Managing winter pressures in primary care

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We recently sat down with Simon Lucas, Livi UK Managing Director, to discuss pressure points facing general practice this coming winter, and possible approaches to address them.

Q: Where do the biggest challenges lie this winter in your opinion?

A: I think it’s a given that we can expect all the pressures we’ve come to associate with this period. The return of flu, further covid variants and norovirus will all pose challenges. Demand surges will invariably continue this time of year. There is also the ongoing booster campaign too.

On top of this, there will be new challenges stemming from the cost-of-living crisis which has the potential to place further pressure on stretched primary care, mental health and community services. We’re already hearing that people with mental health problems are nearly twice as likely as those without to say they have felt unable to cope due to the rising cost of living.

At the same time, the health system is undergoing a massive process of change. Implementing new ways of working and fostering greater collaboration will be made more challenging by the winter season. For example, working out how GP practices, and PCNs will work together with ICBs, and bringing plans for enhanced access to fruition are big operational challenges.

Q: Why do you think collaboration is so important?

A: CQC local system reviews have shown that where systems have joined up processes, they are better equipped to manage pressures.

We saw during the COVID-19 vaccination drive close working of PCNs and the system as a whole to deliver an unprecedented roll-out in a time of crisis. We continue to see unrelenting dedication and tireless efforts of teams coming together to provide services in the face of increasing demand every single day.

In planning for winter, the system is indeed building on this and working more collaboratively than ever before. This must continue. Managing capacity within urgent care will always be a major focus of efforts during the winter season of course, but outside of this, a system-wide approach will be essential.

Q: Where practices are struggling to deliver, what do you think the solution is?

A: I think we can look to some great cases of PCNs supporting practices where demand has been overwhelming.

One particular case that comes to mind involved a pan-PCN partnership working collaboratively with other local providers in the community to provide support in that very sense.

This model has delivered overflow capacity through extended access hubs, utilising ARRS roles and a community pharmacy consultation service. Out-of-hospital care is also provided with patients supported at home through virtual wards. I think once again this illustrates how primary care can come together to work within an integrated care system, and how important this will be during the winter months.

Digital clinical capacity is also an essential tool that can be mobilised at speed to manage winter pressures. Here at Livi, one of the core ways we work with partners is to plan for and anticipate surge demand based on the needs of specific populations. Through our Livi Practice model, we can provide the additional appointments required very quickly and build resilience for this challenging period.

Q: What other tools can practices utilise to cope with demand?

A: I think communication will be all important. If we look at some of the usual challenges of the winter season – immunisations, isolation, signposting, self-care and appointment attendance etc. engaging patients with the right communication strategy is key so patients know what to expect.

The humble GP practice website has a big role in that strategy. NHS England has announced the GP Access campaign in February of next year to increase people using online access routes to contact their practice. I think that is essential. The GP practice website is one of the most important tools at a practice’s disposal. When built to NHS Digital Service Manual standards, it can improve accessibility, drive online engagement and help practices cope with increasing demand. This is just one of the ways we’re supporting practices at present.

Equally practice messaging platforms can also empower patients to self-care and take an active role in their health and wellbeing. We give our partners the ability to run dedicated campaigns for flu season for example, and provide content and functionality to roll it out over a health system in just a couple of clicks.

Q: What about capacity itself and increasing appointment numbers?

A: I think we need to look at how we can actively support both clinicians and practice teams in a more holistic way to meet targets.

We have all read stories of frontline staff receiving abuse and how demand pressures are affecting the health and wellbeing of those who care for us. I think campaigns like Rebuild General Practice and the RCGP’s Fit For The Future are doing a fantastic job to highlight these issues and illustrate why and where primary care needs more support. As well as addressing capacity issues with workforce planning, supporting the health and wellbeing of the existing workforce will be just as essential for the long-term sustainability of primary care in the UK.

At the same time, where there are resource challenges, digital clinical capacity can offer the flexibility of approach that’s necessary to serve same-day urgent care demand. This can help to ease pressure on teams and free up face-to-face appointments. This is how we’re working to support practices, PCNs and ICSs not just during winter, but all year round.

The above article is an extract for our recent winter pressures report titles "Success through winter access". To read the full report, click here.