Wolverhampton practices team up for workforce and pathway redesign

9 June 2017
Wolverhampton Total Health, a partnership of eight practices, has adopted a creative approach to its primary care home (PCH) test site.
 
The practices were spurred into action by a looming GP recruitment and retention crisis against the backdrop of high levels of deprivation and associated unhealthy lifestyles such as smoking and poor diet.
 
Dr Gill Pickavance, GP and Wolverhampton Total Health Limited’s chair, says PCH test site status provided an opportunity to improve collaboration and integration and to shape new clinical pathways. Addressing a recent PCC event, Pickavance said:
 
“We were working in silos and this was a chance for us to get to know our colleagues a bit more and to work together with the clinical commissioning group to shape commissioning. It was seeing what we could do. The population we covered was small enough for people to know each other and to know their patients and their problems. We had always done things like peer group analysis of referral patterns but with PCH we are going into meetings thinking we can change something.”
 
One major outcome is three new clinical pathways effective from this month (April) with planning for another three underway.
 
Pickavance explains: “We try to identify who in the PCH has the expertise we can use. We’re sharing resources such as GPs with a special interest across practices. We’re also able to share a counsellor or social prescriber.”
 
Freeing up time for GPs to have longer consultations with patients with complex needs is, as with all the PCH sites, a key priority.
 
In Wolverhampton, Pickavance and her colleagues are reshaping the workforce by recruiting more physician’s assistants, pharmacists, advanced nurse practitioners and health care assistants. When news broke that the eight practices would share back office functions some staff were understandably worried about their jobs. However, their concern proved unfounded.
 
“What we have done is provide them with more training and identified talents amongst the staff and partners. Recognising that we will not have as many GPs in the future means that we have to maximise our use of current resources and diversify the workforce.
 
“Reception staff, for example, have been trained to signpost people to voluntary services, the PCH is working closely with pharmacies and we’ve introduced social prescribing.”
 
This focus on wellbeing is a central part of the PCH’s platform locally, Pickavance says.
 
“If you are making people feel better because they are less lonely, for example, they tend not go to hospital or need to come to your clinic. People who are happier in their own homes by adjusting their physical and social environment are less likely to fall over and risk breaking their hips. We’re trying to move away from being so reactive. The people we want to reach are not necessarily the very sick but those at risk of being very sick.”
 
“We’re coordinating primary and secondary services and blurring the lines between the two. We are providing more care and diagnostics in the community but we need to be careful not to undersell ourselves – just because we can move it out to general practice it doesn’t mean the care will be cheaper, although it will improve access by making it more accessible. Often the biggest barrier to achieving that is lack of space in the practice and we are working with our CCG to develop premises to suit this transformation.”
 
Several of the PCH practices took part in the extended hours opening pilot over the Christmas and New Year period and on through to the end of February to help relieve winter pressures. Pickavance says the pilot also allowed the practices to test out the compatibility of their linked IT systems.
 
See also related article on PCH set-up costs at:http://bit.ly/2rbnNBR

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

 
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