Welcome to the Transforming Primary Care podcast, an exploration of how teams across the North East and Yorkshire region are making improvements that make it easier and quicker for patients to get the help they need from primary care.
My name’s Annabel Johnson. I’m the deputy director for primary care in the North East and Yorkshire region. Today I am your host and we are covering ‘What does modern general practice mean?’
I have the following NHS colleagues with me:
- Dr Krish Kasaraneni, GP Partner at Steel City General Practice in Sheffield
- Dr Stephan Claridge, GP at Lingwell Croft Surgery in Leeds
- Dr Charlie Sinclair-Lack, GP Partner at Myhealth, in York, and Claire Howard, Office Supervisor at Hillside Practice in Skelton, Cleveland
So as people will be aware, there’s been a huge amount of work done in primary care to improve processes and systems for staff and to help patients access primary care, In the past year to 18 months – we have been referring to that as modern general practice. So the purpose of this podcast is to try to bring to life, what does that really mean in practice?
So in this episode, we will discuss how new ways of working benefit both practices and patients and explore the challenges that are faced when making changes to the way we do things.
These changes include optimising contact channels, so offering patients choice of digital options, for example using the practice website or using an online consultation tool, and also includes improved telephone access.
Streamlining care navigation, which is basically about getting the patient to the right, healthcare professional or service in an appropriate time frame. Improving processes within practises to help match capacity and demand. This should ultimately help GPs and practice staff to use their time where it’s most needed.
Providing support to general practice staff to develop and understand new ways of working, including overcoming any challenges or barriers.
So those are the sorts of changes that we’re focused on. I’ll move into the panel conversation now. So, I’m going to kick off with the first question. So, Charlie, if we can come to you first – Can you describe what do we mean by modern general practice?
Charlie Sinclair-Lack
Yeah, I think it’s quite a broad term, but it’s generally using a few different bits of technology to help mitigate some of the challenges that we have in general practice at the moment.
So an example might be using, well, incorporating online forms much more into your triage process to allow you to triage more efficiently and avoid that rush of patients in the morning. The more you use it, the more you can kind of use the information you get back in terms of the data from that to then kind of mould your practice and the kind of care you give.
Annabel Johnson
Fabulous, so interested to hear from Claire from a sort of more a practice manager -practice operations perspective. What’s your view around modern general practice?
Claire Howard
I think mainly it’s I’ve worked in general practice for about 15 years now and the change within that time has been major. It’s constantly changing, and I think it’s keeping up with the most up to date methods increasing access as much as possible for your patients.
Making sure that they can contact the practice at any time of day, through whatever method that they’ve got available to them, whether that’s presenting face-to-face, telephone, e-consultation online, it’s offering as many services like that as you possibly can for the patients
Annabel Johnson
Fabulous, thanks Claire. Stephan, do you want to give us your view?
Stephan Claridge
Yeah. Hi – Stephan Claridge from Lingwell Cross Surgery. I think it’s something that’s essential really in general practice now. I think modernising the way that we work.
is something that we have to do to deal with the ever-increasing demand. You know, the traditional ways of working from the past, where there was little to no triage, not making the most of the multi – disciplinary team, not using digital services.
I don’t think they are fit really anymore to deal with the demand that’s coming to general practice. It just seems to be more and more and more and more. So yes, I think for me modernising general practice is essential to cope with this demand.
And it’s through efficiencies. OK, so if you’ve got a workload, you know you need to be efficient in your working and to be able to deal with that that large amount of work.
So it’s about improved efficiencies through using your multi-disciplinary team more effectively. So, because of obvious financial constraints within the NHS, you know we can’t have a massive team of GPs just dealing with every single problem. So you know to have better efficiencies, we need to make the most of our multi-disciplinary team to make sure they’re working effectively to deal with this demand.
It’s also about safety for me as well. It’s about effective triage and keeping your patients safe, which for me is a is a real central part of the modernising general practice. So, I mean I’m very happy to talk about that in more detail, but for me that is that is the big thing about general practice is about modernising general practice is about is about a safer way of working and through effective triage.
And you know, I think general practice needed a change. You know, there was a lot of burn-out, GPs were leaving the profession. You know it needed something to change and at Lingwell Croft, we’ve changed the system and actually we found that our workforce are happier. There’s a bit more of variation in the in the work that we do, there’s better team working. Yes, and it’s something that’s been brilliant for our practice
Annabel Johnson
Great, thanks a lot, Stephan. So Krishna, if I can come to you next, I think we’ll move on in terms of the questions, if that’s alright. So next question is around, it was all linked to what we’ve just been talking about. So how do those new ways of working that we’ve just been talking about beat the 8:00 am rush and reduce workload in general practice?
