The practice team at Steel City General Practice, Sheffield have been on a transformational journey to improve access and patient care over the last few years. They have embraced digital technology, expanded their workforce, and adopted a more targeted and proactive approach to people living with long term conditions. All of which has helped them with implementation of modern general practice and to improve the team’s working environment.

Dr Krishna Kasaraneni, GP Partner at the specialist GP training practice, said: “Our approach to modern general practice includes making the most of technology, but it’s also about thinking differently and supporting general practice staff to develop new ways of working to overcome challenges or barriers.

“We’ve focused our improvements on access. By that I mean the patients who need the most support can get it easily. We wanted to be more proactive, more structured, both to improve the experience for patients and give our team a good work life balance.”

Proactive long term condition management

Dr Krishna Kasaraneni

Dr Kasaraneni and his team have used the information accessed via these new ways of working to change the way they manage long-term health conditions. He explains:

“One of the changes we focused on was using our data to understand the impact of chronic disease on the practice and patients. It showed that some of the long term conditions we expected to be increasing, such and heart disease and dementia, weren’t but metabolic and mental health issues were creeping up in our patient cohort. Getting that data enabled us to identify the support patients really needed and to design our service to better meets those needs.”

Focusing on growing health conditions has had a beneficial impact on staff satisfaction, patient experience and the wider health system. Dr Kasaraneni explores how these benefits have arisen.

“The bulk of the work we do now is getting to know the patients, their families, their backgrounds and the potential long-term impact of their condition. We’ve changed our appointments to make them longer and to provide more holistic and empowering care. When we do chronic reviews, the shortest appointment is 15 minutes, but it’s frequently half an hour, 45 minutes/up to an hour, if need be. That way we have adequate time to optimise treatments and support patients with advice on how to manage exacerbations.

“Changing how we manage chronic conditions has helped to build relationships with patients and increased their confidence, through improved continuity of care. But the impact is wider, it’s also helped to reduce pressure on other parts of the NHS including A&E and admissions. Plus, it’s made a big difference to job satisfaction, you finish work thinking that felt nice, rather than I got through the day – that transition is really important for workforce.”

Taking a multi-disciplinary approach

The practice has also taken innovative steps to provide specialist care for its patients into the community by working in a muti disciplinary team (MDT) with secondary care.

Dr Kasaraneni said: “We now have a consultant nephrologist, who specialises in treating chronic kidney disease (CKD), involved in a MDT clinic in the practice. This allows us to act quicker when someone’s CKD is worsening. We make a plan, and we implement everything straight away on that date, to improve the patient journey. We don’t need to call the patient into the surgery, then send a referral, have them wait for a hospital appointment, then put a plan in place.

“When we talk about bringing care into community, bringing care back into primary care, this is how it should be done. You cut out so many different steps, there’s no referral, admin burden is decreased, and it improves patient experience and outcomes through more timely care.

“I think it’s a model that lends itself well to lots of different health conditions, including mental health and complicated metabolic conditions like diabetes. We’re now looking at expanding this way of working across the PCN and I really hope it will continue to flourish in the way it is doing at the moment.”

The team has expanded over recent years and includes the traditional general practice workforce and new Additional Roles Reimbursement Scheme (ARRS) roles. MDT working has been embraced in the practice, enabling patients to see the right professional at the right time. Its proactive and targeted approach to managing long term conditions has enabled the team to identify the most appropriate team members to lead on different elements of patients’ care.

“We’ve grouped patient cohorts, conditions and activities and aligned them to the most appropriate role in the workforce, using a clinically safe care navigation process. This helps us identify who is the best person to lead reviews and whether patients need to see a GP, a nurse, or another professional in the team.

“We’ve changed how we review patients and the whole team is involved. For example, our pharmacists and pharmacy technicians can support some patients with medication queries and reviews, and our nursing team can support many of our patients with asthma, COPD, and diabetes. This proactive approach means that we see the most vulnerable patients at least four times a year, sometimes even more .”

The practice is also exploring how it can most effectively use the ARRS GP Assistant role to support administration of GP practice processes (supporting clinical staff) and provide a quicker service for patients. Steel City has received support for this work from the General Practice Improvement Programme.

Making the most of digital technology

Steel City turned on its online consultation system over two years to enhance its service for patients and offer them the choice of multiple access routes walk in, telephone and online. All requests are dealt with using the same approach so that patients are treated the same regardless of how they have made contact. The team also used it digital capability to improve several administrative tasks and made them more efficient, including its approach to issuing fit notes and communicating with patients.

Josie Matthews is the Practice Business Manager at Steel City. She explained the impact of implementing digital solutions:

“It’s obliterated the 8am rush, having all this digital help, it’s fantastic. It’s helped get around the issue of people having to ring first thing in the morning to secure an appointment and then call back the next day if none were available.

“It’s also useful for communicating with patients because it secure and quick. For example, if a patient contacts us about a rash their child has, we can ask them to send a photo of it and then the GP can review it and make an immediate judgement on whether they need to come in or urgently go to a hospital.

“The digital systems are easy to use, for the team and our patients. It has massively, helped with access and admin staff have welcomed the change because they don’t have to tell patients an appointment isn’t available. The way we deal with fit notes has completely changed.

“Requests come in digitally and are dealt with by GPs on a rota basis – an appointment isn’t always needed. Systems are more streamlined which saves me a lot of time, for example I can send a patient information about minor surgery in one click of a button.”

The speed and efficiency of new systems are popular with patients and staff alike. Josie continues:

“It works for our patients too, particularly those who find it hard to come into the practice or communicating on the telephone. They can get the information they need quickly and easily and choose appointment times that suit them.

“We can also tailor messages using the system. Our vaccination requests and blood test results can be automatically translated into Urdu or Slovak, or another language, to make them more accessible for patients whose first language is not English.”

Advice for other practices

Having implemented these new ways of working Josie has lots of advice for other practices that want to transform how they work.

“My advice would be to really support your team with training because most issues have been down to human error and not knowing enough about the system. You need to put time aside to really concentrate, sit with multiple members of staff and make sure that everything is set up correctly before going live. You can start small; we did it stage by stage and started with fit notes before scaling up.”

Dr Kasaraneni added: “You need to know your practice, look at metrics and the trends you’re seeing in patients. Try things and don’t worry about making mistakes, you’ll learn from it and then you can try something new. It’s also important to bring your staff and patients with you and to work at their pace. You can ask for help – speak to other practices about what they’ve tried and what’s worked.

“Change in general practice is constant so 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 the issue differently.”

For more information about Modern General Practice and the support available visit NHS England » Modern general practice model