Over the last few years, many practice teams have looked to introduce new models of working into daily practice life. Changes have been precipitated by a number of different factors.
From rising appointment numbers and finite resource, through to serving increasingly complex patient needs and growing, ageing populations. For some, there have been subtle shifts that have delivered efficiency gains. For others, more wholesale overhauls that have driven success.
Here, we compare and contrast some different approaches utilised by teams.
The pandemic transformed how practices interact with patients with a move away from traditional triage systems. Post-pandemic, practices continue to adjust their systems in different ways to serve demand.
In response to ongoing capacity pressures, some practices have implemented various forms of hybrid triage systems. Online forms on practice websites play a crucial role in daily practice working, with appointment booking and requests coming through this system. Forms feature a few brief questions for patients to fill out which then comes through to the practice team as a consultation request.
When patients call the practice, they are asked by reception to fill out the form and if the patient is unable or chooses not to, the practice team will complete it on the patient’s behalf. With all requests coming through this one portal, this helps to streamline and make practice workload more consistent.
In another area of the practice, a dedicated team of admin, GPs and associated nurse practitioners will work through the day’s forms and triage accordingly. This is done in the same room, which helps to aid decision making and allows team members to ask questions and discuss the best course of action, whether it’s an urgent same day appointment, a routine appointment or referral to another service.
Practice clinicians will spend a portion of their day working within the triage team and the other part of the day seeing patients. This provides variety in the working day for clinicians and also gives members of the admin team a break away from phone lines too.
It also helps foster a learning culture within the surgery, building confidence and skills in triage. Decision making is shared among the team, which removes some of the stress that can come with triage. And ensuring the right appointment types are allocated to patients consistently can free up capacity and unclog phone systems.
Some practices have looked to structure their workforce to more closely mirror the patient populations they serve.
In areas where there is a high proportion of diverse ethnic groups, teams are utilising healthcare assistants (HCA) and receptionists from many different backgrounds, building in staff from the local community. This includes non-native English speakers who are fluent in other languages prevalent in the area, as well as staff without previous medical experience.
Individuals are given extensive training in many different areas such as communication, patient medicals and prescribing protocols, and can enter the HCA training programme.
These roles are seen as a vital part of the healthcare team within the practice, and once fully trained, both HCAs and receptionists have a pivotal daily role within daily practice life. HCAs work alongside clinicians onsite, and will in many cases see patients first, providing patients with upfront health advice or carrying out certain checks.
The goal is for all staff to have truly ‘meaningful contacts’ with patients to help them take an active role in managing their health.
Teams have also formed dedicated units focused on data within practices, including monitoring QOF registers and performance targets. Within these teams, HCAs will initiate proactive conversations with target populations to support health promotion and prevention.
This might involve outreach to drive weekend health checks, or for diabetic control or smoking cessation. While digital messaging tools have helped practices with patient engagement too, with simple, short messages said to have the most success in comparison to longer patient questionnaires.
Teams are also looking to initiate dedicated population health management projects. For example, identifying high service users with low medical needs, and working to proactively modify behaviours to free up clinical capacity. Teams use data to identify reasons for patient contact and make necessary changes to address these needs proactively.
Practices have also looked to introduce a wider range of on-site services to suit the different needs of their population.
In some medical centres, this means having a pharmacy on the practice premises, so patients can access prescriptions 24 hours a day. Technology is playing a role too, with pick-up lockers and robotic dispensers in some practices helping to free up capacity further. Wider services integrated in practices include endoscopy units linked to hospital pathways and nursing wings with midwife and paediatric nurses.
Practices are collaborating more closely with other areas of the system as well such as community pharmacy, and utilising social prescribers from the voluntary sector for drop in sessions. Additionally, some organisations are looking at ways they can work with ambulance services to support triage and reduce waiting times.
Teams have also looked to bolster resilience at scale through digital clinical capacity models. In the case of one Livi partner, the team had identified a need for additional resource to supplement stretched practices across the region. In particular, the team wanted to increase access in deprived, underserved regions with a low GP to patient ratio.
In just 12 weeks the service was up and running across a full cohort of practices, and would deliver 400 appointments a week on average including 960 consultations in a single week at full capacity. By May, Livi had provided 1600 additional GP hours in just 5 months.
The model functions as a digital extension of the practice team, with bookable appointments with NHS GPs integrated within practices’ clinical systems, so reception teams can book appointments just as they would usually. Administrative support is also provided by Livi and mirrors local ways of working and prescribing protocols. This digital model is increasing capacity, supporting triage and signposting and can provide referrals, prescriptions and fit notes.
Laser-focused on helping areas most in need, Livi’s agile model also allows for clinical resource to be reprioritised and reallocated quickly to support practices in crisis (as defined by the Operational Pressure Escalation Levels OPEL Framework). Livi has also bolstered practice resilience when A&E pressures have created downstream capacity issues in primary care.
The last few years have indeed been a period of evolution within primary care following the pandemic. As to what the future will hold? That remains hard to predict. The old adage of ‘change is the only constant’ is likely to hold true however.
Whether it’s achieving the long-term goal of the Fuller Stocktake to more fully integrate primary care within integrated care systems, or realising the vision of ‘modern general practice access’ from the Plan to Recover Access to Primary Care, there are many ongoing programmes of work that will continue to shift the landscape. And while the capacity-demand mismatch remains an ongoing constant in many areas, the health system will continue to adjust.
How can we help you?
Livi can provide a range of support to GP practices:
Our GP practice websites help to optimise access so more patients can find the services they need online
Mjog provides digital messaging tools to help practices engage patients, supporting QOF attainment and remote monitoring
To find out more, read a case study.