Krishna Kasaraneni
Sure, hi Annabel and thank you for bringing me in on that question. I think the 8:00 am rush to some degree will always exist in general practice and I think it’s about making it manageable rather than trying to solve the whole thing as such. But I think the way we approached it, for example online consultations, we’ve turned that on 2 1/2 years ago, I think and we’ve not had to turn it off once.
Pretty every single online consultation that comes through, we tell patients that we’ll get a reply back in two working days and we’ve not actually breached more than one working day, so it’s part of all of this is to make it easy for patients to access general practice when they’re needed. But there has to be a cap of some sort to be able to try and address the demand in a safe manner. And I think the approach in modern general practice and by that, I don’t just mean technology, it’s also about technology as much as it is about new ways of thinking and modern ways of thinking about general practice.
So what that allows patients to be able to do, it’s essentially that if they feel they need something, it could be something as straightforward as a fit note to something which is quite a complex health problem that they need, to one specific clinician, but they’ll be willing to wait one or two weeks to speak to that person. So it’s not necessarily having a uniform approach to say right, everybody who contacts the surgery will be dealt with in this way, it’s making it personalised enough so that some patients who value continuity of care and who need continuity of care get that in a different way, in a modern way.
And some patients who just need a quick something, that’s like a sick note extension for a couple of weeks, it does not require a convoluted process for them. They can just fill a form in, and they’ll get the note with the next half an hour. So it’s that kind of approach where we’re able to sort of reassure patients that there’s more than one way of getting through the practice and depending on what their healthcare is, the practice is always there. But it’s in terms of accessing it in the right way to support them, to get to the point that they need to in their journey of their health needs.
Annabel Johnson
Thanks, Krish. That’s great and the not turning off the online consultations process is really impressive because I know that’s been tricky in some areas. But yeah, obviously working really well there, great.
Krishna Kasaraneni
Yeah. It depends on how it’s used. I think for us it’s never been a problem since we started off, we did it in increments and even now a clinician will probably get three or four. I mean I’m on call today and I’ve had two so far. So it’s that notion – it’s not something that we see as a burden, it’s something that’s actually enhanced how we’re supporting our patients rather than something that’s actually been detrimental for us.
Annabel Johnson
Charlie, do you want to come in?
Charlie Sinclair-Lack
Yes, I thought that was really interesting. You said you’ve had two today, so it shows how modern GP is so different for different practices, because half of all our contacts are online now. So half of all our enquiries come through online now in comparison to which is obviously a big contrast. And so we, the duty doctors shift actually for us is now triaging all those forms and that allows us to, rather than everyone contact us first thing in the morning with all the different queries, it allows you to look through those queries and then triage them based on clinical need rather than necessarily the order that people have rung the surgery.
And that kind of goes back to what Stephan was saying about safety. And actually, yeah, it doesn’t solve the problem of supply and demand. Absolutely not. But it does at least allow you to prioritise based on clinical need. And that’s really quite useful with the model that we’re using.
Annabel Johnson
And Stephan, looked like you were waiting to come into that conversation.
Stephan Claridge
Yeah, yeah, very much so because, yeah, I suppose it all depends on the system that you’re working within your practice, so it doesn’t sound like Krish, please correct me if you’re doing it, you’re not doing total digital triage I’m assuming so, because we’ve only two e-consultations coming in. So in, you know, we’ve got a 16,000. well, just shy of 16,000 patient list size and you know we get in the region of 350 e-consultations a day that we go through.
For to be effectively triaging patients for me, and I think I said this earlier, you know safety is a massive thing for me, with regards to modernising general practice. I mean I was an A&E trainee before going into general practice and the A&E guys have been doing it for years, haven’t they? So I mean when I was working within A&E, there’s.various different systems they use to triage. But the ones that seem to work most effectively is the most experienced clinician at the front door.
You know, they were able to turn patients around with simple advice or a quick prescription. They recognised the sick patients quickly that went into triage so it was it’s the safest way to run an A&E department and I just kind of thought well why isn’t general practice doing this ,you know, I know we’ve got different patients but why aren’t we doing this? And so that’s what we’ve that we’ve kind of adopted a kind of almost an A&E similar, A&E model at our practice using digital consultations and I find it really safe. Before, when we had the 8am rush, we don’t have an 8am rush anymore but before we had an 8am rush, the vulnerable elderly patients were just sitting, you know, on hold.
