Improving access to General Practice: Improving access to general practice through innovative working, Birmingham

Case study summary

Following the establishment of a GP federation that covers almost 60 member practices and approximately a third of the population of Birmingham, GPs looked at how to improve current services (such as location and timings). This led to an extensive programme, which included the founding six new access hubs, new IT systems and the development of virtual clinics – all designed to improve patients’ experience of general practice.

What was the challenge?

A core challenge faced by the federation was how to ensure all practices in the federation shared the same vision and plans for the improved access programme, which was made more complex by problematic existing ways of working.

What were the opportunities?

By increasing the availability of general practice appointments (including at evening and weekends) for to patients, the federation would be able to greatly improve the offer to patients in their area.

What did they do?

  • Established six hubs to provide additional face to face GP and nurse appointments during extended hours. A foundational aspect of the federation’s programme was the introduction of hubs under a ‘hub and spoke’ model to support patients to access the right care, at the right time, in the right place. The hubs were designed around patient needs, with core elements being that the hubs are no more than three miles away from the patient’s registered practice and are open outside core working hours (8-8 Monday to Friday and six hours a day on weekends). They were also centred in existing practices, which (coupled with an integrated IT system enabling access to the patient’s full clinical record, once explicit consent has been obtained) means they are able to act as an extension of the practices. This has led to excellent utilisation levels of 86% across all face to face hubs during the last quarter of 2017-18, which has continued to rise as Birmingham residents become more familiar with the system. SDS MyHealthcare, the local federation, is now working with practices and the CCG to agree sites for three additional hubs so that more patients can benefit from increased availability and flexibility of general practice appointments.
  • Introduced virtual GP and pharmacist consultations. To further enhance the offer in Birmingham, the federation developed the choice and capacity for telephone consultations. Open between 08:00 and 20:00 Mon-Fri and six hours each on Saturdays and Sundays, the service has been designed and run by clinicians. It was introduced following an extensive consultation scheme, which included a small pilot ahead of launch to ensure any issues could be overcome prior to full introduction. The virtual service was assessed by the CQC in April 2018 and received an overall rating as Outstanding with Responsiveness and Leadership being particularly strong.
  • Extended virtual consultations into specialities. Following the success of the previous telephone consultation initiative, the federation used the methodology and underpinning technology to offer innovative care for specialities such as diabetes and frailty. Working with partner provider organisations including Birmingham Community Healthcare Foundation Trust, for patients with diabetes, the service uses the consultants and specialist nurses to deliver virtual reviews for practices on behalf of identified patients. The use of clinicians working in these virtual hubs has helped to embed closer working and greater trust within the service for both consultants and GPs. After a successful six-month trial period, it is now being rolled out further, with approximately 70% of consultations being virtual reviews; saving direct attendance and improving the convenience for patients.

Patients can book into all the above services either via their registered practice or by using the SDS MyHealthcare digital app.  The app enables them to book appointments at their own practice and in the extended access face to face and virtual hubs, order medications, view their medical records and access health management advice tailored to their medical conditions.

“The initial improving access to general practice initiative has given us the direction and foundation we need to work closely together across the region. We now look forward to continuing to collaborate on projects for the benefits of patients across the area.”  Mani Dhesi, Transformation Director – South Doc Services MyHealthcare Federation.

What are the key messages to take away?

For those looking to implement similar initiatives, there are two key learnings:

  • Engage with all stakeholders. It is vitally important to not assume what others may think or want for their healthcare service. To address this, the federation worked with partners, such as patient groups, local health trusts and clinicians, from across the system to develop their strategy. This work involved a series of workshops across six months, which were centred around building trust and gaining feedback on their strategy.
  • Build a shared purpose across providers. To successfully introduce new ways of working into general practice, the federation needed to unify their strategy because existing ways of working and formal contracts could prove challenging. A series of meetings, alongside the stakeholder engagement programme, allowed the federation to work collaboratively with the practices to develop their shared objectives to improve access for patients.