General Practice Resilience

10 high impact actions to release time for care

The 10 High Impact Actions are a collection of ways to improve workload and improve care through working smarter, not harder.

1. Active signposting: Provides patients with a first point of contact which directs them to the most appropriate source of help. Web and app-based portals can provide self-help and self-management resources as well as signposting to the most appropriate professional.

Each practice has reception staff trained in active signposting or ‘care navigation’. This ensures that patients get directed to the most appropriate point of care first time. Practices have all identified champions to ensure this continues to develop. Receptionists record this signposting on a specially designed template which allows us to monitor the efficacy. This should help us release some GP appointments and improve access.

2. New consultation types: Introduce new communication methods for some consultations, such as phone and email, improving continuity and convenience for the patient, and reducing clinical contact time

Extended Access- Every practice provides appointments outside of core working hours.

Online Consultations- every practice now provides e consultations with a GP through their websites.

Behavioral Health Coaching- nurses have had training to approach chronic disease management in a new way.

Group consultations- Moorlands Practice is trialing group consultations for asthma patients. This has gone very well so far and will be rolled out in other practices.

Video consultations- practices are working with the CCG to trial technology to allow video consultation.

3. Reduce Did Not Attend (DNAs): Maximise the use of appointment slots and improve continuity by reducing DNAs. Changes may include redesigning the appointment system, encouraging patients to write appointment cards themselves, issuing appointment reminders by text message, and making it quick for patients to cancel or rearrange an appointment.
Single ‘Did not attend’ policy for Darlington.
MJOG- this system sends a text reminder of all appointments and allows patients to text back and cancel if needed.

4. Develop the team: Broaden the workforce in order to reduce demand for GP time and connect the patient directly with the most appropriate professional.

Pharmacists- many practices now employ pharmacists who manage medication requests, medication reviews and face to face appointments.

Nurse practitioners- most practices now employ nurse practitioners who are able to assess, diagnose, prescribe, investigate and refer. They work closely with the GPs in their practices. Many are now taking leads in areas such as frailty.

Paramedic – working alongside nurse practitioners as a ‘clinical practitioner’, managing acute problems and home visits.

HCA – this role is extending and can vary from phlebotomy to chronic disease reviews including spirometry.

PM development – Practice Nurses extended roles and prescribing.

5. Productive work flows: Introduce new ways of working which enable staff to work smarter, not harder.

Administrative staff trained in correspondence management so GPs only see letters that are relevant.

Pharmacists managing medication requests

Dual Screens

6. Personal productivity: Support staff to develop their personal resilience and learn specific skills that enable them to work in the most efficient way possible.

Administration staff in Darlington have undertaken Conflict Management training as part of their PLT helping to build personal resilience when signposting patients.

7. Partnership working: Create partnerships and collaborations with other practices and providers in the local health and social care system.

Prior to the PCN development practices were working in 3 hubs developing relationships.

PMs now meet monthly and are looking to share resources and support each other further.

DPCN/TAPS meetings where community nursing teams and practice nursing teams meet to develop relationships and partnership working.

8. Social prescribing: Use referral and signposting to non-medical services in the community that increase wellbeing and independence.

Currently Wellbeing Facilitators for Frail people service funded bythe Better Care Fund and provided by PHD.

PCN Social prescribing plans for Familiar Faces and Families teams.

9. Support self care: Take every opportunity to support people to play a greater role in their own health and care with methods of signposting patients to sources of information, advice and support in the community.

Working with LCP (community pharmacies).

Signposting and behavioral health coaching.

Promotional materials on all websites and in waiting rooms.

10. Develop QI expertise: Develop a specialist team of facilitators to support service redesign and continuous quality improvement.

Staff have taken part in many different development programmes:

General Practice Improvement Leads

Productive General Practice

Fundamentals of Change and Improvement

Working together for a healthier Darlington