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Biggest reform to GPs in a generation brings new services for patients in the North West

The biggest transformation to the way family doctors work in more than a generation will be launched from today (Mon 1 July).

It will see general practices, large and small, working to support each other while offering a wider range of specialist care services to patients from a range of health professionals.

In the North West, Healthier South Wirral, Burnley East and Aintree Primary Care Networks are just three examples of how networks are already rolling out programmes of work which are having a direct benefit to the populations they serve.  (More detail on each of the case studies can be found below.)

GPs will recruit multi-disciplinary teams, including pharmacists, physiotherapists, paramedics, physician associates and social prescribing support workers, freeing up family doctors to focus on the sickest patients.

Around 7,000 general practices – more than 99% – have come together across England to form almost 1.300 new Primary Care Networks. 

In Lancashire and South Cumbria there are 217 General practices with 41 networks and for Cheshire and Merseyside 374 practices and 55 networks.

Anthony Leo, Director of Primary Care and Public Health for the NHS in the North West said, “Primary Care Networks allow the practices within them to think differently about the services they are offering to their patients. 

“By working together, they can share the workload and ease pressure on the individual practice teams.  As primary care networks develop, they will work closely with other health and social care partners and the wider system to offer better access to a wider range of joined-up services more quickly for people who need them most.” 

These will attract billions in extra investment to sustain general practice in the short term and improve access to family doctors, expanded services at local practices and longer appointments for patients who need them.  

This milestone for primary medical and community care, which forms a major commitment of the NHS Long Term Plan, will see neighbouring practices working more closely together and with other services in their area to provide more joined up care for patients.

The additional funding from the five-year GP Contract agreed with the BMA at the end of January, includes £1.8billion to fund the recruitment of 20,000 more specialist health care staff to support general practices.

Up to 40% of GP appointments don’t need to be with a family doctor and the new recruits will free up GPs to spend more time with patients who need them most, offering longer appointments to those who need them, as well ensuring patients can get a wide range of expert specialist services at their local practice.  

This builds on the increase of more than 5,000 extra practice staff working with GPs over the past four years. We will also continue to recruit more practice nurses and GPs, with the number of young doctors choosing to train as GPs now at a record high.

Patients will also have a range of options when it comes to getting appointments at their practice, including the introduction of digital appointments, which will build on the progress which saw evening and weekend appointments made available across the country at the end of last year, with an estimated nine million appointments a year now available at more convenient times. 

It means GP practices will be able to drive further action on killer conditions such as cancer and heart disease as well as doing more to tackle obesity, diabetes and mental ill health, and support older people at home and in care homes.  

The NHS Long Term Plan will see funding for primary medical and community care increase as a share of the NHS budget for the first time in the health service’s 70-year history, with an extra £4.5 billion invested by 2023.

Dr Nikki Kanani, a GP and NHS England’s Acting Medical Director for Primary Care, added: “We’re delighted with the enthusiasm shown across the country with GPs, local medical committees and commissioners working together to establish Primary Care Networks. 

“Of around 7,000 practices across England, 99.6% have joined a PCN with just a handful opting out. We would have liked full coverage but we respect the rights and reasons of those practices who have decided not to sign up and where they haven’t, commissioners will make arrangements to ensure that 100% of patients can access network services. The new PCNs will see GPs large and small working together to provide a wider selection of specialist services to patients. It’s a game changer and signals the start of a new era for general practice.”

While many of the networks are launched today, and it will take some weeks or months for patients to see much change, some PCNs are already up and running and providing new services. 

Burnley East Primary Care Network 

Burnley East Primary Care Network is already seeing benefits for their patients by rolling out this way of working.

The network is made up of seven practices, including Yorkshire Street Practice, Prestige Medical Group (Oxford Road and Prestige Park), Burnley Wood Medical Practice, Briercliffe Surgery, Daneshouse Surgery, Thursby Surgery and Colne Road Surgery and together support around 50,000 people locally.

The network covers an ethnically and culturally diverse footprint, with frailty and social isolation being key challenges for local residents.

