Email sent by Wessex LMCs, on Sunday, 23 Jul 2017
Date sent: Friday 28 July 2017
General Practice is Wessex – have we turned the corner?
This is the subject of my latest email update, because although I can see all the problems that we face as individuals, practices and as a profession but I do believe there are signs that things are beginning to improve locally.
Much more needs to be done in terms of support and additional resources in general practice but as I keep banging on "we are the solution and not the problem" and with these resources we need to find our own local solutions and be positive about our future. But to achieve this NHS England and CCGs need to deliver on their committments to increase the % of the NHS budget that is spent in general practice and the community. New initiatives such as locallity hubs and extended opening for localities must work with and be supportive of the practices that serve that welll defined population.
1. General Practice in Wessex
A recent report by Wessex Academic Health Science Network (AHSN) looked at general practice locally and the report is attached - but are things getting better or worse? What is happening in Wessex?
2. £100m of funding for Dorset - are they the most successful health economy in England?
NHS England has just announced £325m of capital funding and Dorset has been allocated £100m of this but what does it mean for us locally?
3. Sessional GP Update
Information about our updated website, how Locums can benefit from LMC membership and the GPC's Sessional newsletter
4. GP Training - suggested timetable.
Following on from my last email attached is a draft timetable for a full time GP Registrar.
5. Does having an Urgent Care team in your practice really work - a personal view?
Urgent care is not a new imitative but practices are looking at how to get greater control of the demand on the day. I am sure many practice have developed solutions which have worked, if so share your learning, I have described what we have done in my practice.
6. Have you seen my COPD or my Diabetes - it is worth looking at this and watching the demo video.
These great aids should help patients and also general practice and they were developed by local clinicians in Wessex.
1. General Practice in Wessex
No one can deny that general practice has faced a crisis, quite simply the workload and complexity of patient care expected of general practice has not been matched with the resources that are needed.
The reasons for this are well documented and include:
- An increase in the population of the country
- An ageing population
- More people with one or more long term conditions
- Workforce – recruitment and retention
It has been predicted that the population of Wessex will increase by 3.3% by 2019 and by 6.5 % by 2024. The group aged between 75 - 84 is predicted to rise by 11% by 2019 and 39% by 2024. This would mean that appointments would need to increase by 11% by 2019 and 36% by 2024.
Much of the focus and resources recently have been targeted on hospital-based care with general practice and primary care losing out repeatedly.
The NHS needs to wake up and invest in general practice and community services to truly increase the capacity - this is the only way the NHS will meet the demands as described above.
The Commonwealth Fund, a US think tank, looks at the performance of 11 countries and their health care systems. In a recent study The NHS has been ranked the number one health system in a comparison of 11 countries.
The UK Health Service was praised for its safety, affordability and efficiency, but fared less well on outcomes such as preventing early death and cancer survival.
It is the second time in a row that the UK has finished top. Three years ago, when the survey was last done, the NHS performed exceptionally well when compared to other Western nations who spend considerably more than the UK does on health.
This comes despite the NHS facing some of the greatest challenges since its birth in the 1940’s.
The ranking as judged by the Commonwealth Fund:
4 = New Zealand
4 = Norway
6 = Sweden
6 = Switzerland
In Wessex there are a number of areas where the GP vacancy rate is between 10 – 30% and some practices reaching the point whereby they feel that there is no viable option in terms of continuing as a surgery. Some practices have sought mergers with a neighboring practice, explored working as an employed practice or resigning from their GMS or PMS contract.
This may all paint a fairly grim picture of local general practice.
The question that is often asked is "what is happening in Wessex to address these problems?"
I would like to highlight many of the exciting initiatives that are happening locally and to see if we can answer the exam questions: “Has general practice turned the corner and are things looking better, if so what else needs to be done?” this just gives you a flavour of some of the things happening and is not meant to be a comprehensive list.
General practice was a specialty where by doctors worked together in a small organisation, exercised a fair degree of clinical freedom, were supported by their hospital and community colleagues and the working day was manageable.
The answer to the problem is that we have to make general practice a better place to work, to make the workload manageable, to increase the capacity, and basically make the working day enjoyable and ensure that people can go home at the end of the day feeling satisfied that they have done a good and worthwhile days work. Moving away from the current situation of a working day that is out of control, arriving early, leaving late, feeling you have survived another day and just got by rather than a day as described earlier in this paragraph.
