Annie Murphy, GP, Wide Way Medical Centre, Mitcham and Digital Pioneer Fellow.
Overview of project:
- There has been growing demand and pressure on General Practice, particularly pronounced following the COVID19 pandemic with an 18% rise in appointments in March 2021 compared to a year ago (BMA 2021).
- A BMA survey in April 2021 of over 4200 GPs showed that 50% of GPs reported suffering from burnout and depression, with nearly a third of GPs saying they need to undertake additional unpaid hours. Further it reports that the number of GPs per 1000 patients in England has dropped to 0.46 in 2021 compared to 0.52 in 2015. This is significantly lower than the average number of physicians per 1000 patients in comparable nations (3.5) (BMA 2021).
- The new ARRS (Additional Role Reimbursement Scheme) roles see introduction of Allied Health Professionals (AHPs) such as Paramedics, Clinical Pharmacists, Physicians Associates, Care Coordinators, Social Prescribers, Health & Wellbeing coaches into Primary Care Networks (PCN). These roles could support GP capacity if used effectively to maximise their impact.
- However, navigating this Multidisciplinary Team can be confusing for staff let alone patients. If ARRS are not used appropriately and patients are not booked with the clinician with skill sets most suited to their needs, this could create more work for the GP.
- Annie’s team aimed to create a Virtual Roundhouse Model using the ARRS scheme. The model proposes a Multidisciplinary Team with a virtual/digital GP supervising a team of AHPs as part of a “same day team” with parallel “normal” GPs doing routine work.
- They created a navigation template “The GP SatNav” whereby receptionists can efficiently navigate the patient to the right health professional at the right time. This was co-designed by a working group led by the author with representation from receptionists, administrators, managers, GPs, AHPs, nurses and patients.
- This template can be applied to all incoming requests whether in person, telephone or from online consultation platforms allowing parity of access to those who are digitally excluded.
- The team use it to navigate the patient to the right health professional for their care at the right time based on traffic light dispositions and the AHPs are given appropriate appointment slots based on their scope of work. The template uses validated 111 red flags and is designed so that outcomes can be tailored to suit individual practice workforce and services offered.
Now I know what type of appointment to book and am not worried about getting it wrong and am more confident when speaking to patient knowing that I’m following a template.– Patient navigator
Impact of project:
- Active signposting to community services and self-care or urgent care.
- Provide AHPs a safe environment to practice within their scope and grow, taking pressure off GPs by seeing cases within their remit such as medication reviews, acute minor ailments, social complaints and lifestyle management.
- Release other GPs from time consuming activities like clinical admin/visits and allow them more time to see complex, vulnerable patients or undifferentiated presentations.
- Estimated number of patients to have benefited: > 10,000 patients
- Estimated number of NHS/social care staff to have benefited: >30
You were so good, didn’t rush and even though I was hesitant with the outcome suggested, you helped me understand and arranged it. It’s been a long time since I felt like not being rushed off the phone and someone has taken the time to understand.– Patient
Key learnings from the project delivery to date:
The hardest part of change is to bring people with you on the journey. People need to be involved early, to be convinced of the problem and see the need to change. Then they have to be involved in co-designing the change. What Annie found did not work was writing a protocol and expecting people to follow it, as people did not feel the sense of ownership and so were not bought into the vision. Embarking on a journey of change requires much commitment and engagement on the ground and will not always work when the environment isn’t right.
Realising this, Annie instead created a framework rather than a set protocol so that other practices can mould it into a system that meets their own individual needs for them and their patients. In this way, practices can “own” their own change.
The thing Annie found most useful was developing the elevator pitch to quickly impart the vision, the idea and the framework, leaving the seed of change to grow in others’ minds.