Note: Some sections of this case study refer to clinical commissioning groups (CCGs). On 1st July 2022, integrated care systems (ICSs) took over statutory commissioning responsibilities in England, and CCGs were closed down. You can learn more about integrated care systems (ICSs) here.
Case study summary
Gateshead community and primary care provider CBC Health worked with the general practice federation and other stakeholders (such as the foundation trust and local authority) in their local area to develop a more integrated service offering for patients, covering primary and secondary care. The result was a more resilient local healthcare system, reduced pressure on urgent care and increased access to general practice appointments at a time and place more convenient for patients.
What was the challenge?
General practices wanted to address the issues of bottle-necks in patient flow, which were resulting in difficulties surrounding general practice appointment and pressure on urgent care services including A&E. This was in the context of a mixed demographic population of 200,000 predominately urban residents, with some rural areas on the outskirts of the locality. The varied demographics of the area meant providers needed to develop a range of services appropriate to the diverse population needs.
What were the opportunities?
Gateshead aimed to integrate the area’s 30 GP practices alongside other health services. This strategy aimed to improve the service availability and sustainability for patients by delivering the right care at the right time. Stakeholders from across the healthcare network, including GPs, pharmacists and nurses, were able to utilise their long-established working relationships, particularly with the CCG who worked as system facilitators, to enable a smooth integration process that guides patients through their treatment pathway.
What did they do?
- Extended accessibility by integrating services across the area. After speaking with patients, GP providers established that patients were willing to travel slightly further than their usual practice if it meant appointment availability at a time convenient for them. In response to this feedback, providers developed a hub-based model in strategic locations to provide additional capacity without adding burden onto local practices. Two hub sites were established meaning residents could gain access to both nurse and GP appointments outside usual working hours, including at the weekend.
- Worked to develop cross-organisation booking of general practice appointments. As well as allowing practices to book patients into the hubs, the appointment process was integrated with the NHS 111 telephone system; helping to increase uptake, and also relieving pressure on the broader healthcare system. NHS 111 can book appointments directly in to both the extended access hub and local practices. This was achieved by developing interoperability between EMIS Web and the local NHS 111 provider’s system. This involved software developers from both providers working together to develop a solution that would allow NHS 111 to directly book patients into appointment slots within EMIS. After the software solution was developed and tested, they configured the appointment book to allow specific appointment slots to be directly booked by NHS 111. The NHS 111 Directory of Service (DOS) was then updated to ensure the correct patients were directed into the service. Callers are now able to have their appointments scheduled by the operator at a time to suit them, which helps to ensure the services are well-utilised.
- Introduced a home visit service to manage demand. To reduce the bottlenecks that were slowing the flow of patients, providers also developed a system of home visits. This helped to create capacity for patients to be treated in the community and reduce the footfall of patients presenting at A&E. This was achieved by allocating a GP solely for home visits, so practices could send the GP to treat patients at home on their behalf. CBC uses a system called RotaMaster for managing all the shifts available across their portfolio. They extended the Home Visiting service on offer by adding an additional shift onto RotaMaster, which was advertised to all the GPs working in the service; these were a mix of salaried GPs and GPs working on a sessional locum basis. The shift operated between 4pm-8pm, which allowed GP practices to refer patients to the visiting GP.
What outcomes were achieved?
By integrating services, practices were able to work together at scale and with other providers, Gateshead has been able to provide over 1,000 extra GP appointments per month (with an average utilisation rate of 83%), better direct patients to the most appropriate area within the system and work with local groups to ensure the model design is influenced by local area’s needs. The success of the initiative has been demonstrated by the high uptake of the new services, as average utilisation rates of all appointments hit approximately 83%, pressure is eased in other parts of the system, particularly in primary care.
“Our long-established relationships with the proactive CCG and providers here in Gateshead has been critical to the success of our strategy. By integrating general practice services, we have been able to build and strengthen the existing system, whilst also improving patients’ access to general practice.” Jill Mitchell, Chief Executive, CBC Health.
What are the key messages to take away?
For those looking to implement similar initiatives, there are three key learnings:
- Use existing relationships with providers in the area to help develop service specification and strengthen transformation. This also involved working alongside local patient groups who were already working with the CCG as part of the urgent care strategy consultation process.
- Anticipate the strengths and weaknesses of technology. The development of data sharing agreements and the implementation of the same clinical system across all practices facilitated federated working; allowing patients to access multiple practice sites at any appropriate time. Arranging a system of cross-organisational appointment bookings required time to ensure all appropriate regulatory obligations are met, particularly regarding patient confidentiality.
- Continually listen to patient and staff feedback. The teams in Gateshead continue to work with stakeholders, such as patients and GPs, to refine services through regular patient experience surveys, utilisation data reviews and feedback meetings; helping to ensure they remain appropriate to their requirements.