If there were a simple answer we would have found it.
It is clear that many people working in general practice cannot see any significant improvement and have little hope of this coming their way in the near future. As an LMC we see this on a daily basis and try to help and support these GPs and practices but we also see there are many really great initiatives that are already beginning to make a difference.
In 2016 the Wessex Clinical Senate was asked by the LMC with support from local CCGs to take an in depth look at the problems that general practice is facing and to report on potential solutions. This work was commissioned from the Wessex Academic Health Science Network, led by a local GP and supported by Health Education England.
A report was recently published, called “A lifeline for general practice: New ways for Primary Care in Wessex” the document is attached to this email.
A survey of GPs carried out by Wessex LMCs in 2015 demonstrated that:
- About 20% of GPs indicated they were going to retire earlier than they initially planned;
- About 30% intended to reduce the number of sessions they worked;
- Nearly 40% of practices were currently short of GP sessions;
- 28% of practices had failed to fill a GP vacancy in the last 6 months.
The "Lifeline for General Practice" reports the findings of the 2016 GP Patient Survey, which repeatedly demonstrates the public’s strong support for the NHS and especially general practice.
The report goes on to explore ways that general practice can meet the challenges that it faces namely:
- Better management of demand and workload
- New models of care through creating a multi-professional teams that can meet the needs of patients in general practice.
- The workload in general practice increases every year and there are no signs that this trend is going to change in the near future. What is also clear is that the current workforce cannot meet this demand unless it expands.
Many of the proposals in the report are probably things that your practice has considered or is already doing but it is worth reviewing them. It should be remembered that if there was an easy solution we would have found it. The solution will be a number of small changes and hopefully the sum of the changes will be greater than considering each action individually.
A lifeline for General Practice – a review undertaken by the Wessex Academic Science Network (AHSN) (supported by the LMC)
At a recent event in Wessex called “A lifeline for patients and general practice: new ways for Primary Care in Wessex” I was struck by how much is happening to support practices in Wessex and this is in contrast to practices who we visit who are in difficulty and often feel that nothing is happening to support them locally.
The report highlighted:
- A better supply of GPs is associated with lower mortality and reduced health inequalities
- There will be a significant undersupply of GPs by 2020
- It takes 10 years to train a GP
- The increase in GP numbers is significantly lower than the increase in the medical workforce in secondary care
- There is a mismatch between the future demand for practice nurses and their supply
- More GPs are choosing salaried placements
- GPs are prioritising geography of their training and future work over their career choice
In Wessex 74.4 GPs per 100,000 populations compared to national average 67.8
GP workforce is getting younger and there is an increase in women choosing the profession.
…meaning more GPs are needed in training to ensure a full time equivalent level of workforce
So we know the problems – what is being done in locally to try and address these workforce challenges?
At the conference Professor Clare Wedderburn GP and Associate Dean for Dorset described many interesting initiatives that are taking place in Dorset . Clare was instrumental in setting up the Primary Care Workforce Centre.
The Primary Care Workforce Centre (PCWC) is a collaboration between NHS Dorset Clinical Commissioning Group, NHS Health Education England Wessex, and Bournemouth University. The Centre was established in April 2016 to focus on training, education, workforce development and research across the entire primary care workforce in Dorset.
Below are some of their initiatives that are being led by the Primary Care Workforce Centre.
You send them details of the sessions that need covered in your practice, then the team adversties these sessions on the Locum Chambers. A Locum GP logs on and searches for work and applies for the sessions they can do and they complete a form, this is sent to the practice who can accept or decline the application.
How to get started?
Send the following information to: Primarycare.firstname.lastname@example.org
- ? Details of the practice offering the session(s)
- ? Dates of the session(s) requiring the GP Locum cover
- ? Rate offered per session(s) and what’s included
- ? Any further information that will help the GP Locum choose your session(s)
This is a new service offering opportunities to all professionals in primary care to work in a different way at any stage of their career.
Career Flex has evolved from the Dorset GP postgraduate scheme which was introduced in 2016, but unlike the GP Postgraduate Scheme, Career Flex is available for all professions within primary care at any stage of their career.
