The General Practice Forward View published in April 2016, set out plans to enable Clinical Commissioning Groups (CCGs) to commission and fund additional capacity across England to ensure that, by 2020 everyone has improved access to GP services. This is to include sufficient routine appointments at evenings and weekends to meet locally determined demand, alongside effective access to out of hours and urgent care services. North Norfolk CCG is commissioning approximately 45,000 extra GP appointments (2018-2020) and NNPC will be delivering these in conjunction with local general practice.
NNPC has developed a range of GP appointment ‘pilots’ with input from local clinicians and patients. We believe that by offering appointment types that can help our practices with rising demand and also offer appointments that our patients want we can use Improved Access to be a foundation to positively impact on access issues that we see in general practice, due to demand.
We will begin the implementation of this ambitious project in summer 2018 and we hope to have all the pilot schemes running by early autumn. We will use these to continually review and monitor the impact of this added capacity.
North Norfolk CCG (NNCCG) commissioned a Supported Care Service in July 2017 and NNPC were asked to provide the management of this multi-disciplined team. The idea behind this was to ensure that the team integrated successfully with local primary care and provided local patients with a rapid response support service at times of crisis and a team that our local GPs can trust and use to reduce admissions to a hospital setting. The service has now been running a year and we are seeing an average of 70 referrals per month. This is having a positive impact on reducing ‘avoidable admissions’ to the hospital and also supporting quicker discharges for patients back home.
NNCCG and NNPC have recently agreed to joint fund Clinical Pharmacist capacity that we believe will help reduce demand pressures on local practices. There is a tremendous amount of medicines related work and demand created at practices everyday, ranging from general medicines queries to patients medicine reviews and often this work is undertaken by GPs. We believe that by offering this resource to local practices we can begin to re-profile this demand and meet with an appropriate professional other than a GP.
NNPC has recently been commissioned to develop and implement an Enhanced Care Home Team to support both the local care home sector and practices. We are seeing rising demand and a higher level of acuity of patients in a care home setting. This is having a resource impact on local practices. We developed a business case to request funding for a nurse led team that can work with local practices to support care homes and patients. This will release time for local practices to concentrate on more complex patients. The team will also have a training delivery element to roll out a Dementia Awareness programme to local care homes and other relevant staffing cohorts (general practice etc.). We are also developing a Care Home Manager Network to assist local managers with areas such as quality returns, appropriate usage of general practice. A further element of this project will be to trail 20 Whzan devices. Whzan telehealth is applicable to a wide range of chronic and acute conditions. Patients quickly realise the benefits and learn to manage their condition, improving lives and saving resources.
NNPC are an integral part of a multi-agency programme of work designed to better integrate primary and community health and social care professionals. Local system leaders have issued a ‘100 Day Challenge’ to design and rapidly implement a range of small pilots schemes with local practices, to determine and evidence change areas that we can then implement over the entire North Norfolk footprint.
NNPC are working with the CCG to implement a floating primary care resource. We often hear that registrars are leaving the local area as there is no guarantee of employment when they have completed their training. We want to change that by offering the recently qualified a blended work package and the ability to develop their skills in North Norfolk, working across a range of areas. We believe that if we organise this appropriately with local practices, we can ensure that there is a yearly contract for registrars and other health professionals and retain them in North Norfolk. We are also aware that as GPs move towards retirement, they are often wanting to reduce their partnership and other related responsibilities but still work as a sessional GP. Therefore, we are developing an option for them to do this in North Norfolk with a guaranteed work packages and thus reduce our reliance on locums.
In North Norfolk we have 14 practices on SystmOne and 5 practices on EMIS Web. As a result, at scale working becomes more difficult than having 19 practices on one system. NNPC have secured funding to purchase various pieces of IT software that will help bridge the gap between the SystmOne and EMiS operating systems. Implementing this software will allow practices to communicate agreed pieces of data safely, regardless of the operating system and book patients into out of hours service hubs for example. The result of this will be a better experience for patients as well as more efficient administration processes.
This forms part of the wider IT strategy/Digital Programme that will be coming into action across North Norfolk. It supports national regulatory and policy drivers, is aligned with the aims and ambitions the Norfolk and Waveney Sustainability and Transformation Plan (STP), the Local Digital Roadmap (LDR): Connected Digital Norfolk and Waveney and North Norfolk CCG’s Commissioning Intentions.
Ultimately, the strategy is focused on enhancing the patient journey through Primary Care and providing North Norfolk with a stronger data set and insight to inform decisions moving into the future.