The sick patients were not getting appointments and it was the patient shouting the loudest were getting those appointments and it just didn’t seem right. So yeah, so it all depends on which model you use. It sounds like Charlie and I do total digital triage which for us is working really well, but absolutely impossible to keep it on all day, yes. So ours does turn off. I don’t know what, Charlie, if you turn yours off, but yeah, but ours certainly does go off.
Charlie Sinclair-Lack
We tried, we experimented with it a lot when we first started using it originally. We had it on 24/7 seven days a week with alerts you know if patients contact us about something urgent, then they would be saying no, don’t fill this form in, contact out of hours or whatever the advice was didn’t work – patients still would click past it and then we’d get would come in on Monday morning and see these really sometimes quite worrying clinical scenarios. So now -it is on most of the day because it’s actually more efficient for patients to use the online form when it comes.
It’s the patient’s exact words and the exact description rather than kind of going through a call handler or receptionist.
Stephan Claridge
You know that when you make access too easy you, you are encouraging, you know, a behaviour in your patients. And I think for me that’s the next step is about, you know educating patients to say look, you know when to contact general practice, and you know when can you look after yourselves when can you go to the pharmacy and actually not contact us at all, at the moment, that’s a challenge that we’re currently working through.
Annabel Johnson
Thanks. A great conversation. I think behavioural change is absolutely key to this, isn’t it for patients because we’re asking people to get used to new ways of accessing services, which is key. And I think the other interesting point from all of that is just to reflect that modern general practice will mean different things in different areas. This is all about you as practices working out what supports you and your staff to improve what’s happening and be ultimately happier at work and it being more efficient and then also improving, you know, access for patients. This means having all routes of access available during your opening hours. Things will look different. One size does not fit all so that’s really great that’s come out in that conversation.
So I’ll move on to the next question then, Claire, I think I was going to come to you with the next one, which is focusing more on challenges. So can you tell us what challenges there have been whilst making these changes and a bit of a reflection about how you overcame them?
Claire Howard
Yeah. I mean, for us, we did the GPIP programme last year, the general practice improvement programme, and it made us look at a lot of our processes and the way that we do things, but one of the things that we did look at was the care navigation part of things. We were already as a practice quite good with care navigation. I think the national average of inappropriately appointed patients is about 20% and we were at about 11% by the end of the programme. We’d reduce that down to 6% inappropriate appointments, but I think the main challenge that we found was patient education. So when the patients are contacting the practice, they automatically think they need to see a GP, that’s all they want, only a GP can fix it. But we’ve got all these other services in our area. We’ve got ARRS clinicians, mental health practitioners, social prescriber, first contact physio.
So I think at first the main challenge that we had was educating the patients that it isn’t just a GP that they need to see and that might not be the most appropriate patient person for their care.
We did a lot of work with advertising, we advertise on social media, we’ve got notice boards all around the surgery. But a lot of it was training the staff to give them the confidence to give the patients the correct information, because I think when you explain to the patient that they can kind of cut out the middle man, they don’t have to have a referral from a GP to see a first contact physio or they can go directly to the pharmacy and get antibiotics for sinusitis and things like that. I think if your staff have got enough training and enough confidence to give them that information and it reassures the patients and gradually it is getting better.
Annabel Johnson
Lovely. Thanks, Claire. Yeah, I think, well, staff training absolutely critical. But as I said before, it’s behavioural change and that takes a lot of time, doesn’t it? And for people to understand how they’re going to get the services in the best way, it does take time.
Just moving on a little bit, so I think we’ll just talk a little bit more about the data and what the data’s been able to bring to you. So, Krish, I think you’ve done quite a bit of work in this area. So can you explain how the information you received from the systems has allowed you to work more effectively? I think you’ve done work around particularly long-term health conditions.
Krishna Kasaraneni
Yeah. So the approach we took, Annabel, is to try and understand where the actual chronic disease burden on the practice is coming from.
So we approached it as there’s a acute on the demand, which is what the focus has been with the modern general practice aspect of things. And there’s chronic conditions which has traditionally been dealt with mainly by nursing colleagues. And there’s a bit in the middle. So chronic conditions that come with other acute changes to that or people with significant chronic health conditions, or frail, who then have another problem, who want to see the same clinicians.