Career Flex focuses on four important boxes and there is complete flexibility to choose how many boxes are filled and what they are filled with. It is up to the individual to choose their role(s) and how many days/sessions for each role, and the PCWC help make it happen. Plus they can offer education and/or coaching or mentoring to support alongside.
Click here for more info.
The PCWC have a wide team of healthcare ambassadors who can visit schools and provide an insight into a career in medicine, careers in healthcare, life at medical school or the educational journey to become a healthcare professional. Their team of ambassadors are made up of qualified professionals from the local community and trainees currently studying.
The ambassadors will share knowledge from their work experience and discuss the progression from student to an experienced professional. They can offer advice on current topics within the healthcare sector and guide students in choosing a career that could suit them.
The advice and guidance their ambassadors can offer has proven to help students progress with their career in medicine and healthcare.
Introduction to Medicine and Introduction to Healthcare programmes
Both programmes are run over 3 days and provide experience in both a primary care (GP Practice) and secondary care (Hospital) setting. The programmes usually run over consecutive days but there are occasions when this is not practicable.
The programmes are generally run out of term time to make it easier for students to attend.
Click here for more info.
Supporting students to achieve careers in Medicine and Healthcare
The PCWC have partnered with a variety healthcare providers in Dorset in order to offer students work experience opportunities across a variety of roles in healthcare.
Click here for more info.
In the GPFV the plan is to recruit 5,000 additional GPs by 2021, few think this is a reality and probably to cope with the current demand we would need closer to 12,000 GPs. So if we need to expand the workforce how can we do this?
We need to expand our teams in general practice and develop roles such as:
Paramedics have been working in primary care for some time. Increased pressure and demand on primary care services have been a catalyst for more opportunities for Paramedics to work in this environment. Initially practices were incentivised to establish Minor Injury Units and these were staffed by Nurse Practitioners and Paramedics that had minor injury training. It was then highlighted that some Paramedics could fulfill a wider brief.
As Specialist Paramedics were developed within the Ambulance service, they were educated and experienced in dealing with minor injuries and illnesses and could complete episodes of care autonomously and safely discharge or refer patients at scene.
This led to practices expanding the minor injuries clinics into same day service clinics. Paramedics would staff the clinics and could adapt to reduced appointment times thus increasing the same day appointments available to practice patients.
Recruitment of Paramedics in primary care is increasing and formal guidance, a framework of support and an accredited pathway would offer significant benefits and support to employers, Paramedics and patients.
- This guide has been created to highlight the benefits employing a Paramedic can offer and to provide a level of formal guidance and support for employers recruiting a Paramedic.
- The Primary Care Workforce Centre is currently supporting work that is underway to develop an accredited education pathway for Paramedics working in primary care.
- The Primary Care Workforce Centre is creating a development framework for Paramedics working in primary care to support their continuing professional development and the quality of care provided.
Click here for more info.
- Clinical Pharmacists
Feedback from pharmacists that have recently made the move into a role in general practice has been mostly positive. Practices need to manage the expectations of the GPs as to what can be realistically achieved, particularly at first. The addition of a pharmacist to the team has to be part of an overall transformation plan in improved efficiency such as use of Electronic prescribing and electronic repeat dispensing. In the pilot roles, there are fixed requirements for face to face clinical time and whilst the initial impact on GP time may be to take the prescription queries away from them, that is only part of what their role should entail. Automation of systems should reduce prescription queries and allow the pharmacists to have a greater input in medicines optimisation.
A pilot funded by the locality in W&P has been very successful in reducing polypharmacy and waste in domiciliary and care home patients, and was a joint appointment with Dorset County Hospital FT. Savings in the prescribing budget have also been identified.
Click here for more info.
- Physicians Associate
Physician Associate (formerly known as Physician Assistant) is a rapidly growing healthcare role in the UK, working alongside GPs and doctors and surgeons in hospitals. Physician Associates support doctors in the diagnosis and management of patients. They are trained to perform a number of roles including: taking medical histories, performing examinations, analysing test results, and diagnosing illnesses under the direct supervision of a doctor.
