Pilot schemes to test new ways of working in general practice represent a logical next step in the delivery of the Fuller Stocktake.
This initiative rightfully reaffirms general practice as the bedrock of the NHS and one in need of further support. Furthermore, it crucially recognises that surgeries in many parts of the UK are still struggling with rising demand, two years on from that initial landmark publication.
With an aim to identify changes that optimise GP operational models, seven ICBs will now work with respective PCNs to co-develop the best routes forward. This focus on collaborative working has led some to speculate that the programme may eventually serve as the natural evolution of integrated neighbourhood teams in years to come.
While time will tell, this short-read brief looks at how pilots might develop and what they might need to succeed.
Encouragingly, there are indications that pilots will start from an assessment of demand, reflecting the persistent problem facing many surgeries at present.
As data-driven programmes at their core, they will invariably require optimal analytical tools to fuel many of their stated objectives alongside availability of the right data.
Identifying the needs of complex patients at the most granular level will be essential. And two possible areas that could have significant benefit in that regard include utilising search tools to pinpoint those not on registers as well as any overlap across conditions.
These insights can feed into ‘flexible staffing models’ envisioned for pilots, helping to forecast and plan required resource while also supporting structured, efficient chronic disease management.
The focus on prevention of course also inevitably necessitates more hands on deck to boost available capacity.
Facing a growing ageing population and increasingly complex needs that outstrip GP supply, pilots will look to leverage multidisciplinary expertise in an optimal way in line with the Fuller Stocktake.
While we wait to see exactly what form this will take and the models that could emerge, the HSJ anticipates this is “likely to refer to separate clinicians and modes of access from traditional practices.”
One multidisciplinary team model that can deliver results in that context is the virtual clinic.
Combining specialist expertise of clinical pharmacy and GPs, this model can facilitate earlier intervention, supporting condition and medication reviews while easing pressure on stretched practice teams. QOF work can be completed earlier in the year too, creating some much needed breathing space for surgeries.
Where there is shrap fluctuation in demand, virtual clinics also offer the capability to redistribute resource across an ICB or PCN area.
Did you know?
For Enfield South West PCN, Suvera virtual clinics delivered an average 83% target achievement across all practices in key hypertension QOF indicators.
There’s an old adage that for any change to take hold, you need solid evidence to support it.
And welcomingly, the announced programmes will look to share key insights and learnings as ICBs test different approaches in their respective footprints.
Certainly, the focus on “evaluating and systematically capturing data” is right as is the promise of support from NHS England for such endeavours. The ability to generate meaningful evidence consistently across a project lifecycle is vital to building momentum, belief and confidence in any transformational shift.
This will not only demonstrate impact but also provide practical examples for future application in other parts of the system as to ‘what works’.
One key area of evaluation will be around the impact of process automation and risk stratification in general practice.
Certainly, here at Suvera, we've seen first-hand the benefits both can have. For at-risk populations, appropriate sequences of care can be established and automated with the right technology. Risk stratification tools can help teams to initiate proactive outreach to patients before issues arise and optimise call and recall accordingly.
While remote management and monitoring can streamline care management and free up in-practice resource also.
Suvera statistics
Shrewsbury PCN saved over 4,839 hours in appointments, saving approximately £345,000 in 2023 with a virtual clinic adopting a risk stratification approach.
Finally, it would be remiss not to mention how parts of the GP community have greeted the announcement of the ICB pilots.
Some have expressed that current levels of financial investment remain a more pressing obstacle, and that the desire to focus on new ways of working may be out of step with problems facing general practice right now.
Others have argued that pilots seem to focus more on how GP surgeries can support the rest of the system with upstream prevention, rather than looking at the demand at the door of practices at present.
The BMA has commented:
“Rather than attempting new, untried and untested ways of working in general practice, we should be concentrating on ensuring that patients can see their family doctor quickly and easily, in a practice that is local to them, which is well-staffed and resourced, and safe.”
Needless to say, these programmes will require strong levels of input from GPs to ensure they both address such concerns and produce practical solutions that garner support.
In that regard, plans for pilots do note a need to ensure “key stakeholders and subject matter experts including frontline GPs have opportunities to feed in advice and contribute.”
That contribution will be of the utmost importance over the next two years.
Suvera is working with ICBs, PCNs and practices to deliver proactive chronic care through virtual clinics. We risk stratify populations and engage patients at scale, providing ongoing condition management and remote monitoring.
To find out more, book a meeting or contact partnerships@suvera.co.uk.
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