Hampshire practice integrates to grow with its community

8 May 2017

Like many communities that grew rapidly in the late sixties and early seventies, Yateley in North East Hampshire faces a demographic challenge beyond even that confronting the rest of the nation.

Many of the young parents who arrived with their families back then are now either over 75 or soon will be.

The Oaklands Practice and Hartley Corner Surgery have developed an innovative new model of care for these early residents and their families.

The practice’s business development manager, Jennifer Taylor, explains: “In our business planning in 2014 we were looking at these pressures – such as GP recruitment and rising patient expectations – and decided to start with literally a blank sheet of paper. We worked with a flipchart to start redesigning local primary care that would be more integrated.”

Three years down the track and following a merger of the practices (and with a third on the way) the practice, now called Oakley Health Group, is set to reach a practice list size of 28,500 in the next few months. With new homes being built or planned, the practice’s list is expected to reach 30,000 over the next year or two.

That figure is increasingly seen as the entry level for primary care transformation – for instance, it’s the minimum recommended population for the primary care home model pushed by NAPC.

The range of services and the multi-disciplinary, integrated working now cemented in place at Yateley are also characteristic of the emerging primary care home pilots.

Taylor says one of the key innovations has been the separation of routine and urgent practice appointments. “With patients seeking urgent same day appointments, GPs were never sure what their working day was going to look like. Having to squeeze people in to the day also meant they often could not dedicate enough time to patients with complex needs. We also had patients going to A&E because they couldn’t get an appointment with a GP quickly enough.”

The practice’s response was to adapt part of its sprawling premises into an urgent care centre for patients who need to see a GP on the same day. Around 80 patients a day are seen by GPs and nurses working in the centre – on a booked appointment rather than a walk-in basis. This frees up additional time for GPs to support patients with chronic or complex health problems while also building in greater certainty to their working day.

It is one factor in a 5% reduction in A&E attendances by Oakley Health Group patients compared to a 3% fall across the CCG.

The practice’s 17 GPs, seven practice nurses and five health care assistants are supplemented by a range of professionals delivering integrated care with an emphasis on prevention and self-care. Two orthopaedic practitioners are provided by the local acute trust, Frimley Health NHS Foundation Trust. Patients with musculoskeletal problems can make an appointment with an orthopaedic practitioner from the hospital who provides clinics at the practice.

Taylor says: “Patients book directly with the orthopaedic practitioner and it’s better for the patients because they often had several appointments with the GP and physios before those that needed a referral to an orthopaedic specialist finally got one. The practitioner can book patients directly into the consultant if necessary as well as referring them for physiotherapy.

“We’ve cut orthopaedic referrals to secondary care by 30%. It’s a good example of a service that can pay for itself.”

That latter point also applies to another innovative appointment – a paramedic working with the practice full time. Formerly an employee of the local ambulance trust, he spends time in the practice’s urgent care centre but works extensively with the hospital discharge team and supporting patients who have been recently discharged.

The paramedic also cares for patients from other practices and is employed by the GP federation that covers four of the CCG’s five localities.

Taylor says: “We believe that by reducing the numbers of hospital admissions, the service will be self-sustaining.”

Practice and community nurses and nurse specialists see hundreds of patients a week for services ranging from asthma, diabetes and cardiac care reviews to cancer, end of life care, Parkinson’s disease and catheter care.

Taylor said: “The nurses like it because they have GPs on hand if they want to talk about a patient’s medication but the GPs can also talk to a nurse specialist about a particular patient.”

With a community matron, midwives, a dietitian, a mental health professional and adult care social worker also part of the team the practice is a byword for integration.

That is reinforced by siting “help hub” call handlers next to the integrated team desks. They handle an average of 700 calls a day – booking appointments but also signposting to appropriate services and checking with members of the integrated team in the adjoining room.

Taylor concluded: “Demand is increasing but there is not a bottomless pit of money to support this. We must use the resources we have in more innovative ways to provide excellent patient care.”

For information about PCC’s support for primary care development, contact enquiries@pcc-cic.org.uk

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