Practices working more collaboratively as a primary care network will enable the whole area to benefit from an initiative that was initially established by one of the surgeries – Burnley Wood Medical Centre – working in partnership with Lancashire County Council’s public health team to improve local health.

Burnley Wood Community Assets Network (CAN) brings together partners to address local health issues including high instances of deprivation, high smoking prevalence, childhood obesity and low life expectancy.

The area has gone through a period of regeneration which has resulted in a disconnect between those who have spent their lives in Burnley Wood and new people coming to live in the new housing. The community project aims to use resources available in the community to improve the health and wellbeing of people living in the area and bring community cohesion by everyone working together.

The membership started in 2014 with a variety of partners including community voluntary services, local community centre, council, police, fire service, local schools and colleges, faith groups, housing association and residents.

Over the years more and more groups and organisations have joined the group and shared their resources and knowledge. 

Working as a primary care network, Burnley East PCN were selected as one of five neighbourhood teams in Lancashire and South Cumbria to take part in an accelerated programme for population health management earlier this year. Healthier Lancashire and South Cumbria, the integrated care system for the area – which is a partnership of local councils, NHS, public sector, voluntary sector and community organisations – was one of only four areas in the country selected for the programme by NHS England and NHS Improvement, because it is recognised as leading the way in starting to improve outcomes, reduce inequalities and address the broad range of individual, social and economic factors affecting the health of local people.

The accelerated programme looked at changes in working practices to develop a culture of cross-organisational working as well as how data and intelligence can be better used by GPs and community services to help people live longer, healthier lives.

Dr Santosh Davis, a GP at Burnley Wood Medical Centre and East Lancashire Clinical Lead for Integrated Care Lead said “This was very much about establishing a grass roots movement which could make a difference to the people living in our community. It’s not about medicine, it is about using non-medical interventions to improve people’s lives.

“We have been able to make great progress as a single GP practice working with partners, but the impact will be even greater now we can work with other practices across the area as a primary care network.”

The group have worked together on a number of successful projects aiming to bring the community together and improve the health and wellbeing of those living in Burnley Wood which include a history project, Burnley Wood Big Lunch, Cycling project with local primary school children.

Dr Davis added “We are taking the concept of population health management to the people through community centres and churches and addressing frailty through community connectors: social prescribers who are employed by our Community Voluntary Organisation. 

“More than 70 patients have already received help and support through the scheme and we hope for that to increase even more across the whole primary care network over the coming months.”

Dr Sakthi Karunanithi, Director of Public Health for Lancashire said, “We are looking forward to working ever more closely with our GPs and primary care networks at a neighbourhood level. This gives us a tremendous opportunity to improve health and wellbeing of our residents.”

Aintree Primary Care Network

Aintree Primary Care Network is working with partners to transform patients’ experiences of mental health, community health and children’s services.

The network, which is made up of four practices and covers a population of 37,000, established in 2018 and is already delivering a number of innovative projects including a joint initiative with Mersey Care NHS Foundation Trust to put on monthly joint mental health clinics with consultant psychiatrists.  This is happening in half of the network practices and will expand to all soon.

The clinics are a mixture of virtual review with access to records, discussion of shared patients, advice and guidance for GPs on management of patients with mental illness and discussion of care plans of patients being discharged from mental health teams to primary care.

The arrangements have improved professional and personal relationships, fostered trust, mutual education, sharing of evidence from mental health and general practice as well as a greater understanding of each other’s role.

Because of the multi-disciplinary team working there has been a reduction in referrals to psychiatry because most are now discussed in the monthly joint meeting or seen together in a joint clinic at the practice.

A joint project with Mersey Care NHS Foundation Trust to involve social workers in primary care. Initially focussing on improving safeguarding for the most vulnerable patients, an adult social worker now attends monthly adult safeguarding meetings to better aid collaboration and improve services to patients.

This has proved valuable to the network as well as to the social worker who both share patients of concern so that the social or medical picture can be better understood.

By coming together and working more collaboratively the network is seeing some real benefits. 

