Improving access to General Practice: Integrating services to improve access to general practice, Bristol, North Somerset and South Gloucestershire

Case study summary

With a large patient population, Bristol, North Somerset and South Gloucestershire GPs developed a network to unite the eighty-two practices in the area around a shared vision; centred on improving access to general practice. This scheme encompassed many different elements including joining up software systems, developing an intranet service to encourage collaboration and supporting practices to better use data when planning services.

What was the challenge?

GPs in Bristol, North Somerset and South Gloucestershire cover a patient population of approximately one million people, spread across eighty-two practices. Due to the substantial number of practices in the area, working together at scale was often a very time-consuming process, but GPs recognised the need to start to work more innovatively if they were to enhance service provision.

What were the opportunities?

By working more closely together, GPs and other healthcare providers would be able to enhance their resilience, improve their offering to patients and build upon the shared learnings from across the region.

What did they do?

  • Worked collaboratively to provide out of hours services. In 2014, GPs started the programme with a series of ‘discovery interviews’ to understand the practices’ priorities and concerns. A key principle of the programme was to be able to deliver appointments in the early mornings, evenings and weekends. Practices now work together in ‘clusters’ to offer this service, which means that if an appointment is not available at the patient’s registered practice, they may be offered an appointment at another surgery close by. Patients are also able to access a range of services via their practice that may include appointments with a GP, nurse, physio, pharmacist, mental health nurse or healthcare assistant.
  • Integrated EMIS software across the area. The cross-organisational clinical platform provides in and out of hours clinicians in Bristol with access to the full patient record, even if they are outside a patient’s registered practice, which leads to improved continuity of care for patients. Practices are also able to directly book onto appointments that are taking place in other locations which opens up flexibility and availability of appointments for patients. This has all been enabled through data sharing agreements that ensure that all appropriate data protection legislation is observed.
  • Developed intranet system. To facilitate the sharing of good practice and to help practices avoid duplication, the federation established a collaborative intranet system that all practice staff can access. This is used to aid the sharing of best practice and develop communications across the area, including the promotional materials that were produced to support practices with promoting the new appointments they are offering in the early mornings, evenings and at weekends.
  • Established service for data analytics. It was recognised that every GP practice has a wealth of data in their system, but a lack of time to process and analyse the data for useful trends. Employing business analysts, the federation supports practices by providing quick and precise data analysis relating to practice systems and operations, as well as patient profile and activity reports; helping practices to plan more effectively. The success of this project has led to collaborations with other organisations in the local health system, such as hospitals, to better understand how what is happening in primary care impacts on secondary care and vice versa.

What outcomes were achieved?

Patients are now able to access early morning, evening and weekend appointments, with records shared with appropriate practices across the area. Utilisation of improved access appointments has been at 81% between April 2017 and April 2018. Meanwhile, practices also have increased access to a mix of clinical staff, are better able to share best practice through their intranet system and gain better understanding of how their practice operates from the wealth of data produced by their services, which can inform planning and delivery of services.

“The improving access to general practice work has made a positive difference for patients and GPs alike. We are proud of our work in Bristol, North Somerset and South Gloucestershire, as we continue to support practices deliver resilient, sustainable general practice services”  Dr Jacob Lee, Medical Director.

What are the key messages to take away?

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

  • Set clear objectives and share ideas. The collaborative process must begin from the start; by working closely together and understanding the importance of building trusting relationships the federation was able to think precisely about how to develop general practice services. A continual programme of support and communication has facilitated an ongoing process of service refinement and improvement.
  • Use data wisely. Although individual practices often lack the capacity to process and analyse their data, collaborative working enables a centralised method of data analysis. This can then be presented to practices in reports and used to improve service planning based on analysing demand and patient need.