Simon Stockhill
Thanks for joining this episode in the series of transforming primary care podcasts today. The episode is going to be discussing the topic of creating the multidisciplinary team. My name is Simon Stockhill and I’m a GP in the outskirts of Whitby, and I’m also the clinical lead for primary care across the Humber and North Yorkshire ICB area. And to help with this conversation today, I’ve been joined by a group of people, all of whom bring their own unique perspectives on a multidisciplinary team.
So, I’m delighted to be joined by Natalie Jones, who is an AHP clinical manager and the ARRS project manager for South Yorkshire – the additional roles reimbursement scheme.
I am also joined by David Coleman, a GP partner at Conisbrough Group Practice in Doncaster and a joint clinical director of a primary care network, another primary care network clinical director from York Medical Group is Polly Smith. Welcome to you Polly. A single practice PCN in your case, so you’re both in the practice management team and the PCN as they’re one and the same.
And last but not least, we’re joined by Faye Nesbit, who’s a team manager for the additional roles reimbursement scheme mental health practitioner roles at the Tees Valley Primary Care Mental Health service. So welcome to you all and thank you very much for joining this conversation.
What we’re going to try and do today is just talk a little bit about what is a multidisciplinary team, what are the roles that can make up a multidisciplinary team and my guests will talk through some of the reasons why they chose the roles that they did and how that’s all working out.
And then also how they’re best used – how those roles are given have the most value for patients, how people are triaged to those roles, how we how we move people around in the system so that they can see the right person and also then talk a little bit more about how that can link to some of the wider concepts within modern general practice and within integrated neighbourhood team working over time.
So without further ado, first, I guess thinking about how we explore the right care for the right patient each and every time. Let’s start with a with a sense of what do we mean by a multidisciplinary team in primary care and what roles can be included. So let’s head over to one of the teams. So, who wants to kick off with that? Nat are you willing to give it a start first of all?
Natalie Jones
Yeah. So over the last few years, the additional roles reimbursement scheme has enabled the employment of a really broad range of roles. And I think at the last count there was around 17 different roles that you can employ within networks.
So these range from GPs now and allied health professions and other supportive roles like social prescribers and health coaches.
So it’s a really broad church of roles that we’re able to access and each network decides what roles they want for their population, so it’s trying to tailor the needs of the population to the available roles.
So, for example, in some areas where there’s a high prevalence of diabetes, you might be looking to employ a dietician. In other areas where you have a lot of older, frail people, then a paramedic might be a good addition to the team and lots of areas are looking to employ care co-ordinators, health coaches and the supporting roles who enable people with psychosocial interventions.
So it’s a great smorgasbord of things that you can choose from now, and I suppose the challenge for networks is deciding which of those roles they want to employ.
Simon Stockhill
Thanks, Natalie. And you win a first point for using one of my favourite words: ‘Smorgasbord’. So David, let’s, let’s come to you first of all from Conisbrough and tell us how you’ve been using different roles within a multidisciplinary team approach.
David Coleman
Yeah. So when I started work as a GP partner in Conisbrough in 2010, we had a fairly traditional setup in the practice. We had GPs, practice nurses, healthcare assistants. We also had a role called ‘first contact practitioner’ which was like an ANP (Advanced Nurse Practitioner) role. But that was about it really and it was quite traditional – reception used to book the patients in. We dabbled in a little bit of triage and we muddled along and over time even before the introduction of primary care networks, we started to bring in other roles such as pharmacists and a paramedic. They were the first roles we sort of brought in.
As we brought in the roles, we started to develop our triage to make sure that the right patient was getting to the right clinician because it’s really frustrating for patients when they get booked in with someone who can’t help them. And it’s also inefficient when you’re running a practice. You don’t want these wasted opportunities really and having to duplicate the work, so we started to triage more, we started to learn that if the most experienced clinicians did the triage, the outcomes seem to be more optimal.
So we started having doctor-led triage and then over the course of the pandemic, we started integrating more digital triage, which gave us even more information about what the patient was presenting with to help us get them to the right person. And that coincided with the advent of primary care networks and really, a sort of explosion in the number of different roles, as Nat was saying.
