Category Archives: My Vision

Primary Care In 2018

Interactive Health Record Part Owned By Patients

In 2018, patients are part owners of their primary care health record. The record is now interactive and patients are able to input information into it. Patients are able to get advice, information and guidance about healthy living, self-care. This advice is triggered by the record through practice / locality based software packages. For example patients are now regularly able and encouraged to input health determinants like their own blood pressure readings, their weight, height, exercise levels, smoking data and much more and in return will get suggestions. Where patients forget to put in their readings they will be sent text messages similar to meter readings at present. However, patients unable to do so can still go to the surgery.

Support Network  of Expert Patients

There are now 500 trained expert patients and patient advocates with expertise in different disease areas in Bracknell & Ascot alone. Whenever a new chronic disease is diagnosed, patients are immediately referred to an education centre, where they can enroll into one to one or group courses and activities, get a mentor and intensive education avoiding depression so often associated with chronic disease and fostering hope.

Expert Patient Advocates Supporting Healthwatch

Patients will be involved in all decisions about their care and at all levels. Healthwatch, once a struggling entity, has now become a powerful organisation with a lot of patient support. There are patient advocates for every disease group, which has been locally identified through the Joint Strategic Needs Assessment. These advocates not only are involved in patient education and therefore have excellent expertise in their area of work; they also are able to give excellent advice to Healthwatch about examples of great care and opportunities for improvements in care.  Patients have excellent local self-care educational materials available to them and are aware of them.

Safety through technology, pathway design and semi-automatic decision support software

Chronic disease management will be totally pathway driven and mainly automatized. Gone will be the time when the GPs main task is the prescription of drugs. Drugs will be the results of centrally agreed pathways. Computers will overall result in big improvement in safety margins of prescribing through suggesting drugs by automatically putting them onto a patient’s record. For example a patient with blood pressure or diabetes now has totally pathway driven prescribing.

GP as expert councel, coach and mentor

My role as a GP has changed significantly. Technical skills are now less important and coaching and motivational skills are more important as the technical detail is increasingly computer supported and pathway generated. I am now spending more time to look at complex patients and in motivating patients to improve their lifestyle. I am also increasingly attending multidisciplinary meetings in order to improve patient care and look at complexities of patients problems.

Automated Telephone Support and Triage

We now have an automated telephone or computer based triage system for all acute conditions in primary care by a software developed from centrally by the Department of Health, which is also used for telephone systems in primary care. This has led to a reduction of patients calling for coughs and colds. Patients can even triage themselves for certain drugs.

New Purpose Built Premises

Personally I am now working from a brand spanking new Health Centre in the centre of town. The practices took the opportunity and developed a new community centre with coffee shop, pharmacy and patient education and self-care centre. Doctors and nurses of Forest Group Practice and Evergreen have been working from new premises for 3 years.

Working within a Federation or Community Organisation

The now 4 year old federated GP community interest organisation is providing support to all local practices. Plenty of volunteers are helping GP federation to make patient centred care a huge success. Local practices are benefitting from the savings by being able to invest into new and enhanced services for their patients. The GP federation not only provides back office services, has centralised scanning for the letters still not coming to the practices electronically (most do by now), secretarial work, policy development, policy updating, regulatory work, GP education documentation for appraisal and revalidation. They have also become a competitor to other providers in bidding for local contracts and moving services from secondary care into the community. Profits go into investment into new primary care practice based services and only through GP fed all local practices have been able to stay open and patients have local access to services 7 days a week 12 hours a day. GP fed is organising all this, too. GP fed has become an essential part of GP practices in Bracknell and Ascot.

7 day working

My terrible Monday duty days are not as terrible as they used to be. They are still busy, because patients choose to take the weekend off, too, but they are more manageable through seven days working. I have not started working on Saturday and Sunday myself, yet, but I am considering it in the future when the children are older and I am doing late shifts already. The practices work together federating to bring together GPs for practices from a central pool to support 7 days working.

