Case study summary
Six practices in the East Dorset area are working together as a primary care network to broaden their workforce to provide a more efficient service to their patient population and to reduce waiting times for diagnostic testing. They have introduced new responsibilities for roles including clinical pharmacists undertaking medical reviews and paramedics conducting home visits, with an aim to reduce pressure on GP workload and improve local GP retention.
South Coast Medical Group
What was the aim?
Patients in the East Dorset area had reported that they were often waiting a long time to be seen at hospital for diagnostic tests and were then returning to their GP with concerns which required a further appointment. With a high population of older people, multi-national local workforce, ethnic minority communities, a large population of students, social deprivation, homelessness and high turnover of transients (holiday makers), the demand on primary care was high.
To combat this, in 2018 six practices formally began working together as a primary care network across the East Dorset area, covering a patient population of 31,000. The initial aim was, to broaden the workforce to provide a more efficient service to their patient population. Local engagement exercises were carried out with staff and patients to understand the needs of the local community. Once the data was collated, a project plan was developed to focus on challenges, with options about how these could be tackled.
What was the solution?
One of the focus areas identified was around diagnostics and testing and the solution included setting up a full diagnostic clinic. This provided ultrasound and echocardiograms and patients were then able to book into one of these appointments without having to wait for an appointment at the local hospital.
A further focus area included looking at how to extend the workforce to release GP time. Three physiotherapists and a chiropractor were recruited and were made available for patients to access faster assessment and treatment, releasing pressure on hospital physiotherapists with long waiting lists.
In addition, four paramedics and three clinical pharmacists now work within the network, to support patients in staying out of hospital and reduce pressures on GP appointments and other clinical staff. A dedicated pharmacist is in post to deal with learning disabilities, care homes and nursing home patients. The PCN have also been named a pilot/exampler site for personalised care including end of life care and care for the homeless through the HealthBus Project.
Finally, all practices in this PCN have now centralised their HR and business function, establishing a business unit to manage recruitment and business management processes. The PCN are developing clinical and management leadership in the organisation through a programme called “Walk in the same direction”. A First5 GP has been appointed as Clinical Director and there are plans to rotate the leadership for progression and succession planning.
What were the results?
Patients are now reporting that they receive an enhanced service in all aspects of primary care, particularly in terms of diagnostics, musculoskeletal problems and fast access to all primary care services. Waiting times for primary care services are significantly lower than they have been previously, and patients are no longer waiting for hospital appointments, especially the vulnerable patient (homeless and the frail).
Medication reviews are now undertaken by clinical pharmacists and home visits are being conducted by paramedics, reducing the pressure on GPs and providing a quicker, more targeted service. South Coast Medical Group has also introduced a community psychiatric nurse to look after the patients with mental health near home and reduce referral and progression of their illness.All these factors have contributed to a reduction in GP workload and pressure, which has in turn improved GP retention for the locality. The majority of surgery sites within the network have been rated as “Outstanding” by the Care Quality Commission.
South Coast Medical Group is now looking at a proposal to locate a pharmacy on site along with a care home linked to the practices. They are also engaging with other neighbouring practices to expand the network covering a larger patient population.