We’re fortunate to have a physician associate, a pharmacist, a number of pharmacy technicians, first contact physios, a dietician, health and well-being coaches, two mental health practitioners. A whole team of care co-ordinators, each with different roles and responsibilities for leading in different areas. Nurse associates, social prescribers and in addition to the ARRS roles, we have a worker coming in from the Citizens Advice Bureau who we can triage patients to with their problems and more social-based issues with benefits and things causing stress. We have a Macmillan nurse who comes in and we have a drug and alcohol counsellor as well, so there’s just a really wide team so that we can identify who’s best placed to help someone.
Simon Stockhill
Thanks, David. I wonder if you could just help us with one thing. You talked about sort of doctor-led triage, one of the sort of buzz phrases that we hear a lot about modern general practice these days is around care navigation. I guess what experience have you had about the difference between, if you like, a clinical lead triage and a care navigation type process? Do you deploy them both or differently or one or the other?
David Coleman
It’s a good question and probably one of the one of the points about the standard blueprint for modern general practice that I quibble with a little.
I found in our practice that having senior clinical decision makers making the decision and then utilising the care navigators to make it happen tends to be the best approach and digital triage unlocks the opportunity to do that. I get the information directly from the patient and within a matter of seconds I know what needs to be done, but with all these different roles and all the different nuances about who can do what, and the added knowledge we have about our patients and our community, I feel the senior doctors are best place to make the decision. But what we don’t want to be doing is then getting on the phone and spending 5 minutes chatting to someone because that’s what invariably happens.
Then the patient will say, ‘well, I know you, Doctor Coleman, why can’t you have a look at my shoulder?’ And it’s sort of having a discussion which is, you know, sort of undermines the whole process really. So we use the care navigators to enact the decisions made by the doctors at our practice.
However, sometimes when people present at the desk or on the phone and it and it is a case that requires simple care, navigation such as: ‘Oh, you’ve got toothache. You’d be better placed going to the dentist for that.’ The Care Navigation team will take care of that.
Simon Stockhill
Thanks, David. Natalie, did you want to just come in on that same thing before I come to you, Polly?
Natalie Jones
Yeah. So building on the discussion around triage: in primary care, Sheffield, we run 9 GP practices across the city and we have recently transitioned to digital triage across all of those practices. So we have a central hub and every day we triage across all of those practices, the requests coming in. And that hub is a multidisciplinary hub.
So, for example, occupational therapists, physiotherapists and paramedics are able to do sick notes. So we know that we get a volume of sick note requests coming in every day from our 9 practices. So they might, for example, be able to triage those requests and we have advanced nurse practitioners and other advanced clinical practitioner roles, such as pharmacists, also working in that hub.
So we have GPs and it is a full MDT [multidisciplinary team] approach to triage and we’re building that up as it’s a fairly new innovation, but learning loads together and also making sure the patients get an appointment with the most appropriate health and care professional. So yeah, it’s great to see how these things are evolving in practice.
Simon Stockhill
Thanks, Nat. Polly, let’s hear about your experience of this kind of working in York.
Polly Smith
Yeah, I think they’re much at the same as David and his practice. I mean, before the introduction of the ARRS roles, we were a traditional GP practice that employed doctors and nurses, but I would say that we started to diversify our workforce, our clinical workforce before the ARRS roles.
Just looking at as we had GPs leaving, seeing who is the right person to see the patients. We were seeing a shift from secondary care into primary care of the workload, what was coming out into community, which was putting an increased pressure on GP appointments. So how could we sieve some of that away from the GPS to other allied health professionals? So we then increased our nursing pool, who then very much took on all of the long-term condition managements and preventative care.
So as the shift went down, the practice nurses then got more skilled, took off as a long-term conditions from the GPs. They then needed to get rid of their workload. So then we employed more healthcare assistants and so on, and so on. So then when the introduction of the ARRS roles came out, it was an opportunity to look at our workforce once again and see where could the value of some of these other roles to support the traditional clinical roles.
So one of the first roles that we introduced were the clinical pharmacists and we have spent a good part of the last few years of building up our pharmacy team because it was very, very new to us. Traditionally, nurse prescribers, GPs did all the prescriptions.
So it was like how do we integrate pharmacists within our PCN? And we started off with one pharmacist who very quickly was telling us I can’t manage with perhaps the 45,000 patients. Naively we thought that we could just have one (?) and since then we have now got a team of 4 pharmacists, 2 pharmacy technicians and 2 pharmacy assistants who have taken a huge burden away from GPs.