So we’ve kind of split them into those different groups and we started this process off in January 2020. So just before COVID, and now we can tell you so the changes that we’ve noticed in the chronic conditions we’re dealing with are mainly metabolic issues that are going up, mental health that’s increasing considerably and to some degree is also conditions related to that. So, what we would have seen traditionally as the bread and butter of general practice, so things like coronary heart disease or strokes, those kind of things, are actually dropping for us.
Now, that may be a national trend, or that maybe just unique to us to some degree in each practice will have those numbers looking slightly differently. So, what we were able to do is to put plans in place to say actually now if this is what’s changing. These are the areas we need to be focusing on whilst not compromising on the other stuff that needs to happen in general practice.
So, making it more intuitive and responsive to what actually patients, what actually works for patients. So for example, if somebody needs a cervical screening done and they’re at work most of the week trying to offer them a 10 o’ clock appointment in the middle of Monday isn’t going to help, it will create need. So those ones can be done either evenings or weekends at the convenience of that. But if somebody has significant heart failure, coronary heart disease and things, we identified them as vulnerable physical health or vulnerable mental health patients and all the chronic diseases are mainly dealt with by the GPs in the building rather than the traditional approach of nurses or somebody else dealing with that. What that allowed us to do is to essentially first rebuild relationships with our patients again, rather than the current or rather, the recent issues with literally dealing with on day demand, so confidence, relationship building, all that has meant that exacerbations of chronic conditions and the demand from patients with significant frailty or health conditions on the rest of the system like A&E attendances or walk- in centres, all of that has completely dropped off.
So that’s why when we talked about earlier on in terms of how we use online consultations versus everything else. We don’t have one door open, we have all the doors opened. So say if you ring, if you need to speak to us on the phone, give us a call. Or if you’d need to come in, come in, if you want to use online ones, use online ones. All those are open all of the time and that allows that relationship building and the confidence both sides to be able to manage the chronic conditions well.
So that meant that a huge chunk of work, which was probably a result of chronic conditions not being optimised because we just haven’t got the capacity -nobody did – has now disappeared off for us. So metrics from that point’s very good. And all this information is within the GP systems. Now there’s information that’s required, approaching the integrated care bard (ICB) to try and understand how we can get that information through about your own practices I think is an option that’s available to everyone.
Annabel Johnson
Great. Thanks, Krish. Charlie, you’ve clearly got something to say. So please come in.
Charlie Sinclair-Lack
Yeah. I was going to – that was really interesting actually Krishna. So we use data in a different way recently to change, we completely changed the structure of our admin team based on the data. So, it wasn’t data from just one source, but it was from multiple sources. So for example we were looking at coding times and all the letters, the thousands of letters we get a week, we were looking at the duration of the telephone calls. We were looking at times of day where patients were contacted us.
And so we used a combination of all that we see to completely restructure our team in that sense, so that we moved a lot of people around, we changed what times of day people were working and that’s a big, that was a lot of effort, talk about challenges you know when you’re making those big changes to teams and people’s jobs, that’s really tough and that, you know you have to do that collaboratively, but that has been a success in recent months, in the last month or two that is. We’ve only been able to do that because of the data that’s come out of some of these systems, telephone system prints and that’s improved our efficiency a lot.
Annabel Johnson
And I guess when people can see the data, see the evidence and people buy into it, don’t they? Because the staff then own that and can understand it and can see it, which is so much easier to bring about change than, you know, somebody saying, well, we’re going to do it like this. If you can own it and understand it, then that that gets people into a good space in terms of wanting to make the change.
Charlie Sinclair-Lack
Yeah, absolutely. So yeah, because actually we, so the first thing we did when we had this idea was, we went to all our staff and said, this is what we’re thinking about -what do you guys think, what do you guys suggest? And it hopefully has changed people’s days from constantly putting out fires or being moved from one area to practice to another to cover sickness or whatever it may be. And it’s reduced that significantly. So hopefully, yeah, that’s improved people’s job satisfaction.
Annabel Johnson
Yeah. Satisfaction and well-being hopefully, Krishna and just going back to the point you were making. I think the thing that’s come across to me is a continuity for those patients and how much, well, I guess from a patient perspective, how much easier that is for them and you build up that trust and relationship. And then from a professional perspective, a clinical perspective, you’ve got the continuity, haven’t you in particularly with complex conditions – that must make a difference.
