Case study summary
In one of the largest schemes in the country, covering a diverse population of 609,000, Manchester GPs sought to transform access to general practice with an ambitious programme of practices working at scale, alongside nurses and healthcare professionals. For this scheme, every area practice joined a federation to set up community hubs, improve their ways of working by focussing on a community-based model and connect software systems from across the city into one, more efficient, platform.
What was the challenge?
The city-wide federation working with its member general practices wished to increase the accessibility and reach of general practice, particularly the number of available appointments, whilst ensuring patients were aware of how to access the most appropriate point of care; to help relieve pressure on other areas of the system (particularly A&E). They identified two key barriers to achieving this : managing capacity of existing general practice to meet the new demand and facilitating access to patient data across Manchester city practices.
What were the opportunities?
All practices within Manchester are part of a federation that is designed to facilitate close collaboration across the city. To provide the best localised care, the city’s practices worked collaboratively within the federation to identify the specific areas of need and the most appropriate care provision required by each of the 12 wards (local areas). If successful, this would enable improved, personalised patient services that more precisely address health needs.
What did they do?
- Established twelve community hubs and three hubs within A&E departments. At the end of the pilot, the scheme was consolidated in thirteen community hubs. Twelve are based in existing GP practices, with another in North Manchester Hospital. Initially dedicated to providing GP appointments between 6.30-8:00pm and at weekends, the hubs have now been expanded to include nurses and HCA appointments; all providing the necessary care for patients and referrals as appropriate.
- Directed people to the hubs through a large-scale communication programme. An extensive communications programme was implemented across the city (including advertisements on buses, radio and TV) to raise awareness of the new initiatives and how patients can access the right care. This helped to encourage use of the new general practice hubs. All practices were given a suite of literature and other supporting documents that was adapted for each practice to ensure it was suitable for that locality. This included developing materials in the key languages spoken in the area. Furthermore, a mobile app was developed and offered to patients for free to support them in accessing their nearest hub. To enhance accessibility, this app was made available in both android and iOS formats. The campaign was highly successful with a post-campaign research report finding an 85% recall rate.
- Developed data sharing agreements with every practice to share patient records. The biggest challenges facing the Manchester federation – and ultimately one of the greatest success – was realising a data sharing agreement with each practice. The federation believed it was important to provide continuity of care by being able to access full clinical records at the point of consultation; helping to build patient confidence in both existing and new services.
EMIS systems were configured and users’ guides developed to establish clear governance procedures to enable practices to book their patients into the additional Extended Access appointments within the community hubs across the city. Once the systems were in place, practices began a communications programme for both staff and patients to raise awareness of the initiative and to ensure patients understood and consented to how their data was being used. As data protection was an important consideration for the scheme’s success, the federation developed a patient consent form, which sought specific patient consent for the clinician to view their records at the point of consultation, which patients were happy to sign.
- Created health development co-ordinators tasked with identifying the specific needs for particularly communities. Each of the city’s 12 wards (local areas) has different population demographics and healthcare needs. The co-ordinators were asked to review the specific needs of each area through an engagement programme with the community to ensure they were adequately supported. For example, they established that one ward had a high ethnic population with a diabetes issue and so put additional diabetes services into that area.
- Recruited new GPs. To fill recruitment gaps, Manchester embarked on an ambitious recruitment programme that targeted newly qualified GPs. The federation managers spoke with local deaneries to recruit new GPs; particularly GPs living within the local population, to help retainment. Another aspect of the recruitment process was the use of Rota Master; a software programme that puts all rotas online, so GPs can select available slots that work with their preferred times of working. To support this, regular GPs were employed and paid on an hourly basis. This flexible approach to scheduling meant Manchester was able to provide additional appointments at times of need, for example during the winter months. The popularity of this amongst patients was demonstrated by the take-up of the services; additional winter resilience hours saw an 84% fulfilment rate. Meanwhile, their core contract (including extended hours) is providing 100% of contract hours. This enables the area to regularly provide additional appointments at times most helpful to patients; a claim supported by high utilisation rates of around 94% during the week and 72% during weekends.
What outcomes were achieved?
By working together, GPs in Manchester have been able to increase the availability of general practice appointments, connect their separate IT systems to ensure continuity of care of patients and mobilise their teams quickly when appropriate. This was most clearly demonstrated following the Manchester Arena attack, when GPs and administration staff from across the area were able to work together at scale to provide the services most needed by the victims and their relatives.
“Working at scale has delivered transformational benefit to the people of Manchester, and the services it delivers. Through a “can do” attitude, we are continuing to work together to provide more and better services for patients.” Kathy Toppin, Operations Director, Manchester Primary Care Partnership.
What are the key messages to take away?
For those looking to implement similar initiatives, there are three key learnings from Manchester’s programme:
- Data-sharing is critical to working at scale. By sharing patient records, healthcare providers were able to build patients’ confidence in new services (such as community hubs), whilst also enabling continuity of patient care; as they do not have to repeat their stories to different practitioners. Taking the time to explain to patients the benefits of secure record sharing resulted in nearly all agreeing.
- Work alongside software companies. Data sharing was important to the programme, but this cannot be achieved without the support of the software companies, such as EMIS. All Manchester practices bar one used EMIS, which simplified engagement with the software provider and supported a smooth transition to integration and configuration of systems.
- Invest in communications, both for patients and stakeholders. New programmes and initiatives can often seem overwhelming to staff and patients, particularly when accompanied by lots of jargon. Therefore, reception staff were trained in how to use and navigate the new systems, to best advise patients on where to access the right care. A separate communications programme was developed to enable healthcare managers to not just inform stakeholders of the new services, but continually evaluate and improve the services, based upon feedback; the extended access patient questionnaire for October – December 2017 returned an 97.5% rating the service as excellent/good.