New roles such as the Physician Associate present opportunities to tap into a previously untapped potential workforce. The development pathway for a Physician Associate stems from a different place to many other healthcare roles creating an opportunity to create a valuable new addition to the workforce without draining the existing pools that are near depletion.
What roles might a Physician Associate undertake in Primary Care?
There is no limit to the roles that Physician Associates can have in primary care. Upon qualifying they will be able to manage most of the on the day cases that present to primary care and with time they can expand their experience to manage chronic conditions, undertake home visits, manage paperwork and other clinical administrative tasks. Within the UK there are already examples of Physician Associates being a partner in a GP surgery – which demonstrates their potential for progression and the value they can add to the practice clinical team.
The only current limitation is that Physician Associates cannot currently prescribe or request ionising radiation and this is because the role is currently non-regulated. This is currently being reviewed by the Royal College of General Practitioners with a view to becoming regulated.
Physician Associates will generally need to work under the supervision of a GP whilst they are in primary care, although they will be able to see patients and do home visits unaccompanied, they will need access to a doctor to discuss challenging cases. Experience of Physician Associates in primary care to date is that they learn very fast and can quickly manage a very impressive portfolio of cases and some very challenging situations.
The career path chosen by people who train to be Physician Associates is one that prioritises patient facing services, and to this end Physician Associates tend to want to remain loyal to a population and develop excellent professional relationships.
When a practice needs someone who cares about people and will deal with the clinical demands put on the practice, a Physician Associate may just be the person they’re looking for.
For more information on what a Physician Associate can do click here .
- MSK Practitioners
Musculoskeletal (MSK) conditions make up to 30% of a GP’s caseload. This rises to 50% for patients over 75. Yet 85% of those do not need to see a GP.
This means millions of appointments could be freed up for other patients each year if patients were offered a choice of professional as their first point of contact. GPs are now choosing to bring in MSK Practitioners to work alongside them as the first contact practitioner for their MSK patients.
Recruiting MSK Practitioners within General Practice settings can have many benefits such as:
• Reduce referrals to secondary care orthopaedics
• Reduce unrequired investigations (x-ray, MRI etc)
• Reduce onward referrals to MSK services in community and secondary care
• Increase the number of patients able to self-manage effectively
• Increase the number of referrals to leisure centres and other forms of physical activity prevention.
• Reduce MSK related appointments seen by GP
• 99% conversion rate to operative intervention
• 98% of red flags are accurately assessed by MSK practitioners
• Freeing up GP’s time to do what they do best.
Click here for more info.
- Practice nurses
It is easy to get carried away looking at new roles for healthcare professional and forget the development of Practice Nurses and Health Care Assistants.
Over the last few yers the role of the Advanced Nurse Practitioner has been developed but do you know what skills they have or what they can contribute to your practice?
The nurse role has developed within general practice in response to extended clinical and patient demand and workforce issues and have been evolving over the last 20 years. The advanced role is as yet not regulated and tis can cause confusion for nurse's, employers and patients. The term ‘Advanced Practice’ defines the level of practice at which the nurse works. Advanced Practitoners are responsible for the safe delivery of a number of defined roles not routinely performed by nurses within primary care, and requires competence in specific areas of knowledge, technical skill, nursing expertise and clinical decision-making.
“The ANP is an experienced and autonomous registered nurse who has developed and extended their practice skills beyond their previous professional boundaries. The ANP is able to use their expert knowledge and decision making skills, guided by The Code (NMC) in unpredictable situations. This may include managing patients with undiagnosed health care problems and is shaped by the context of their clinical practice” Ref: RCGP/RCN General Practice Advanced Nurse Practitioner Competencies (Nov 2105 pg. 6) http://www.rcgp.org.uk/membership/practice-team
The RCN’s competencies for ANPs were mapped in the early 2000s against the NHS Knowledge and Skills Framework and are linked to the NHS Career Framework. These were updated in 2012 click here for the document.
Department of Health Advanced Practice position statement (2010) It describes a level of practice, not specialty or role, that should be evident as being beyond that of first level registration.
This focuses on under the following four themes (as agreed by expert practitioners)
- clinical/direct care practice
- leadership and collaborative practice
- improving quality and developing practice
- developing self and others
Click here for more info.