We also – during the Covid pandemic, when less patients were coming to see us face-to-face, and we were doing more home visits with the Covid vaccinations, and also just generally more home visits – we saw that we weren’t serving our housebound patients very well. If you couldn’t get into the surgery then you weren’t really being managed in a proactive way, so with the introduction of the ARRS roles and the complex care coordinators, we saw an opportunity there to really develop a team to look after our most complex and most frail patients.
And from there, we’re very, very proud to have a complex care team and a home visiting team that sit side by side that are made-up of complex care co-ordinators who have either got a history of being a nurse or background in healthcare or quite a few of our receptionists saw an opportunity that they wanted to be more integrated into the care side of the practice rather than the administrative side.
And through the complex care team we then looked at an opportunity of which of our other vulnerable groups could we move over to be looked after by this team, so they now co-ordinate the care for all of our patients with learning disabilities, severe mental illness, dementia, frailty and just general complex cases which also relieves the doctors and the nurses and the nurses because often a doctor will be faced with a challenging, complex patient on a 13-minute appointment and thinking I don’t know how I can support this patient. That doctor has now got somewhere that they can signpost to.
Simon Stockhill
Great. Thanks, Polly. So, Faye, we’ve talked about loads of different roles so far. We’ve not quite touched on the mental health practitioner roles yet. Tell us a bit more about that, the work that that your team do.
Faye Nesbit
OK, so the Tees Valley primary care mental health service covers 14 PCNs in the Tees Valley area, and within that we have various roles. So we have our own mental health MDT which sits inside of each PCN that they work into.
We’ve got, well, the main roles that we have are the clinical nurse specialist role in mental health, we also have generic mental health practitioner roles, so these can be and for many nursing background or allied health professional. But they would need to have significant experience within mental health. We also have mental health well-being practitioner roles and these staff work with patients who are referred via the CNS role [clinical nurse specialist] and the generic mental health practitioner roles.
And their focus is around those psychologically informed wellbeing interventions. So they might spend a bit more time with the patient going through those interventions. But it helps with that re-occurring door and it sort of helps people within primary care in a proactive way to stop them having to access secondary care services for their mental health.
And the most recent role we’ve got into the team is serious mental health physical, healthcare community associates. It’s a bit of a mouthful that role, but basically those staff are targeting the patients who are on the SMI [serious mental illness] register who don’t engage with the physical healthcare checks. So it’s more of an assertive outreach approach to try and get them to engage. And with that, it also builds on those relationships and getting them to access support for their mental health should they need it. So yeah, that’s what’s going on in the Tees Valley at the moment.
Simon Stockhill
Great. Thanks Faye and I and I really like that sort of integrated approach of physical health practitioners working with patients with significant mental health issues as well. And the blending of the two, that’s proper integrated working, isn’t it and patient focus.
So thanks everyone. That’s a really good introduction to the sorts of roles and the sorts of ways of working that can make multidisciplinary teams working. We’ve already heard from Polly a bit about some of the advantages to that and how that can help free up time and improve quality. What about any of the rest of the team in terms of talking about some examples of where you’ve seen really significant, I guess, sort of quality type improvements to the delivery of care for patients. Who wants to go through on that – Faye first, let’s come back to you.
Faye Nesbitt
Yeah, it might just flow nicely on from speaking about the mental health well-being practitioner role. So TUVE who governs and line manages the staff, they’ve recently completed the two-year evaluation of the mental health well-being practitioner roles and it’s been really a successful evaluation in that sense.
So we looked at a range of feedback – obviously from patients, but from partners also who work within the PCNs – and 91% of those people asked did recommend the roles.
Some of the quantitative feedback that did come from that was the reduce in demand on other practitioners because of the roles, there was obviously really good feedback from patients.
Since they felt that the support and guidance they received from those mental health wellbeing practitioners was great and it also improved the patient care for those patients, so I think it’s the main, the main things is just stopping those patients that GPs or clinicians in the PCN historically might have struggled with because it may be patients who fell through the gap of not fitting into secondary care mental health services because there might not be seen as complex or risky enough, but they might be too complex or risky for talking therapies.
It’s managing those patients that might have bounced around a little bit in primary care without getting the care that they needed.
Simon Stockhill
OK. Thank you very much. So good, David, I know you’ve got some experience with your physios and how that introducing physios into the team had had an impact. Tell us a bit more about that.