Dr Mark Wigglesworth, GP lead for Aintree Primary Care Network said “Through mutual trust, we are able to have the confidence to manage more complex care in the community with a “can do” attitude and with the patients’ preferences at the centre of our management aims.

“Improving our working relationships with mental health team, district nurses, community matrons, social workers, medicines management and therapy teams have improved significantly and has helped our services work together with more mutual trust.

“Working as a network, we receive fewer hand offs from other teams asking us to refer on to another team in the next office. Improved working relationships and community staff feeling supported by GPs have allowed us to manage patients in the community by phone without necessarily having to see them in their homes and knowing that our community colleagues will be able to act as the eyes and ears for us and report back if any deterioration in their condition.

“Our referral rates for mental health have reduced because of holding monthly virtual clinics with the community psychiatrist.”

Aintree PCN is also working with Cheshire and Merseyside Children’s Transformation Programme to pilot integration of children’s services in the network. 

There has been wide reaching engagement on this work involving families, children’s centres, schools, housing, social workers, primary and secondary care clinicians, health visitors, school nurses, Children and Adolescent Mental Health services and voluntary sector organisations.  The network is also exploring ways to develop the workforce in the community to better cater for children and their families.

Dr Wigglesworth, added “We are seeing how integrating services can have significant benefits for our patients.  Our hope is that more and more integration will happen as relationships and pilots develop.

In an NHS where resources are constantly under severe pressure, it is liberating to have within our gift the ability to make small changes to different parts of the system and start to see the beneficial effects on patient care.”

Healthier South Wirral 

Healthier South Wirral is a Primary Care Network (PCN) of seven practices made up of Spital Surgery, Civic Medical Centre, The Orchard Surgery, Allport Surgery, Eastham Group Practice, Parkfield Medical Centre and Sunlight Group Practice supporting 49,356 people.  Through working collaboratively, the PCN has been able to implement a number of key projects which are making a real difference, not only to the day to day working of the practices but most importantly to the patients the practices serve. 

Dr Thomas Wyatt, one of Healthier South Wirral’s Clinical Directors, said, “There is already so much great work going on out there, both in our health and care services as well as our local communities.  But we need a place to pull it all together, where nobody has to do everything but everyone is able to do something to help people in our communities stay well for longer.” 

By encouraging better conversations and new relationships, both patients and those who work in health and social care are able to focus on what matters, what is currently working and how together we can create new solutions.

To help improve access to mental health care we were able to trial the use of a Psychological Wellbeing Practitioner within General Practice. This member of staff was able to see people sooner and deliver group educational sessions.  Our experience of this role has been used to inform our future local service design. 

To help relieve the pressure on our GPs and expand our team we are developing new patient services with our team of Physician Associates. These individuals work alongside our GPs and help to care for people in care homes and the housebound, they also support those recently discharged from hospital and those attending the surgery when unwell. 

Supporting our Physician Associates we have an established Clinical Pharmacist team who provide patient care both within our GP Practices and Wirral University Teaching Hospital.  Sharing a workforce with our local hospital has helped us build stronger relationships that have already started to deliver closer working. 

Working as a network has also enabled the Practices to build new partnership with our voluntary sector organisations.  We are working with Age UK to extend a frailty pilot that provides early help to frail patients.  A Personal Independence Coordinator (PIC) was appointed to help people in their own homes.  The work focussed on being person centred and looked at how non-medical interventions could be used to improve quality of life. 

The team worked with an 85-year-old patient who had used 10 GP appointments in just three months for recurring urinary tract infections (UTI).  The PIC worker worked in collaboration with the patient to increase education on the importance of hydration and even provided a measuring water bottle to ensure the patient was drinking enough.  As a direct result of this the number of GP appointments needed for this patient reduced by half and she hasn’t had a UTI in two months.

Following the pilot, the network has seen between 50 and 87% reduction in GP appointments in this group of patients and a 25% reduction in unplanned admissions to hospital in the patients who took part in the pilot.

Dr Wyatt added “The important thing we have learned in our PCN journey so far is to listen to stories, use data and improve the environments we live and work in.  Also we don’t actually have to agree on everything – as long as we’re moving in the right direction together.”

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