Primary Care At Scale

GP Engagement At Scale

Nina Jhita 22 November 2017

• 1 of 4 GP Led MCPs

(Multi-Speciality

Community Providers)

• Bringing together local

health system leaders to

developing our new care

model

• “Working together

differently”

• Improving the delivery of

care to 160,000

population

Summary

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About Connected Care Partnership

3

Why Transform General Practice?

Operational and System Challenges:

• Rising patient demand and complexity

• Primary care becoming more under-resourced

• Continuity of care being lost

• Patient experience/satisfaction reduced

• Difficulties in recruiting and retaining staff

• Increasing workload

4

Our Response: Enhanced Primary Care Programme

Creating Multi-Disciplinary Teams

3,500 Patients

EPC Team 1

3,500 Patients 3,500 Patients

EPC Team 2 EPC Team 3

Complex Case Management MDT

10,500 Patients

5

Receptionist

Receptionist Receptionist

Receptionist

ReceptionistMSK

MSK

MSK MSK

Our Response: Enhanced Primary Care Programme

• 2 sites tested model first

• 20/23 GP sites have been

transformed to date:

Resource - Clinical

Pharmacist (13) & MSK

Practitioner (5)

Training & Development -

Care Navigation & Team

Development

Smaller Teams -

Distribution of patients &

workload 6

What Did We Do?

Our Vanguard Footprint: Sandwell & West Birmingham

7

Our Approach - How Did We Transform?

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GP Engagement At Scale

Strategic engagement & Operational engagement (Top Down

and Bottom Up Approach):

CCP Partnership Board

CCP Operational Steering Group

Modality/ICOF Practices

Modality Board

ICOF Board

Modality EPC Lead

ICOF EPC Lead

EPC Programme Team/Practice

Managers

• Clinical Leadership –

‘like-minded innovators’

• Commitment to vision

and implementation at

Board and Practice level

• Protected time to

engage with practices

(clinical & operational

support)

At Scale Engagement With EPC Model

9

Feedback from GP to support transformation (Dr Khan video)

Post ‘test site’ implementation

• Sharing of experiences from

test sites (outcomes &

benefits, feedback from

surveys)

• Change Champions (clinical

and non-clinical)nominated

to support widespread

engagement across the

Vanguard

• Individual clinical lead

engagement meetings

• Individual practice

engagement meetings

• Collaborative recruitment

• Sharing of lessons learned

• Sharing of successes

Design & Implement Daily Huddles

10

Daily Huddle Process Co-Designed with GP Lead & Practice

Operational Managers (Dr Randhawa video)

Induction/Orientation of New Roles

• CPD sessions/networks led

by Lead Clinician: Clinical

Pharmacist & MSK

• Collaboration with Clinical

Leads and Clinicians to

develop operational

intervention dashboards to

convey impact/benefits of

role

• Encouraging confidence at

peer sites

Co-Recruitment, Selection,

Induction of New Roles

Design & Implement MDTs

12

• Holistic, person-centred

approach

• Identification of patients

via. risk stratification

• Right clinicians to

review/discuss patients and

make appropriate decisions

• Standardised: Frequency,

Admin support, size

Co-Designed with Clinicians

to develop MDT philosophy

13

Design & Implement Care Navigation

Co-Designed with Medical

Director, Clinicians, Frontline

Outcomes to Date:

14

• Confidence growing: new roles and smaller teams

increasing GP/ANP capacity

• Operational and system savings being demonstrated

Summary:

New Roles: 5.2 WTETotal GP Sessions Released: 894

Outcomes to Date:

15

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Key Take-Away!

Any Questions?

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