Primary Care Recovery Things that didnt change you want to stay: - - PowerPoint PPT Presentation

Primary Care Programme Board Discussions – 18th May and 10th June

Things that changed you want to keep:

• Total Triage and remote consultation - 50-80% contacts do not require face-

to-face appointment and care can be targeted more effectively

• Greater co-ordination and sharing of data between partners to support

vulnerable patients and target MDT working to this cohort

• More flexible working and working from home – will support recruitment
• Opportunities to work more flexibly with secondary care
• Opportunities to use estates more effectively
• Enhanced care home support
• Social prescribers supporting vulnerable
• Patients’ taking on greater self-care role

Things that didn’t change that should have / challenges:

• New access models need to be underpinned by effective business

processes and communications to ensure do not create unmanageable demand / risk.

• Need improved IT in care homes
• Better targeting of care through PHM methodologies and predictive

modelling to better manage capacity.

• Need variable appointment types/lengths for routine and acute care needs
• Greater alignment required between public

health and frontline services

Things that didn’t change you want to stay:

• Providing flexible, responsive care for patients
• Not using a one-size-fits-all approach; as move forward new

ways of working will continue to be appropriate for some cohorts but not for all.

• Good communications with patients regarding situation and

how to access care.

Things that changed you don’t want to keep:

• Variable access to IT may have created inequities to address
• Initial issues with prescription collection for vulnerable patients
• Freezing of Lloyd George digitalisation – should now proceed
• GP Clinical Lead role needs greater clarity as part of

implementation of PCN DES

• Need to ensure Advice and Guidance approach does not create

undue pressure on primary care

Primary Care Recovery

Key changes to lock-in from practice survey (32 responses)

Changes made: >10 practices:

• Total Triage
• Remote consultation
• Remote working

>5 practices:

• MS Teams meetings
• EPS/Batch Prescribing

Other changes:

• Split hot/cold working
• Working with hubs
• Reduced bureaucracy
• Virtual group clinics
• Redesign focus
• Reduced focus on routine

work and income

• Remote nursing home ward

rounds

11 practices would not reverse any of the changes they have made however several noted importance of now reinstating appropriate face-to-face care

Key changes to lock-in: Total Triage Remote consultation Remote working by clinicians and teams Other lock-in priorities:

• Use of MS Teams for meetings
• EPS usage
• Reduced bureaucracy
• Recruitment opportunities – reputational and increased flexibility
• Effective use of social prescribers
• Better use of estates

Lock-in challenges from practice survey (32 responses) Challenges to sustaining change >10 practices:

• Changing patient expectations post-peak
• Social distancing / safely seeing patients / face coverings

>5 practices:

• Embedding new ways of working amongst clinicians
• Planning for increasing respiratory workload / need to see ‘hot’ patients in practice

as approach Winter - unknown Covid levels

• Flu
• Addressing backlog in routine work / patient reluctance to attend
• Additional time required now to see patients face-to-face
• Effective selection of patients for face-to-face care, managing risk

Other challenges:

• Shielded/high risk staff and ‘Test and Trace’
• Supporting staff working remotely, maintaining morale and avoiding burnout.

Childcare remains a concern.

• IT support / equipment
• Training backlog/new training requirements
• Time to focus on embedding change
• Backlog in PCN development/staffing
• Potential income shortfall
• Reinstatement of administrative tasks

Potential CCG support:

• Consistent supply of PPE
• Support patient communications
• Consider maintaining hub

arrangements

• Clarify Nursing Homes clinical

lead role

• Share predictive modelling

around Covid-19

• Reinstate TIPs training
• Progress Lloyd George

digitisation

• Reduce email traffic
• Maintain digital meetings
• Continue to freeze QOF/ES

returns

• Reduce email traffic
• IT equipment availability

Berkshire West Primary Care Recovery Pathway

1) Next phase operating model (key focus for next 3-4 months)

• Core primary care delivery resumes with clear arrangements in place for managing increased prevalence of respiratory illness which

may make it difficult to differentiate Covid and non-Covid presentations / potential increased complexity. Work with respiratory consultants and clinical leads to define ongoing role of both hubs and practices.

• Practices operating with social distancing and clear business continuity arrangements in place. QOF/CES asks defined.
• Predictive modelling used to determine capacity and assess escalation triggers (pilot work with Oxford University)
• Escalation plan remains in place including ability to go live with home visiting service and expand hub capacity if required
• Enhanced care home support remains in place – implementation of PCN DES requirements and further define clinical lead role
• Full roll out of Advanced Advice and Guidance
• Successful delivery of flu campaign

2) Lock in change

• Time for Care/other training to embed business processes to underpin use of new technologies
• Work with AHSN and Healthwatch to develop best practice model for video consultations and patient engagement strategy

covering Total Triage and remote consultation

• Greater use of GP Connect to support new pathways and collaborative working within PCNs
• EPS 4 implementation
• Further provision of IT equipment – laptops and care home IT infrastructure
• Further embed PHM risk stratification approach to underpin partnership working to identify and support vulnerable patients
• Social prescribers and others to continue to support self-care / patient activation

3) Drive further transformation

• PCN OD work and ARRS recruitment back on track building on new ways of working. Implementation of all DES service specifications.
• MDT care planning as core element of delivery – shared multi-morbidity care plan in place
• Estates Strategy refreshed to reflect new ways of working / PCN models of care
• Closer working with secondary care as part of outpatient transformation, improved referral practice