David Coleman
Yeah. So we’ve been working with a provider to offer first contact physiotherapy for for a number of years. I think it’s about four years now. So the service is quite well bedded in. I’ve got some data from November – we referred 71 patients to the service from our practice. So, we’re a 12,000 patient practice. So it’s a, you know a reasonable number, 15 to 20 a week are being referred to the physio service. So that’s having a direct impact in terms of reducing appointments at the practice level.
Of those referred 98.6% of patients did not require any further GP input at all, so they’re being entirely managed within the service. And what I like about this is, for an acute presentation of a musculoskeletal problem where emphasising a movement-based model rather than often what the GP will do, the time-pressured GP, who has 10 minutes, maybe 15 minutes if you’re blessed (!) to manage a problem, is often turning to prescribing medication to try to help because what else can we offer in that sort of time frame so I think we’re moving away from an analgesia-prescribing model to more emphasising movements and exercises and the evidence is showing that these patients aren’t coming back to us and saying ‘well, it’s still no better -can I have some co-codamol?’ which is which is great.
And we have seen our prescribing rates for opioids reduce over the period we’ve been using the FCPs as well. So I think it’s really working in that regard and it’s the appointment saving is an additional benefit as well.
Simon Stockhill
That’s really that’s. I mean, really interesting, isn’t it, Nat? Did you want to come in with your experience of this?
Natalie Jones
Yeah. So, earlier this year, I conducted an evaluation of the impact of the additional roles reimbursement scheme. So, I specifically looked at the experiences of patients of the multi professional workforce, which included 9 of the additional roles and 3 things came out as really sort of key themes and they were:
The patients appreciated the relational opportunities, so an ability to have an ongoing relationship with a health and care professional. Their supportive approaches – they were able to build up rapport and the empathetic approach that they received.
They also talked about professionalism and the knowledge of those members of staff (of the local communities, of access to services) and of the abilities to signpost and advocate for them (particularly patients of non-English speaking or ethnic minority backgrounds).
And then they also talked about personalised care. Not in so many words, but the essence of how things were tailored to them, how things were specific to their ‘what matters to you’ and meaningful and enabling them to self-manage. So those were the sort of three human aspects of the role.
And then they also talked about 3 other key things: One was timely access. So being able to access a professional when they needed it most; and the flexibility of access, so being able to come back or self-refer and that continuity of care, that consistency of the same person; and then the sort of wider aspects of connecting them to other things in the local communities and neighbourhoods.
So those were the sort of 6 things that they talked about as making the difference in their lives. And then out of that I was able to describe 6 specific domains of impact for these roles.
So not all of the roles, but majority of the roles had some impact across the social determinants of health and most of the roles that people experience were delivering some sort of psychosocial intervention that might be psychological and emotional support or coaching or lifestyle interventions. Some of the roles were able to deliver, for example, medical investigations and diagnostics, but mainly the impacts were around access – flexibility of access, equality of access, care, navigation and coordination and helping people build resilience within themselves and within what they could access within their local communities and importantly, carer support. So those were the sort of key impacts that came out of the evaluation I did.
Simon Stockhill
That’s great. Thank you. And who doesn’t love a bit of evidence and particularly where you’ve done some really good qualitative stuff around patient experience as well because one of one of the things we often hear isn’t it, is that, you know, the continuity of care is such an important aspect that lots of patients feel has been lost a lot with more modern general practice if you like because of their larger teams and often larger practices.
But it sounds like you’re almost bringing some of that back for people with that continuity of care with people embedded in their neighbourhoods who know the communities, know the patients and where that can be positive and and that would actually fit with my experience, I think where you where we’ve developed a wider team of people other than just GPs that it at first there may be a bit of scepticism about worldwide: ‘Why am I being fobbed off with somebody who’s not a GP?’
But that very rarely lasts beyond that first consultation where people do seem to get that real personalised approach of whether it’s our advanced practitioners or whether it’s care co-ordinators, for example, where they can have our mental health practitioner in the practice where they can have that more personalised experience and then some ongoing appropriate ongoing care and then very often kind of that, that personal resilience building, that personal resilience and social prescribers, I know which we haven’t mentioned yet, but social prescribers can often play a great role in that as well. So thanks for doing all that work in terms of providing the evidence and as David’s been doing with the impact of physios.