Krishna Kasaraneni
Oh, absolutely. And I think it’s nice to be able to work in that way again, where the bulk of the work we now do is actually knowing them, their families, their backgrounds and what’s going to be happening in the future too. So when we do sort of the chronic reviews and the shortest appointment is 15 minutes, but it’s frequently half an hour, 45 minutes to an hour, if need be, where you’re spending that time sorting out all the, if they’re on 20 different medications and have all sorts of things that you need to be dealing with, you sit down once and do it properly.
And then say, actually we’ll see you in three months, six months or in the meantime, if this happens to your chest, these are the kind of things you can do. And if this happens to your pain in your ankles, this is the kind of things you can do, then that straight away decreases that bit of demand because I think these are the most vulnerable ones who, if not optimised, will end up needing to use the different parts of the NHS multiple times. So we take it on ourselves to be able to spend that time with patients to do that thing properly, which then means all the acute stuff that would happen if it’s not been dealt with, seems to have tailed off and from a job satisfaction point of view Annabel, I think that’s a bit that makes a big difference. So it’s that human connection, it’s a human factor aspect of it, which means you’re actually you, you kind of finish work and go on thinking that felt nice, rather than I got through the day – that transition is really important for workforce.
Annabel Johnson
Yeah, I think job satisfaction and knowing that you’ve added value I think is so important. It’s probably the reason why many of us, most of us come to work and that really makes such a difference to teams. In terms of thinking about the roles, a number of you have already mentioned around you using the additional roles in many different ways. In particular, have the new ways of working enabled you to expand your team at all. Krishna, do you want to come in?
Krishna Kasaraneni
Yes, I think the ARRS roles certainly expanded the teams significantly compared to where we were four or five years ago and that’s been a welcome change to general practice. So yeah, until recently, all those roles have not been GPs, but there’s valuable input from pharmacists and others and so on so forth. But what we’ve been able to do, Annabel, I think is again it comes down to understanding your practice and being able to see what’s likely to happen in the next few years is for the first time that I’m aware of, we now have a consultant necrologist doing an MDT clinic in the practice, so we don’t just look at, oh, this person has their CKD worsening, therefore we need to refer them into the hospital we just add them to the list for the next week’s discussion, a consultant joins us, we go through their records, we make a plan, and we implement everything straight away on that date. So it’s actually cut down the patient journey from what traditionally would have been, see the patient, call them into the surgery, then send a referral, wait, how many weeks, months for that referral to be processed by secondary care. Then a letter comes back. The plan in place by that time you lost valuable time for the patient.
And there’s too many steps in that process. And when we talk about bringing care into community, bringing care into primary care. This is how it should be done, so it’s actually bringing the workforce along with it. You cut out so many different steps, there’s no referral, so their admin burden is decreased. And in terms of the patient wise, hang on, you’ve only had a blood test last week and it’s already been discussed with the specialist and there’s already a plan in place and that’s been very positive. So we’re now looking at expanding that across the network and we’re also discussions with the ICB to try and expand the pilot out to other practices in the region as well.
And I think that’s a model that lends itself well, to lots of different health conditions that have been looked at, vulnerable mental health would be another option complicated sorts of metabolic conditions like diabetes and things again, removing the steps, bringing care into community. So I really hope that’ll continue to flourish in the way it is doing at the moment.
Annabel Johnson
Great. That sounds really good both for the patient but then in terms of that, you know, working together from a primary care secondary care perspective, that’s ideal, isn’t it and bringing that care closer to home. Thanks Krishna.
I will move us on a little bit just if we move to talking about what support you’ve had in practice. I don’t know if any of you have been part of the general practice improvement programme, but from an NHS England perspective, have any of you access support that’s been available from NHS England.
Krishna Kasaraneni
We started the process, Annabel, I think we’re looking at it from a ‘this is what we’re doing now’, we feel we’ve optimised most of the things that are within our gift to be able to optimise with in general practice. But what we want to be able to understand is to see if it can use technology in a in a more intelligent way rather than just simply approaching it as we have photos open.
So I think hopefully the team will come spend time at three of our sites which are very, very different. So whilst we have one practice and one list, we actually have three very different aspects of the practice that we need to be dealing with and how we want to approach it is some of the points that Charlie was mentioning before and Stephan with respect to different parts of general practice work and obviously it’s approaching the workload element and how staff can be structured around where the work is and how it needs to be done and also approaching it from a clinical point of view is to say how clinicians can be rota-ed in and structured in a way that work is a lot more defined and structured rather than the nebulous undefined where that happens at the moment.
