I have now had the chance to let the dust settle on this document – Delivery plan for recovering access to primary care – and all 46 pages of the guidance therein.
Within my work with general practice, the Primary Care Networks (PCNs) and the GP federations, my workshops in May and June have all been planned around this very document.
Specifically, we look at access, capacity and money that is being paid into the PCNs because the problem is really clear – when it comes to recovering access to primary care, there will never be a one-size-fits-all solution.
So, how do you know what’s going to work for your surgery or network?
What is the plan meant to achieve?
On the face of it, this document sets out the support and money that’s now available to tackle the 8 am rush in an attempt to help patients access services, and the practices cope with demand.
That comes down to diagnosing the demand and the supply issues – we have far too much demand, and we haven’t got the workforce to meet it. Although there are sometimes ways around that for GPs.
To mitigate that, the idea is that items from within that document are put in place. How that happens will vary from network to network and from practice to practice. Federations – and I’m working with one or two that are supporting the practices and the networks with this – will likely take a different approach, depending on their circumstances.
The four essential tests for a project to be viable
Regular readers of this blog will know that most of the projects I work on at network and federation level are designed to release workload. That’s absolutely key.
I have four tests that each project has to pass:
1) Does it significantly improve the patient outcome over what you’re currently doing?
There is absolutely no point tinkering at the edges because that just results in a tinkering-at-the-edges outcome.
2) Does it result in a significant reduction in GP and wider practice team workload?
3) Does it have an impact on your income?
It’s always preferable that it doesn’t reduce income, but if it does, it’s crucial that a reduction in workload is the price we pay for that. Nobody is going to accept a reduction in income if the workload stays the same or gets worse – why would they?
4) Do you have the team to get the job done?
Or can you get the team together to deliver this aspect of work or change? There’s fundamentally no point in planning to implement something or deciding to work in a different way if you haven’t got the right people and resources in place.
There might be a will – but is there a way?
While every network and GP wants to implement the plans set out in the document to empower patients and give them the access they want, that desire is bound to be impinged upon by the capacity of the buildings they’re working in.
With that in mind, networks have to think more widely to solve their problems. As an example – if you’re using a clinical room, you must be doing face-to-face patient work. If you’re not working face-to-face, don’t consume the clinical room space, because it’s a waste. Work somewhere else and help free up room capacity.
A lot of this is common sense. Of course, everyone wants to empower the patients, they want to give modern access to general practice, they want to create new building capacity, and they want to cut bureaucracy.
But a lot of that depends on factors that I would argue are not necessarily in the control of general practices and PCNs. Integration with secondary care and hospitals is difficult because they’re drowning in work as well. But there has to be that integration to meet patient expectations.
I’m currently involved with a number of projects where we’re working on a fully integrated basis with secondary care. That’s primary care talking to secondary care counterparts about improving patient outcomes to reduce unnecessary GP appointments. That has the knock-on effect of reducing avoidable referrals into secondary care and therefore avoidable admissions because the patient is getting a better outcome.
There’s no extra cash to boost your workforce
There is a lot to commend in the document but much of what’s been said in there has already been done. Most makes an appearance in the GP Forward View from 2016, just rehashed and reheated this time round.
That will be good for areas that haven’t implemented measures as outlined in the 2016 document but a lot of the networks and practices I work with have already done that.
It’s also worth pointing out that the workforce is badly depleted and there’s no money in this document to invest in a new workforce, other than what’s already been committed to through the Additional Roles Reimbursement Scheme, as part of the PCN DES.
So it’s a bit of a mixed bag – but I’ve interpreted it and am now working with networks individually – we’re not doing anything off the shelf, we tailor the work and the needs around what’s going on at network level.
I’ve come up with lots of ideas and practical suggestions around improving access and capacity and using the money networks have got to really change the way they work. If that’s of interest to you too, drop me a message on LinkedIn.
Scott McKenzie helps GPs, PCNs and GP federations build sustainable and resilient practices and organisations that thrive. If you want to know how to double your revenue and reduce the overwhelm, Scott can share these processes with you too. Schedule a call today.