I’m going to just move us on a little bit in the conversation. Polly, I just want to come to you because one of the things that picking up I guess on that sort of broadening the team and we still hear, don’t we in the press, from politicians and others for instance that you know and even from you know hospital teams go to your GP and your GP will do XY and Z as opposed to go to your general practice team or your primary care team. How in York Medical Group do you kind of decide what’s the preserve of the GP still, what’s the stuff that they’re best at doing that others maybe can’t do and how do you sort of help guide patients through your system so that that they see the right, the right person for the right sort of problem?
Polly Smith
Yeah, so you know, it is a multidisciplinary team in your GP practice. So we do support our MDT approach, very similar to David, where we have a triage system. Now several years ago, we looked at this because we had diversified our workforce. Then we spent a lot of time doing a big project, which was called ‘Right First Time’ and it was all about the right person seeing the right practitioner at the most appropriate time frame. And from that we developed a huge document for our reception team that we were then calling care co-ordinators to go through and every time a patient then requested an appointment, they would go to this form. That was an electronic form that they could see and they would go down to the condition and then say which person should they book into. And that was working to a certain degree.
But again, like David has already identified, we felt that it needed to have a bit more seniority to shape that. And so we then introduced the urgent triage team and it was managed by experienced GPs who had an interest in that urgent triage because it’s not everybody’s bag. Not all GPs like that work and they work with the care coordinators. So for every appointment we also at the same time introduced the online form that the patients either love or hate.
And so all appointment requests, either if the patient has completed the online form themselves or they have phoned up the care coordinators for an appointment, they then support them to complete the form over the telephone.
But it all goes through the urgent triage and the GP then decides whether that patient should be seen on the day or in the next two to five days, or whether it can be routine.
And then he or she works with a team of care coordinators who are then placing those patients into the most appropriate person. And our experience again, you know, it was difficult at times because patients were just saying, but I want to see my GP. But you know, through the care that they got when they did see the other allied health professionals who often had a little bit more time, as well, than the GPs. The poor GPs are always working on 10/12/15 minute appointments but we were just able to expand that for our allied health professionals and give them a little bit more time to spend with the patients and in time, patients they get to know their practitioner, they get confidence in the service. So we’ve now gone from all of our appointments are now triaged so that the urgent, same day and the routine appointments are all triaged.
Simon Stockhill
Yeah. Great. Thanks, Polly. It’s certainly been a common theme. I’ve seen several times in my career where you know, including in things like emergency departments in this country and in the states where I’ve visited where the more at the busiest times of the day, they bring in the more senior decision makers to the front door. Because otherwise you’ve got less experienced decision makers dictating the workflow of everybody else, which does seem the wrong way round.
So I mean, maybe GPs should be the people answering the phones on reception, but no -I’m joking, that would be a terrible idea. But I think it’s a great idea and it’s interesting that that both that you and David have talked about the importance of that senior clinical decision maker at the earliest point in the contact of patients to get the most efficient use of the system. So it’s really helpful despite potentially different ways of doing it.
David, I’ll just bring you in again just to say because I know you’ve got some experience of how you manage some of your clinics to help with this kind of workload and workflow issue which I know is often on the minds of all staff who work in primary care? Tell us a bit more about that.
David Coleman
Yeah. So, like a lot of practices, we have a duty doctor on call system. So if I’m the duty doctor on call for the practice, I will be responsible for doing the bulk of all of the triage and making all of the decisions about where every single patient presenting whether it’s routine or urgent and up which sounds quite overwhelming. But with the digital, I think over 90% of our requests come in digitally anywhere so that they’re easier to process.
And what that’s kind of unlocked is, is the ability to have more control about what everyone’s clinics look like. So if I know a particular patient is presenting with a string of problems, I can choose to book a double appointment. In the olden days, this was often left to the patient to self-declare if they wanted a double appointment. But I can look at the problems and make a rough decision about how much time it’s going to take.
But I can also do other things like if a clinician is seeing a lot of complex chronic pain or mental health, it’s quite demanding and perhaps is going to run the risk of them running late. I can then book in a few different cases, some easier material that might help give them a little bit of headspace and help them catch up. I can also address learning needs, so we have a number of GP registrars at the practice who are doing their training. If I know one of the trainees is very inexperienced in Women’s Health, for example, I can book a few of those cases in to help with their professional development as well. We have a lot of nuance as well with our practitioners. Some aren’t able to see children under 5 or pregnant women.