And obviously most importantly is the outcome of that is to allow that improvement programme to be able to convince patients and to show them that there’s better ways of doing things in some circumstances whereby they can get what they need in a quicker, more efficient way and which also improves the health, I think that’s a bit. So this needs to work in all those different aspects. So from a clinician point of view, from the staff well-being point of view, and a patient outcome point of view. So yeah, we’re early on in the process and I certainly would want to reflect on this again with you in a few months to see where that’s taken us from where we are and I’m hopeful that it will be a positive change.
Annabel Johnson
Great, thanks, Krish. So moving on to the next question, I wonder, Claire, if I could come to you on this one. What have these changes meant for your patients?
Claire Howard
For our patients, like I said earlier, we took part in the GPIP programme and Roger our facilitator, he was absolutely fantastic. And we had to look at all sorts of different processes that you probably wouldn’t normally look at because it’s too easy to get bogged down in your workloads that you don’t take the time away to, to look at everything.
But the main things for us is we invested more time in, like I said earlier, care navigation. We got a new digital telephony system which is working fantastic and mentioning the data that helps us a lot. And also our e-consultations and digital services such as our website, Facebook page, things like that.
But so far it’s definitely improved the access for our patients, the 8 o’clock rush, as I wouldn’t say it’s died down, but it’s kind of levelled out a bit.
We introduced some extra lines on our telephone system so that not all patients were coming through to one line. So, they were kind of filtered out. We had a prescriptions line, we’ve got a test results and general queries line and that one only opens at 2 o’clock on an afternoon. So, it means that the phones aren’t getting clogged up with all the calls that are unnecessary at 8 o’ clock on a morning.
And I think what that’s done like say we’ve opened up the methods. So we still, we’re not totally digital. So, we do offer e-consultation but we do have patients who still present at the practice. We have patients who ring up for appointments. But I think what it is it’s offering is like an equality of service to our patients, because no matter how they present to the surgery, they’re all triaged in the same way.
When people were mentioning earlier regarding their e-consultations and the doctors triaging them, I don’t know whether they triage all of them, but because we’ve invested so much work into care navigation, our receptionist at the point that an e-consultation comes in, it’s our receptionists that process the e-consultation initially.
Because if the patient is suitable to be care-navigated to another service, we care-navigate our e-consultations.
So if it was someone who was appropriate for a PharmRefer, our receptionist would contact the patient, explain to them what PharmRefer is and with their consent send a referral. So not everything is going to the GP. Obviously the more clinical e-consultations that the receptionist can’t triage, they would go to the doctor, so I think it’s improved access and equality of service to patients and it’s a more simple and streamlined process.
Annabel Johnson
Stephan, can I come to you about the same thing? So how do you think it’s improved things for your patients?
Stephan Claridge
Yeah. I mean, it’s been, it’s been brilliant. I mean, so the first thing. well, first concern we had about the new system was how the frail elderly were going to access the practice and also the patients who are digitally illiterate as well who don’t, who don’t have a smartphone, who are unable to use the internet and being in a, you know, a very deprived area of Leeds you know that was obviously a significant concern. We’ve got a very high digital illiteracy rate and a lot of elderly patients.
So we’ve actually used a telephone, so a voice recognition technology for patients. So those who are on online, the younger patients, they just do the online consultation and those that are digital illiterate or elderly, or unable to use online services, they essentially ring the surgery but they leave a voicemail.
And then there’s voice recognition technology that then transfers what they’ve said on to an online consultation and that online consultation goes into the same queue.
for triage. So that was that was what that’s the first thing I just wanted to say was about as about just making sure that there’s.equality and that’s made a big difference for our elderly patients. So. before that like I said before, there was a sitting on the on the phone. Now they don’t sit on the phone, they get through straight away and they’re able to leave essentially a voicemail using this technology, and they go into the same queue and get triaged. So I think it’s made a big difference. It’s made a big difference for all the patients with regards to access, it’s much better access and it’s made a big difference for care navigation – patients are seeing the right person straight away.
