A new five-year contract for general practice across England will see billions of extra investment for improved access to family doctors, expanded services at local practices and longer appointments for patients who need them.
The deal – the biggest reform to GP services in fifteen years – was approved by NHS England yesterday. NHS England chief executive Simon Stevens said it is the first major pillar implementing the NHS Long Term Plan, coming just three weeks after the Plan was published.
The new contract has been welcomed by health and care leaders in Lancashire and South Cumbria, who said it would accelerate work already underway to sustain and transform primary care.
The extra investment will increase the numbers of staff working in general practice and look to increase the numbers of pharmacists, physios, paramedics, physician associates and social prescribing support workers in general practice. The contract will also see neighbouring practices working together as primary care networks, with multi-disciplinary teams working alongside other community services.
Dr Malcolm Ridgway, Senior Responsible Officer for Primary Care, for Healthier Lancashire and South Cumbria, said: This is fantastic news and a welcome boost that will accelerate our programmes of work to support, sustain and transform primary care.
“One of our key priorities is to grow the general practice workforce to meet current and future needs, and in addition to our work to recruit and retain GPs we are supporting increases in the wider clinical workforce such as nurses, pharmacists, physicians’ associates and paramedics working in practices across Lancashire and South Cumbria.
“Our work to support primary care networks is moving at pace, with network agreements in place for all of our practices, and we will continue to work closely with our local clinical commissioning groups and practices to support their development.”
Examples of work already underway to transform primary care in Lancashire and South Cumbria include:
- 100% of practices within Lancashire and South Cumbria is included or linked to a primary care network, which is ahead of the national target.£1.75 million has been invested to support the development of primary care networks across the whole of Lancashire and South Cumbria.
- 3 physician associates (PA) are already working in practices in Lancashire & South Cumbria and there are plans to increase the numbers over the next year. Find out more about PA’s: https://youtu.be/Brwb8KI16qw.
- 14 clinical pharmacists are already working in practices in Lancashire & South Cumbria, with a further 11 clinical pharmacists approved for recruitment his year.You can view a video on Clinical Pharmacists here: https://youtu.be/KMpzNByQpE4
- Across Lancashire and South Cumbria 18 Primary Care networks are taking part in the digital exemplar programme and currently have access to services online.98 practices are currently enabled to use the MyGP app, which has been downloaded by over 36,000 patients.
Case studies – Practices of the future
Darwen Healthcare, Darwen
The changes introduced by Darwen Healthcare in Darwen – including becoming one of the first practices in Lancashire to have the new role of physician associate – are increasingly seen as the way forward for general practice.
Innovative new roles created by Darwen Healthcare mean that patient journeys are now even quicker, patients have more dedicated services and GP time has been freed up to see patients with more complex needs and offer longer appointment slots. They include:
- Admin staff upskilled into new roles including healthcare assistants and prescribing clerks.
- A physician associate undertaking home visits with a tablet and video linking patients to GPs back in the practice
- An advance nurse practitioner, who runs minor surgery clinics and supports patients with complex health needs
- A clinical pharmacist, who works as part of the surgery team to resolve day-to-day medicine issues and consult with and advise patients about their medicines directly.
- Trained care navigators to help patients to see the right health professional for their needs.
The changes have enabled Darwen Healthcare to provide new, dedicated services to improve patient outcomes, including a clinic for pre-diabetic patients and a scheme to encourage men to have health checks.
Darwen Healthcare GP, Dr Ray Sudell, said: “We looked at what our patients and staff needed for the future. The results showed us patients need more access to us and staff needed more time to complete processes for their patients. We embarked taking on new roles and expanding colleagues’ roles in the practice.
“This has resulted in more appointments and access to staff, more efficient ways for patient to order prescriptions and arrange blood tests and our staff have a better work life balance.”
Practice Business Manager Ann Neville said: “There are so many changes within General Practice now and it is an exciting time, with many new roles starting to emerge.
“Before we made these changes, our GPs used to come in early and leave at 9pm when the cleaners finished. By making changes to our team and the way we work, we have been able to free up GP time. This has enabled us to look at increasing appointment times for patients who need to see a GP from 10 minutes to 15 minutes and our GPs can leave work on time, so everyone benefits.”
You can find out more about Darwen Healthcare by viewing our video here: https://youtu.be/xT85rfgNL_8
Healthier Fleetwood Primary Care Network
Fleetwood in Lancashire has a population of just under 30,000 residents, with significant health inequalities and traditionally poor health outcomes. It is also home to the National Association of Primary Care – Primary Care Network of the year, Healthier Fleetwood.
Over the past four years the three GP practices in Fleetwood have been developing integrated care across the town, working with other health and care providers such as community pharmacy, the local dental practice, community nursing, Lancashire Care Foundation Trust, providing specialist mental health services, Blackpool Teaching Hospitals NHS Trust and Inspire, the local drug and alcohol service provider, to address the health needs of the town.
Together, Healthier Fleetwood has been looking to improve mental health services, services for people with long term medical conditions such as Chronic Respiratory Disease (COPD) and focussing on the health of the towns children. There is also a significant focus on empowering residents and on promoting wellness, along with a wide range of social prescribing initiatives. Social prescribing involves helping patients improve their health, wellbeing and social welfare by connecting them to community services which might be run by the council or a local charity. For example, signposting people who have been diagnosed with dementia to local dementia support groups.
The Primary Care Network is also addressing childhood obesity by teaching children to cook through the Fleetwood Young Chef programme. Working with the Children and Families Division of Blackpool Teaching Hospitals they have are also working with 20 families in the town whose children are at highest risk of hospital admission. This integrated approach has received excellent feedback from the families involved and has also significantly reduced the need to hospital services, especially A&E.
Mental health services have been integrated across primary care, at a GP practice level and secondary care, in hospitals.
Dr Mark Spencer, GP at Mount View Practice, Fleetwood and Clinical Lead for Primary Care Transformation for Healthier Lancashire and South Cumbria said, “The most significant change that we have seen through Healthier Fleetwood is with residents genuinely taking control of their own care. They have designed and implemented their own social prescribing pathway with over 24 different activities now available, many of them resident led.”
Together a Healthier Future, Pennine, Lancashire
The East Lancashire social prescribing scheme has been running for four years and has invested approximately £2.5M into community schemes, groups and activities that GPs in the area can refer their patients to. The social prescribing scheme, called ‘prescription for health’, is a tangible investment in local communities and recognises the skills, experience and knowledge that communities can bring to support patients with a range of non-medical, socially orientated support.
These services can include everything from debt counselling, support groups and walking clubs, to community cooking classes and one-to-one peer mentoring. Social prescribing is a powerful and useful means of investing in communities and reducing demand on the NHS, the team at Pennine have now also seen the practical benefits that these schemes have had in supporting independence, reducing social isolation, building confidence and self-esteem, and improving the overall health and wellbeing of people in all communities.