Or some aren’t able to do sick notes whereas some are. So you’re able to kind of gauge, you know, who the best person is to book in, but also what is that person’s clinic going to feel like for them? And what can I do to make their day run a little more smoothly, be a bit more varied and be a bit more challenging? And that seems to work well, and I think that is part of the reason we’ve been able to successfully move from 10 minute appointments as standard to more 15 minute appointments as standard for GPs. And sometimes we’ll book 30 minutes for an appointment if necessary.
Simon Stockhill
And I’m sure there’ll be lots of people listening in thinking that I wish they had somebody helping curate their clinics to make them interesting and challenging and working to the top of their licence and also not, you know, necessarily always too much of the same really challenging things that that then leads to burnout. So that’s really interesting. Thanks for that.
I’m just going to move it on again, a little bit just to talk. We’ve talked predominantly so far about sort of practice or PCN based staff supporting the work within a practice and I just wondered whether it’s worth just thinking about this concept of neighbourhood teams and neighbourhood team working and spreading out from the practice to that sort of wider community type networks of people who exist, who can very often have great impacts with our patients and even if we’re the sort of front door that they come to, actually there are other people who can help.
So Faye, I’ll come to you. So I think you have some experience of working with the voluntary, community and social enterprise sector as well with this – tell us a bit more about that.
Faye Nesbit
Yeah. So the across the five localities of the Tees Valley, we have what we call virtual huddles set up and it’s came about from the mental health community transformation work that Tees, Esk and Wear Valley Trust’s doing, but within those huddles and they’re held either weekly or two weekly, depending on the locality. But we have representation from third sector services, social services, secondary mental health services. We’ve also got talking therapies who attend that.
Our primary care mental health staff also attend and patients are brought for discussion, obviously with their consent, who individual practitioners may be struggling with, and they’re not quite sure who’s best to meet the needs of that patient.
So the patients are brought to that huddle and it’s really quite collaborative.
People are very forthcoming in sort of saying, look, we can take that patient on, we can offer them this support and it feeds in nicely to the integrated neighbourhood team work that is going on in the different PCNs. We’ve also been piloting a mental health care navigator pilot within one of the PCNs in the Redcar and Cleveland area, and that’s a bit of a hand-holding service, you could say, for patients in that they’ll support the patients to link in with those third sector services that can provide that support, and that’s for patients with low-level mental health needs, but who might just need a bit of additional support to get them to the other third sector services out there. And it’s been working really well from our point of view.
Simon Stockhill
Great. Thanks, Faye. I’m sure that that can also have an impact on people who may have not been accessing some of the services, particularly things like prevention services, vaccination, screening, things like that as well to also access those services, which is part of the role that an MDT can play into that proactive and preventative healthcare as well as the kind of reactive healthcare.
Faye Nesbitt
Yeah, I mean just on that note, in terms of the, from a physical health perspective, our SMI physical health, one of our nursing associates won a Star award for the trust for a piece of work she did in engaging a patient who hadn’t seen the GP for a lot of years, but was on the SMI register and hadn’t had any physical healthcare checks. She eventually managed to track her down through her Department of Work and Pensions worker, so there’s a bit of investigatory work.
But when she did, she managed to get the patient reviewed by the GP. Unfortunately, the patient was diagnosed with cervical cancer, but subsequently she could access the treatment she needed for that. Whereas if that work hadn’t gone ahead, the patient may never have been seen, and it may not have been picked up on.
Simon Stockill
It’s a great example and a good outcome, hopefully as well. Thanks Faye. Nat I just want to come to you because I know you’ve had some experience in Sheffield around occupational therapists and working with housebound patients or patients who are resident in care homes.
Natalie Jones
Yeah. Yeah, that’s right. So I am an occupational therapist and I do some clinical work with frail older people and also people that use services in primary care frequently to see if we can support them in a different way. And we have over the last five years grown the number of occupational therapy posts based in networks across Sheffield. So we have some OTs that are a mental health focus, some OTs that have a frailty house bound or care home focus and we’re also looking at growth in other areas like vocational rehabilitation.
And I think it’s what you were saying, Simon, about the housebound patients or the patients that aren’t able to access health checks or offers or we really want to have a anticipatory or prevention approach. So we’ve got a number of OTs that are working with care homes to do care planning and also admissions avoidance work.