The care navigation, we use a hub system -so basically we have two GPs, two care navigators all sitting in the same room, and we encourage conversations between the four individuals and they work through all the online consultations as a team, so the care navigators deal with what they can do in the in the same way Claire’s describing, just flicking them over to Pharmacy First, etcetera. At the GPs, you know, go through the more complex ones, making working out which ones need to be seen that same day. And also they – we have something called a ‘quick list’ where the triaging GP feels like they can deal with a problem in 5 minutes and that just goes into the quick list and they’ll just quickly give the patient a quick ring. Say, here you go. Here’s – quite often on the online consultation, for example, there’ll be a picture of some eczema and they’ll go. Yeah, that’s eczema. Here’s an emollient and that’s the end of it. So we have called it the quick list and so patients dealt with a lot quicker that way and it’s saving our main consultations for the patients that need it.
So like Krish said so, because we are dealing with so much in the hub of all the kind of quick wins, all the quick sort of snotty noses, care navigation etcetera, you know we are able to that the rest of the team GP AMP team are able to deal with those chronic conditions, deal with the complex patients, they’ve got, you know, longer appointments to, to be able to deal with these patients. So I think it’s that’s made a big difference for them as well because they because the GP has got more time for them now because of the new system.
Annabel Johnson
Right. So we’ve got a quality, much better quality of access there and also you know patients having been able to see being able to be seen quickly if they need to be seen quickly. But also that continuity of care, I will move on to our last question now, I’ll probably come to Charlie and then and Krishna on this. So, last question is around advice. So what advice would you give to either a practice manager or a lead GP or a practice when they’re considering these new ways of working?
Charlie, I’ll come to you first, if that’s OK.
Charlie Sinclair-Lack
So I would talk to your neighbours because people will have tried these things. People have tried what’s worked and what hasn’t, and there’s no point making the same mistakes that we’ve made or that you’re that the colleagues in the surgery next door have made.
Because you, you will have some options of what you want to do and I would really do that. With I think pretty much every new bit of technology we’ve literally gone to other practices first and said have you tried this, what was it like? So I’d really recommend doing that.
Annabel Johnson
Great advice, thank you. And over to you Krishna.
Krishna Kasaraneni
And I’m allowed to say first is to try and understand your practice. I know that sounds very simple, but most of us think we know where the workload is, we know our patients and we know what the future looks like to some degree and only when it started off on this process really started looking at the metrics that we wanted to understand better is how we started off this journey.
So you know the change in the metabolic health that we observed in the last 4 ½ years -we could see it happening within the first year or two, so we knew we needed to spend more resource on those aspects of things. So, use the data source available and, if you’re not sure, ask others for help who can point you in the direction. And like Charlie said, I think others would have tried different things to speak to them. So where do you get access to information about the most vulnerable asthma patients in your practice? How do you start it? And I think for somebody who’s starting that off, that sounds so massive and then you speak to someone who’s already done it and think actually that’s relatively straightforward. And the second thing we need is about to not be afraid to make mistakes. So try out different things throughout the process.
When we started this, we kept on making mistakes and when others ask us, we tell them mistakes we made too and I want to say to people is just don’t be afraid to make a mistake, but just don’t make those same ones that others have made – make new ones. Try out different things and learn from those new ones too. And I think, be honest to yourself when you try something and it doesn’t work, it’s important to say, actually that hasn’t. So, we need to let that go and try something different. But it’s a very slow process and it’s important to bring staff and patients along with you on the journey. So if you are a very keen person and want to really progress the organisation and want to take everyone with you, you’ve got to work at a pace of the slowest person in the organisation, but not expect everybody else to work at your pace. So, with those I think it can be done and change in general practice is constant. Whatever you do today, two days down the road, two months down the road, you may need to review it because something’s changed and you need to approach it differently. So yeah, positive – understand your patients and speak to others and don’t be afraid to make mistakes.
Annabel Johnson
Thanks Krishna. So, I think some takeaways for me and we said this before is engagement, engagement, engagement with your staff so that they understand and can contribute and own those changes. Ask others for help. That sounds really obvious, but sometimes we don’t do it. And as you say, Charlie, there’s there’ll be many people who’ve tried different things before and then be brave in terms of we all will make mistakes but learn from those mistakes. And I suppose ultimately, I think what I’ve heard from today is, you know, through different approaches, ones that suit your practices.
Hopefully I’ve heard this quote from others, but hopefully you’re getting a sense of being able to thrive in 2024 , which is really positive because there’s lots of challenges out there. But if people can get a sense of that, being able to thrive and that well-being and feeling good about what they’re doing from a work perspective, then I think that’s real positive and a real positive to improve the access for patients.