Across North West London, Integrated Care Boards want patients to know they will get high quality, timely, care at their local GP practice.
The NW London Improving access specification aims to support general practice services to develop models which build resilience and make effective use of resource. This should mean better access, best use of clinical time, reduced waiting times, and increased continuity and proactive care for those that need it. The first year of delivery will focus on the responsiveness of general practice, build the foundations of a model to provide high quality continuity of care, and drive better use of digital tools to promote access.
Note that OC refers to Online Consultation (submission)
Details of the improving access scheme for Health Alliance PCN (which includes Aspri Medical Centre, Belmont Health Centre, Circle Practice, Civic Medical centre, Streatfield Medical Centre and Stanmore Medical Centre) include the following:
- This plan has been formulated to improve access for the 58,641 patients who use Primary Care services across the registered Practices in Health Alliance PCN, which covers 5 Practices in Harrow East, one in Harrow Central
- The plan builds on the achievements of 24/25 plan, which focused on increasing referrals to Pharmacy First, providing longer appointments for patient with complex needs, and increasing workforce to cover times of peak patient demand.
- The plan will now incorporate the new specification requirements for 25/26, to include improving responsiveness, so that 90% of calls received are answered within 10 minutes, and 90% of e submissions are responded to by the end of the next working day ( 48 hours ) . We will carry out an audit of clinical time, to assess appropriateness of appointments .We will look at how much Clinical time involving patient care is unrecorded.
- The 24/25 Access plan has been shared and discussed with PPG’s across the practices and with the wider population.
- The 25/26 plan will be published on the PCN website and on individual practice websites. PPG’s will take an active role in achieving targets in the plan through meetings and events.
- Building on our approach in the 24/25 plan , which had improving continuity of care at its core . we will now build in flagging of our most at risk patients , and assigning a clinical team to be available for these patients . We will also carry out a one off audit , to look at the patient journey , and learn lessons from any identified omissions/failures in the care pathway .
- This group of patients were be selected at Practice level, based on WSIC and, personal knowledge , but also taking into account information from voluntary sector , and social services , district nursing . the group to include patients with mild to moderate frailty , chronic conditions with potential for seasonal exacerbations , palliative care patients, and other groups that would benefit from continuity of care
- Patients will be made aware that they are on a continuity program , by letter and text messaging. Any patient who declines will have the continuity flag removed.
- When patients contact the Practice via the online platform , the triager seeing the Continuity Flag, will fast track the patient to a member of the continuity team , to assess and respond . Similarly when patients contact via the telephone system, the triager , being aware of the flag , will message the continuity team to respond within the appropriate time frame .
- There will be a focus on improving digital access. The plan will a look at ways of ensuring that as many patients as possible are using digital tools . Currently, only 54% of the patients registered with Practices in Health Alliance are registered to use the NHS APP, with a range across Practices of 46% to 68%. We will seek to improve these numbers by a minimum of 10 % .
- Building on the 24/25 plan we intend to send out another patient survey, to track patient experience , and satisfaction, using Survey Monkey, which will then be followed by a patient engagement meeting, which will be a virtual meeting, based on the success of this in 24/25. The previous Face to face meeting was attended by mainly the elderly population , so was not representative of all cohorts .
- Effective triage and navigation: The goal is to aim to, ensure timely access to appropriate care while managing capacity efficiently and maintaining safety, and making sure that access is equitable, and clinically appropriate for all patients. All practices use a Multi- Channel access ,including digital access via Patches , used by 5 of the constituent Practices in Health Alliance , Klinik , used by one Practice as OC platforms. Currently 33% of patients use the OC platforms.
- All Practices have Cloud telephony systems, allowing telephone contact for digitally excluded patients , and also where a telephone request might be more appropriate than an OC request . In person requests are also dealt with on a daily basis, including home visit requests .