We’ve had a care home where we’ve actually brought in some dietetic students to do some work with the OTs around Food First approaches. So we’re really at the sort of forefront of trying to prevent admission to hospital, but also OTs are very good at working across different agencies, they’re boundary spanners, in many ways. So working with local authority services, voluntary sector organisations.
So a number of us work really closely with voluntary sector organisations to get patients access to health coaching, motivational interviewing, support, social prescribing and really enabling people to the point where they can access some of these services that perhaps that they haven’t already taken up. Yeah. So OT is a growing profession within primary care and obviously now it’s funded by ARRS, it makes that all the more possible. So definitely the work I’ve been doing with high frequency users.
I’m working with the whole family, so the whole family attend the practice and very often there are multiple and complex health conditions, children and adults, so it’s working across the lifespan and I think that’s where we can really add value.
Simon Stockhill
That’s great. Thanks, Natalie. And certainly, I’ve recent experience earlier this year when my mum was receiving end-of-life care at home of the excellent work of occupational therapists in being part of the team that was supporting that. So I’m a great, great fan of the work that you and your colleagues do.
David, I just want to come to you because I know just well as we’re thinking about kind of next steps in the future. And we’ve been hearing how these roles and this team working has been evolving so far. I think you just had a couple of points linked to some of the things that need to happen in the future as well.
David Coleman
Yeah, it was just, I think as we look towards the 10 year plan coming out and I think there’ll be a strong suggestion for more neighbourhood working, just a word of caution really to that we remember to build in adequate supervision. I think people often underestimate how much supervision we have to provide really for these roles.
And in terms of the supervisors of tomorrow, that’s GPs who are in training at the moment.
We need to be careful to build in ways for those trainees to get experience in the things that they’re going to be supervising. So if our GP trainees are seeing a lot less musculoskeletal caseload because it’s all going to the first contact practitioners, first contact physios. These are the people that are going to need to be doing some of the supervision and picking up the more complex things in the future, so we need to just be mindful of that and make sure we build that in as well.
Simon Stockhill
Right. Thank you. I mean, you’re absolutely right.There’s lots of wonderful things about the additional roles reimbursement scheme, but the lack of recognition within that for the amount of time for supervision is something that I hope in future we’ll see corrected because and also value – there’s something about, I think, retaining some of our more experienced practitioners as they reach the later stages of their career, that actually they may want to reduce their clinical commitment but they’ll be very, very willing and able to use their experience in supervision of other roles and that will be a great way to retain some people. I think who at the moment we lose far too early from the profession.
Very last point to you, Nat, and then we’re going to wind up from there.
Natalie Jones
Yeah. I’m just really touching on the supervision aspect. Obviously, I’m so glad we’ve brought this up because it’s so important some of the earlier work I did around retention in these roles, a lot of people left roles because they didn’t have the sort of induction and supervision and support. One of the things that we can do within ICBs work with primary care workforce hubs, who obviously have offers for training and development and support.
But in in a lot of areas, they’re starting to develop personalised care teams, where you would, you know, collectively work together and have a supervision structure within that team. So, it might be a paramedic, a dietician and occupational therapist who is able to provide support and supervision for health coaches, social prescribers, care co-ordinators. So, it’s really thinking differently about what other supervision models could we have and also how can we draw on the superpowers of those allied health professions who are able to provide that supervision and support if they have some dedicated and allocated leadership time to do that.
Simon Stockhill
Thank you very much. So, thanks everyone. That’s been a really interesting conversation about this. The way that you’re developing roles, different ways of working, creating that multidisciplinary team at practice and PCN level and beginning to then reach beyond the bounds of the practice into neighbourhoods, which is absolutely the sort of the direction of travel that we hear from NHS England and from ministers about the fact that this is the way that we should be working.
And also thanks to those that brought great case studies, case examples and also summaries of some of the evaluations that you’ve been undertaking to underpin the quality improvement aspects of the work that you’re doing.
So, thank you very much to all of my guests today and thank you very much for listening. We’ve talked a bit about this as modern general practice, some of us are old enough to remember when we had multidisciplinary teams of old with district nurses and health visitors and others based in our practice, perhaps we’re going back to the future with this in a modern way, traditional general practice in a modern setting. What’s not to like about that? Thanks everyone.