Vulnerable Practices Programme – Pioneer Medical Group

Case study summary

Pioneer Medical Group (PMG) was formed on 1 April 2016 and is the merger of Bradgate Surgery, The Medical Centre Ridingleaze and Avonmouth Medical Centre. Technology was invested and synchronised, to support service delivery to expand the number of options available to patients in how and when they access care. The development of seven day access and integration of clinical teams, without the traditional boundaries of premises and organisations working in isolation, is key to transformation of primary care.

 

Pioneer Medical Group (PMG) was formed on  1 April 2016 and is the merger of Bradgate Surgery, The Medical Centre Ridingleaze and Avonmouth Medical Centre.

By merging, the group became  a larger organisation with one identity, one image, and one support structure; yet they are still able to retain individuality and patient centred focus.

This new model of general practice supports clinicians and support teams to deliver a truly exceptional service to patients across multiple sites in Bristol. Patients are able to consult at any base with any clinician and IT is used to expand the range of options available to patients.  With a larger clinical workforce, increased number of clinical bases and greater use of IT, PMG are able to support the development of access to primary care during evenings and weekends.  PMG believe that this model is safe, sustainable, responsive and can grow as patient need and numbers dictate.

Technology was invested and synchronised, to support service delivery to expand the number of options available to patients in how and when they access care. The development of seven day access and integration of clinical teams, without the traditional boundaries of premises and organisations working in isolation, is key to transformation of primary care.

Solution

Pioneer Medical Group operates clinical sites with front of house/receptionist support only; in essence, GP ‘shop fronts’.  All administrative functions come from one of two hubs: a scanning/coding/summarising/secretarial hub, and telephony hub.

The merged new practice created:

  • One single base of call handlers dealing with incoming patient communications (telephone and web-based patient access.)
  • One clinical duty team (one GP partner and a salaried doctor or a GP in training) based near the call handlers. Thus creating good communication between call-handlers and clinicians ensuring a timely, responsive and seamless service whilst the clinicians still maintain confidentiality needed. The ability to respond to patients and their carers within a short timeframe gives patients confidence and decreases the inappropriate use of acute care services.
  • The care coordinator sits alongside the clinical duty team. All out of hours reports and discharges from the previous night are reviewed and discussed as necessary.  The duty doctor directs the care coordinator to ensure that those patients with most need are contacted before 10am.
  • The clinical duty team are unencumbered with other clinical work – so they have no routine surgery, consultations or visits.
  • All surgeries run a late morning open surgery with extendable appointment slots. Appointments for the open surgery are for patients who choose to access their care in this manner and for urgent on the day need.
  • Appointments are bookable online.
  • The on-call/duty team absorb urgent requests coming in that don’t fit the open surgery model; phone calls from outside professionals (like paramedics or nursing home nurses), urgent prescriptions, urgent home visit requests, webGP consultations and potentially Skype consultations in the future.

Their role is to ensure all contacts are safely triaged. The available dispositions will be:

  • Closing the case – which may be within that phone call or a task to other staff or a prescription or other non-face-to-face solution such a ordering a test or investigation for the patient.
  • Arranging a face-to-face consultation at a clinical base convenient to the patient.
  • Arranging an urgent home visit.

Technology innovations

By merging and working with centralised/cloud based solutions PMG was be able to transform how and where work/tasks are performed – for both clinical and non-clinical staff.

EMIS

The EMIS clinical database has merged and PMG works from a single database. Non face-to-face contact with patients can occur from any site e.g.: telephone consultations, e-consultations, medicines management, exploration of skype consultations. By using IT to its full potential the new organisation is  able to re-distribute workload from any site and/or clinician/staff group.

Telephony

PMG has invested in a solution which simplifies the entry point into the system for patients. Telephonists/call handlers work alongside the urgent care team to ensure timely reactive and responsive care. Patients have confidence that their call will be signposted to the right service/person at the first contact.  Staff are well trained, have the right skills, values and behaviours and  sufficient numbers to support the delivery model of care.  A hub model ensures that PMG are able to ride the peaks and troughs of holidays and sickness.

Digital dictation

All clinicians are able to access a safe and secure digital dictation solution, facilitating working from any site with all dictation going back to the centralised secretarial team. The secretarial team are moving from the traditional typists to problem solvers; they now spend over 50% of their time helping patients through the maze that is the secondary care system.

The cloud-based digital dictation system ensures that there is a secure audit trail which facilitates typing.

Alongside the technology robust information governance processes and procedures are in place.

Tips for adoption

  • Do not assume that a process is the same in each practice. Language may be the same, but its use and understanding is very different.
  • Change must be discussed within teams.
  • Ensure that all working parties have a partner to lead discussions.
  • The partner must have autonomy to make changes on behalf of the partnership.
  • If you want a change/behaviour/action to happen then it must be planned – don’t leave actions to chance.
  • Listen and keep listening to staff and patients as they are working with and in the system.
  • Keep up the channels of communication.
  • • Join the teams earlier in the process.
  • Staff and partners naturally gravitate back to their original teams.
  • Don’t expect to see economies of scale in the first year.
  • Adding different practitioners to the skill mix makes an enormous difference to service delivery.
  • Make sure that buildings are ready for new teams. If they are not then delay the move. Don’t under estimate the level of work required post merging of clinical database.
  • The model for urgent care introduced as part of the merger is appreciated by all. It is timely and responsive.
  • Keep referring to the business and merger plan to ensure that you are on-track.

Business Partner Sharron Normam said: “Looking back we now ask ourselves why we didn’t merge earlier.  Our greatest achievement has been understanding the way the three practices worked, extracting all the areas of good practice and then producing a system which is stronger and more resilient than before.  Everyone from patients to doctors to call handlers appreciate the responsiveness of the duty doctor team.

“Every day is a learning opportunity and we thank our staff and patients for keeping us on our toes.  Pioneer Medical Group is an exciting and innovative place to work where challenges are viewed as opportunities for which we have yet to find solutions.”

For further information please contact:

Sharron Norman
Business Partner
Pioneer Medical Group
Ardenton Walk
Brentry
BS10 6SP

Tel: 0117 9591919
Fax: 0117 9581400