- Currently all access requests are dealt with at individual Practice level, but the format follows the modern General Practice pathway , using triage, care navigation, team working, focusing on same day response , or next day response where appropriate. All access requests are triaged first, and clinical or administrative priority is determined. Patients are then navigated to most appropriate service. All the Practices have access to ARRs staff , including First contact physiotherapists, pharmacists , physician associates ,mental health link worker, social prescribers, ,in addition to their other Primary care workforce , allowing a wide and appropriate number of possibilities to direct the patient . Requests are reviewed and actioned in an appropriate timeframe, depending on clinical need. Using this multichannel approach 75% of OC respond to OC platform requests are responded to by the next working day , and 75% of telephone contacts are responded to within 10 minutes.
- Each Practice within the PCN follows a Standard Operating procedure to manage online consultations, involving appropriate triage, prioritisation and safety netting, particularly focussed on clinically urgent issues . As stated the Platforms used are Patches and Klinik, and the SOP applies to all incoming online consultation requests.
- Overview of Process: patient submits an online consultation, via Patches or Klinik. Trained Admin/ HCA, team reviews and categorizes the request. Triage is then performed by the clinical team , which includes Pharmacist , GP and Physician associate. Patient is then contacted or booked in based on clinical need. Safety netting measures are used to manage risk.-, with escalation if Red Flags identified. Red flags would include , Chest pain, mental health crisis children under 1 , pregnancy, not defined but giving concern. All responses to an OC request, advise that if symptoms worsen before the timeframe of an action, to contact surgery by telephone or contact 111, or 999 if an emergency .
- Admin team also checks that all calls on the system have been actioned on the day , or by the next day
- OC platform is viewed continuously, during core hours. Receipt of message is acknowledged with in a 2 hour timeframe. Request is triaged to a queue, within 30 minutes of receipt .
- Outcomes of clinical triage may be same day telephone or face to face consultation, next day or later routine appointment, written advice ( usually via Accu rx txt message, referral to another professional eg First contact physiotherapist , community pharmacist etc, or escalation to urgent/ emergency care .
- All the triage decisions are recorded in the clinical system, with an action shown.
- All urgent issues are escalated to the on call GP.
- IT system breakdowns reported to the Practice manager , for onward discussion with Patches or Klinik .
- Response and schedule reviewed quarterly, and changes made to the SOP, where there are changes in clinical guidance, or platform updates , and response to staff and patient feedback .
- This SOP (Standard Operating Procedure) is standard across the 6 Practices , but there is variation in the staff make up of the teams involved .
Expected achievements for the 25/26 plan:
- The 24/24 and 25/26 model of access has the goal of ensuring patients can access care and advice quickly and appropriately, regardless of how they contact the Practice. The audits and survey built into the current plan will assess the success or failure to meet this goal, and will help to guide future plans for 26/27/ and 27/28.
- By delivering a more responsive , and convenient service , it is hoped that patient experience and satisfaction should be enhanced, and this would be reflected in patient surveys .
- The plan also helps to ensure that even the most vulnerable patients can access the care they need , without unfair barriers ( continuity teams in place for most vulnerable ) , and encourages digital inclusion and self care and autonomy ( increase NHS App use by a minimum of 10 % ).
- Improvement of how care is delivered to make the best use of clinical time , reduce unnecessary demand, and support sustainable working, is also an important goal for this plan . The success of this will be measurable , by a reduction in avoidable GP appointments, and the data obtained will help to drive continuous quality improvement across the PCN..
- The continuity of care / personalised care offered to 2% of the patient population , should result in better long term condition management, by reducing fragmented care .
- The proposed plan looks at improving the patient experience of access across all demographics of the PCN population, which should be reflected in public surveys , which currently show Health Alliance at below average for patient satisfaction , and is therefore an appropriate plan for this PCN . The elderly ( over 65 ) group in the PCN population is 8 % higher than the NWL average ,and the issues facing this group are addressed by focusing on continuity of care .
- Going forwards , access plans will focus on increasing digital inclusion, and operating a PCN hub , that accepts all online and telephone contacts from across the practices , thereby streamlining the process, and in line with the modern general practice concept of access. The time frame would be to introduce this by 27/28.
- The ultimate goal to deliver a faster , fairer and more personalised access, reduce inequalities, empower patients through use of digital tools, and build a more resilient and patient centred system, and thereby improve health outcomes and experience across the Health Alliance population.