpatient clinic letters to state “For Information Only” or “GP Action Required”, resulting in substantial time and cost savings
Dr P spent time in general practice and reflected that 90% of the letters were being read by the admin team in primary care. They coded the letters and only passed on to GPs those that required a specific issue for a GP to action. Dr P considered and has begun to change their own practice by heading their letters with ‘For Information Only’ or ’GP Action required’ in order to reduce the administration in general practice. Discussions have begun with University Hospitals Southampton to see if this could expand across all specialties to save time in primary care.
Capturing the evening graphically and on digital media with help from local students put a spin on developing leadership as well as giving them insight into life beyond medical school. There is now a body of resources that will be used within the medical school to provoke reflection on artificial barriers that impact on patient care and quality.
- Promoting the scheme nationally.
- Supporting other localities to roll out similar projects.