Case study summary
Fleetwood in Lancashire is a beacon study for improving access to general practice services through community engagement. GPs have worked alongside community pharmacists, social workers and mental health workers from across primary and secondary care to proactively focus on improving the health and well-being of the local population.
What was the challenge?
Fleetwood serves an urban community suffering from high deprivation, where the life expectancy of its 26,000 residents is significantly lower than the national average. With rising service demand (A&E four hour waiting times were consistently below the national average), declining local health statistics and a GP understaffing rate of 50%, change was needed.
What were the opportunities?
By transforming general practice, Fleetwood moved away from simply managing people’s illnesses towards helping people improve their lifestyles and preventing illnesses from developing. GPs in the area extended beyond the surgery room and traditional face to face appointments to work with residents and explore how they could live better, healthier lives and roll out community well-being projects. Fleetwood’s three GP practices formed an integrated federation, developed relationships with community pharmacists to enhance their services for patients and made residents central to the decision-making process.
What did they do?
- Developed the Healthier Fleetwood scheme to ensure that residents remained active players in the local healthcare system. Healthier Fleetwood is a partnership of residents, healthcare providers, charities and other groups, which is empowering residents to make a difference to their lives, thereby boosting their long-term health and wellbeing. Based in the local Health & Wellbeing Centre, the initiative organises events such as free sports lessons, mental health support classes and drop-in sessions to engage residents with new programmes.
- Consulted the local community from the start. An initial meeting gathered residents together to find out what matters most to them. People felt they wanted help to stay well and have a greater say in how their healthcare was organised. Following the initial consultation, a series of regular consultations and meetings were held across several months with the local community so that the plans could be co-created in line with their needs. Residents remain central to the project; Healthier Fleetwood is chaired and organised by local residents – with healthcare providers acting as facilitators for residents’ conversations.
- Formed a federation across three general practice sites, including community pharmacists and multi-disciplinary teams. Working at scale and sharing the resources of three local practices in the form of federated working enabled clinicians to tackle staff shortages and provide appointments outside of ordinary working hours, across seven days.
- Engaged with community pharmacists to enable pharmacists to access GP records; providing another avenue for patients to seek support. As pharmacy teams are not part of the existing data sharing platform, this was a complicated process that took several months of negotiation, between NHS Digital, GP teams and pharmacies. The process was also accelerated due to existing relationships between the general practice and pharmacist managerial teams. This means pharmacists can further assist Fleetwood residents by being able to directly support them with their medical requirements.
- Established multi-disciplinary teams including social workers, GPs and mental health workers from across secondary and primary care to design pathways better suited to the needs of their patients.
What outcomes were achieved?
Greater community involvement through Healthier Fleetwood has given longevity to their concept of wellbeing. There are now over 100 clinicians, including GPs, nurses and mental health teams, working to support Fleetwood residents in a range of areas from mental health to drug abuse. Additional community groups include the Harmony & Health singing group, where residents come together to improve their health while enjoying an afternoon of companionship, and a year-round calendar of outdoor activities such health walks. Local schools are also involved in mental health access schemes; helping to provide support and build resilience amongst school children. Fleetwood is helping to support its local community to live well; focusing on school children can help to prevent the development of long-term conditions and ensure a healthy adult population in the longer-term.
Significantly, from a previous 50% GP understaffing rate, Fleetwood is now fully staffed with 16 GPs, as the new model enables the sustainable delivery of local services. This has helped to reduce the pressure placed on GP workloads. Furthermore, the use of targeted multi-disciplinary teams across primary and secondary care has led to a reduction in patient input.
“The Improving Access to General Practice initiative has been hugely significant for our town. We are now able to do what all GPs want to do; care for their community. Helping residents becomes active players has transformed their relationship with us. The increased community confidence, events and wellbeing schemes would not have been possible without this initiative.” Dr Mark Spencer, Fleetwood GP.
What are the key messages to take away?
For those looking to implement similar initiatives, there are three key learnings:
- Empower local citizens by engaging them with the process from the very beginning. Working with them to design a service appropriate to their needs and ideas helps to give residents ownership and create a flexible system with longevity at its core. Fleetwood demonstrated that what clinicians think patients want is not necessarily the same as what they actually want. Clinicians and the health service tend to begin by looking at how to manage illness, but the local community needed someone to help them live well.
- Work with stakeholders from across the system in an integrated, collaborative approach. By developing ongoing relationships with other providers in the area, it is easier to overcome the hurdles to improving GP access and transforming care.
- Appreciate that not all changes occur instantly; it took ten months for the team to integrate GP records with the community pharmacy. However, integrating data and medical records has been essential for encouraging collaborative working. Although a lengthy-process, it was critical for transforming general practice that patient records were shared between general practice and pharmacists. As a next step, it will be important to ensure this data is shared with paramedics and social care.