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Preparing for winter 2021/22

One of the hottest days of the year saw people from practices, primary care networks (PCNs) and federations gather to start to think creatively about managing their winter pressures in this session hosted by PCC and the NHS Confederation PCN Network.

The session introduced delegates to the free PCC winter planning tool and its accompanying how-to video. The tool provides an easy-to-use framework for planning and is based on the NHS GAP Analysis tool which can be easily adapted to your requirements and help you get ahead with your planning and thinking for winter 2021.

Karen Higgins assistant director – PCN Network at the NHS Confederation shared some top tips for getting your winter planning underway namely:

  • Identify what is certain
  • Be clear what’s ‘out of your donut’ i.e. not in your control
  • Identify your assets, who can help you with the work, and who do you need on side? Arrange to talk to them over a cuppa (or virtual cuppa) and get them involved in the early stages of your thinking and planning and importantly, share the workload.

Speakers shared their practical experience and learning about what works, and several themes came out of the session:

  • Starting is key, don’t wait for everything to be perfect, move forward and make changes as you implement and learn from what you do
  • Take a pragmatic and measured approach to thinking about your population needs
  • Use your system and other data to help you identify those most ‘at risk’, and don’t wait for data to be complete/perfect – use what you have
  • Keep your lines of communication open with all key partners and stakeholders and be proactive – use the connections you and others have
  • Everyone experiences challenges when implementing new ways of working, you need to find ways to overcome them. Don’t let the barriers and issues stop you from moving forward.
  • If you always do what you’ve always done, things will stay the same, and you risk missing out on innovation that brings benefits for patients, practices, and stakeholders
  • Learn from others, share, and adapt ideas
  • Don’t give up
  • Making a small change to what you do this year can lead to bigger changes over the coming years.

Addressing inequalities in winter planning

The first speaker Dr Charlotte Hart, clinical director, Shrewsbury PCN talked about how her PCN had taken a pragmatic approach to the COVID-19 vaccination programme by prioritising proactive care for vulnerable people to tackle health inequality in relation to homeless people and people with learning disabilities.

Existing relationships with the local authority homelessness team had been key in reaching out and offering vaccinations to Shrewsbury’s population.

The PCN identified that although NHS England and NHS Improvement (NHSE/I) guidance on vaccinations for people living in care was targeted at older people, the guidance could apply equally to people with learning disabilities who formed a significant part PCN’s population.

Using the learning disabilities register the PCN coded these patients as clinically vulnerable and as such invited them in for vaccination through their vaccination hub, in advance of NHSE/I guidance to do so. The PCN also recognised that attending a vaccination hub may be challenging for some people with learning disabilities so put in place alternatives for those people.

Charlotte’s advice is:

  • Identify the resources and networks that exist around you
  • Take time to build connections with them
  • Communicate regularly
  • Talk to your CCG about your plans.
  • Identify your PCN’s priority groups as early as you can
  • Agree a plan of action.

Importantly, act within the spirit of any guidance but don’t wait for permission to move ahead.

An asset-based approach

Dr Sian Stanley, clinical director, Stort Valley and Villages PCN talked about how the collective assets of the practices across this PCN group were used to rearrange services and respond to the challenges of the pandemic.

The PCN knew that the winter would be tough and wanted to mitigate against the pressures that they knew were coming their way. They set up a respiratory hub having won a transformation bid to embed a GP consultant in a hub with registrars, PCN additional role reimbursement scheme (ARRS) funded staff and health care assistants (HCAs) providing the workforce. The Hub operates without receptionists.

Each practice gets a pro-rata share of the appointments (in line with ARRS allocations). GP’s triage patients in the mornings and then book people in for a face-to-face appointment at the Hub in the afternoon if needed. There is a GP supervisor (experienced GP’s who are trainers or used to providing supervision) who oversees the clinics, provides supervision, triages, and sees the ‘hot patients..

The clinic has now evolved into a same day urgent clinic which includes dealing with respiratory illness but also now also includes other minor illnesses and conditions. The vision is that this will be developed further into a valuable same day service for the PCN.

The PCN have found that the approach makes effective use of GP time and having the hub allows them to focus on the patients who really need their expertise.

Sian’s advice is to make sure your IT systems support your approach, particularly with the ARRS staff, get people to work “at the top of their license” identify who they are, and then explore how you can access additional funds to support your approach and clinically extremely vulnerable patients.

A population health approach to winter planning

Claire Niebieski, system population health manager, NHS Morecambe Bay CCG talked about how they have enhanced the focus and coordination in primary and community care to mitigate for a “COVID winter”. They wanted to ensure that the citizens who may be at risk of harm are supported to maximise health and wellbeing and mitigate against avoidable impacts of COVID-19 and other health conditions through holistic and proactive targeted support.

Underpinning this approach was the desire to:

  • Minimise impact on statutory services
  • Contribute to helping reduce inequalities in health
  • Support communities to make positive lifestyle changes and stay well over winter

Working with partners was paramount at locality level (using care coordination teams, PCN social prescribers and council colleagues) and at district level through established health and wellbeing boards. A steering group was established to oversee and guide the work.

Underpinning the approach, Midlands and Lancashire Commissioning Support Unit provided analytical support to risk stratify the population for the targeted intervention and a cohort of people was identified, namely those patients with:

  • four or more long term conditions including mental health
  • diabetes and/or hypertension
  • at risk of obesity

The people in this cohort were contacted and as a result new care plans were developed; unmet health and social care needs were identified and people previously unknown to locality teams were identified. People were referred into a range of services including for example food banks and be-friending services and were booked into appointments for reviews of their long-term conditions.

The approach is being rolled out more widely with a focus on narrowing the premature mortality and closing health inequalities gaps.

Claire’s learning and advice to maximise your approach to population health includes using all your available assets, routinely embed the approach across all agendas in an ongoing and meaningful way, make sure you have the right data and information to make decisions and measure and evaluate the outcomes so that you can see the difference your approach makes.

At the end of the session, our poll showed, less people were dreading the forthcoming winter than they were at the beginning of the session and feedback included enthusiasm from delegates returning to their practice and PCN with new ideas to implement.