IT integration, workforce and  appointment times

All GP data systems are connected in Bracknell and Ascot, so that professionals can access health records and input data when the patient’s own GPs are not on duty. All over 75 years old now have a nominated GP with responsibility of their care. However, due to changes in the workforce and more and more outside responsibilities, patients are not able to see the same doctor every time.  Patients are now able to see clinicians for significantly longer appointments addressing all their problems at once. The standard appointment time is now 12 minutes for acute and 15 minutes for chronic illness.

Health Checks and a playground near every primary school

Not only over 40 year old patients, but also children and young adults now get regular health checks to stem the tide of obesity and inactivity and give children a better start in life. Every primary school in Bracknell and Ascot now has a playground attached to it where children are encouraged to exercise and let off steam after school and parents can have a chat and a coffee at the charity café.

Non-Elective Admissions have reduced through better primary- and self care

The unplanned (NEL) admissions rates have reduced by 50% in Bracknell and Ascot. Long Term Condition (LTC) meetings are common place and happen for a much larger number of patients. Improving NELs started with simple improvements in COPD, diabetes and heart failure care as well as hydration levels in nursing homes. Every year new areas were added and patients are now much better cared for in the community and are not allowed to deteriorate without anybody picking it up and correcting it quickly and before they have to be admitted. Also, patients have become fitter, healthier and more self-reliant as well as more knowledgeable. They all know now how to prevent their conditions from getting worse and where to go long before they get so bad they have to go to hospital.

Excellent training and leadership in all nursing homes

Staff training in all nursing homes is now excellent and every staff member has an excellent and inspiring introduction as well as regular training. Elderly patients with dementia receive outstanding care. Leadership in all nursing home is excellent and supported through mentors.

111 redundant

Overall, healthcare in Bracknell has now truly become patient centred. Patients are in control of their conditions and are able to access primary care services 7 days a week. Large efficiencies have been created and clinicians are happier and less stressed with longer appointment times and more quality of care through reduction of routine tasks. There was only one looser in the game. The chaps at 111 in Banbury had to all been made redundant in 2017, because primary care and the urgent care centre are now so good, they didn’t have enough work anymore. Never mind, 111 is now manned locally by expert patients in the urgent care centre at Brants Bridge.

Vision for 2018
What do you think about this vision?

Struggling For A Vision On How To Reduce Non-Elective Admissions?

How long have we all struggled to create a vision on how to reduce our non-elective admissions.
However, reducing them means patients are being stabilised at home before they become sick and healthy patients demonstrate high quality work by the NHS and public health.
Below find a simple list that is the result of an away day of Bracknell & Ascot CCG and my own thoughts. We are currently implementing these changes and I believe we can reduc NELs by at least 20% once they are all implemented.

  1. Every patient discharged from hospital with heart failure to be seen by the community heart failure team within a week
  2. Every patient discharged from hospital with COPD to be seen by chest rehab within a week
  3. Every patient SCAS (ambulance trust) is called to with a fall to be automatically referred to LTC cluster meetings / community physio.
  4. Consider Cancer patients discharged to receive a tailored physiotherapy
  5. Every hospital discharged patient to be provided with follow up phone calls on how they are and what they still need
  6. Every frail elderly discharged to be considered for referral to LTC
  7. Patients in home visiting books of practices to be considered for LTC referral
  8. All three CCGs to publish a DOS of the  three trusts following
    • Rapid Access Consultant Advice Lines
    • Rapid Access Clinics and how to Access
    • Any Rapid Access outreach Service
  9. Promote pushing hydration in all nursing homes to avoid admissions for UTIs and consider weekly urine testing.
  10. Checking every medical and orthopaedic inpatient over 65 had a flu / pneumonia jab. Vaccinate 4-17 years old in practice. Also ALL carers on practice register regardless. Fund search & mailshot for all patients not having had flu jab.

Click  below to download this list as pdf or print it.

Vision to reduce NELS_final

NEL Vision
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