- December 2023
The Chiswick journey exemplifies the transformative power of Modern General Practice. By merging three practices under a unified vision and using this as a springboard for transformative change, the practice not only ensures the continued delivery of high-quality care but also positions itself as a model for the future of primary healthcare.
Using the principles of the Modern General Practice Model and by working closely with patients to gather feedback and understand their needs, Chiswick Medical Practice were able to develop a model that addressed the needs of their patient and staff cohorts. The transformation was supported by Health Integration Partners, a clinically led management consultancy who BearingPoint are currently working in partnership with.
Navigating the Modern Landscape
The merger makes it easier to work on a larger scale by sharing back-office functions, having a digital hub for managing reactive care (new health problems or health problems that have got worse) and a specialised management team to streamline operations.
The merger allowed the practices to expedite implementation of the modern general practice model because the three practices who have the same group of GP partners, were able to implement the digital hub by running three separate clinical systems.
By using a digital tool called Klinik, they were able to work seamlessly across three separate clinical systems with little impact on the service allowing the implementation of the hub to come before the formal merger of the contracts.
Efficiency and Financial Streamlining
By merging under a single General Medical Services (GMS) contract, the practice aims for efficiencies such as cross-site team working and financial efficiencies in merging suppliers. This streamlining also allows for more focused allocation of resources towards patient care and staff development and promotes more specialised training of staff.
Segmentation of the demand has led to a clear picture emerging of the workforce needed to deliver care in the most efficient and effective way. For example, Klinik has highlighted that 20% of demand coming into the hub could be dealt with by a pharmacist, whereas only 5% currently is. This demonstrates this is an area where the workforce could be enhanced which would also mean less locum doctors may be needed.
Following implementation of the hub, the practices have seen a reduction in up to 1000 telephone calls in a week meaning that some administration staff have been repurposed into supporting the digital hub team and are working closely with the GPs and developing enhanced care navigation and communication skills from their colleagues.
Patient-Centric Approach
The Chiswick Medical Practice places a strong emphasis on patient engagement. The development of a merged Patient Participation Group (PPG), comprising of representatives from all three practices, ensures that patient voices are integral to decision-making processes.
Feedback from patients, gathered through various channels including a feedback form and patient surveys, is actively incorporated into the practice's action plans, addressing concerns and enhancing service delivery. Feedback for the digital hub has yielded positive feedback with more negative feedback coming from the over 65s.
Through analysis of this data, the practice has been able to put targeted interventions in place, such as tablets in receptions where receptionists can teach patients to complete the form themselves or for receptionists to use the CONNECT function of Klinik which requires receptionists to complete a form over the phone. This function has meant that all requests go through the Klinik system.
The practices have also asked the FY2 doctors to work with the patient group to create a video that explains the digital hub and reassure patients of using the service and that all clinical requests will be completed in the day and reviewed by a GP led team.
Modernising Access to Care
A fundamental aspect of modern general practice is redefining how patients access healthcare. The practice has implemented a digital reactive care hub managing patients with new or worsening health problems, with access throughout the practice's opening hours and no limit on numbers. This approach, complemented by a reactive care hub utilising digital tools, has not only reduced telephone calls by up to 1000 a week but also ensured any patient who is unwell is dealt with on the day and with no cap on numbers.
By segmenting demand in this way, it has allowed the practices to have dedicated appointments for both reactive care and proactive care, giving more opportunity to ensure continuity of care for the patients that need it. After 3 weeks of the hub being in place, we are seeing the duty doctors at each site repurposed in the hub and a 60-40 split of appointments. 60% for proactive care and 40% reactive care.
Proactive patient centred care
The practice's ambition includes improving patient outcomes, particularly in areas like cancer screening and reducing hospital admissions. A dedicated Proactive Care Team has been established to lead this work and focus on promoting continuity of care and longer appointments where needed. A plan to use data to make real change will be implemented. Ideas include community-based partnerships to improve understanding of inequalities and cultural nuances to improve outcomes.
Conclusion
The merger has given the practice partners the opportunity to redesign care aligned with national strategy, ensuring the surgery is fit for future purpose and patients get the care they need.
As the healthcare landscape continues to evolve, models like Chiswick pave the way for a patient-centric, technologically advanced, and efficient approach to general practice that meets the needs of both patients and staff alike and creates a sustainable general practice model fit for the future. There is also a clear direction emerging for Primary Care Networks and integrated neighbourhood teams to enhance this model of care by providing an arm to general practice with multidisciplinary teams for both reactive care and proactive care.
With the generous funding available and the paradigm shift to modern general practice there has never been a better time to rethink and redesign care delivery in general practice, particularly with staff resilience and wellbeing becoming a more prominent and common issue. A shift to new ways of working can improve resilience and wellbeing in ways we could not have imagined, enhanced through more structured care pathways and patient education.
Get in touch to find out more how HIP and BearingPoint can help you and your practice on your journey of improvement from income optimisation, person-centred design, demand and capacity planning and improving access.
Written in partnership with Health Integration Partners