It is essential that recurrent funding is associated with the expansion of the workforce and that general practice not only benefits from the new roles but has 100% funding for them.
We are promised an annual uplift of about £2.4bn to support general practice. Initially very little of this money is coming directly to practices and is being used to implement the GP Forward View, I would like to see much of this been used to expand the workforce in general practice to help create stability and transformation - which is what I think STPs are expected to do?
Which practices are thriving and which are barely surviving?
At a recent meeting with some of the Medical Accountants, I discussed what the latest situation was with practices who have a year end for their accounts of 31st March - therefore their annual accounts for 2016/7 are being finalised.
It would appear that most practices are financially stable but are always at risk if they lose a GP. Those that have done best are the larger practices who are training practice and those that have been forward thinking and not only embraced the change that is coming but have used it to their advantage.
2. £100m of funding for Dorset - are they the most successful health economy in England?
Last week NHS England announced that there was £325m being invested in capital projects across the 44 STPs.
Dorset was one of only 25 allocations to be made and was by far the largest at £100m.
The investment comes following a major review of clinical services and a period of consultation with the general public. In June the NHS announced nine areas in England – covering seven million people – which will be the forefront of nationwide action to provide joined up, better coordinated care breaking down the barriers between GPs and hospitals, physical and mental healthcare, social care and the NHS.
‘Accountable care systems’ (ACSs) will bring together local NHS organisations, often in partnership with social care services and the voluntary sector. They build on the learning from and early results of NHS England’s new care model ‘vanguards’, which are slowing emergency hospitalisations growth by up to two thirds compared with other less integrated parts of the country. Dorset was one of the 8 ACS announced.
So what does all this mean for the GPs and Practices in Dorset?
There are major challenges in the provision of hospital based care with the Royal Bournemouth and Poole Hospitals being close to each other and a plan to merge the hospital that makes financial and clinical sense, was blocked a couple of years ago by the Competition Authority. The rationalisation of services can now go ahead. The more isolated position of Dorset County Hospital in Dorchester poses different challenges.
None of this will work unless Dorset retains a sustainable workforce in general practice and more broadly in the community.
The CCG has been developing a primary care strategy and also an integrated community care strategy. The LMC has been discussing these with the CCG and challenging areas where support for general practice does not go far enough.
Working on the Hampshire Dorset board and for most of my 30 years as a GP, I have looked across the boarder with a degree of envy because of the services that the Dorset GPs have access to and the level of funding they have received compared to Hampshire. When parts of Wessex started experiencing recruitment and retention problems Dorset faired much better, but despite this the LMC warned the practices and GPs that the problem would come to Dorset shortly and it has. The practices in the urban conurbations of Poole and Bournemouth have had difficulties in recruitment and this has also been experienced by the more rural practices.
The LMC repeatedly challenged the CCG during the clinical services review because in our view it focused too much on the hospitals and not enough on the bedrock of the NHS, namely general practice and community services.
3. Sessional GPs
As an LMC we represent over 3000 GPs working in 500 practices. As part of the GP workforce we also represent and support GPs working in OOHs and as Locums.
The LMC is paid 36p per registered patient by every practice in Wessex and this pays for the work carried out by the LMC on behalf of the GP Partners, Salaried GPs, the practices and the profession. This workload has increased greatly over the last 10 - 15 years. In 1996 Wessex LMCs employed a Chief Executive and a part time GP Medical Secretary; now employs a Chief Executive, 4 GP Medical Directors, 3 Directors of Primary Care and a Nurse Advisor.
In addition to the work associated with Practices, the workload associated with GPs working as Locums has also increased significantly over the last few years. The LMC now has over 550 GP Locums registered on our database. Increasingly Locums are coming to the LMC seeking help and advice. The LMC does provide general information free of charge, hence you may be a Locum and not pay a membership fee to the LMC but you are reading this email.
With all the problems with IR35, pensions, Capita, performance procedures, Indemnity etc the LMC is being approach for individual help by Locums. In fairness to all we cannot undertake this work unless you are a paid up member of the LMC.
The cost of LMC membership is £100 per year (tax deductable) or £50 per year if you pay by direct debit.
What do you get for your membership?
- Full access to the help, advice and support of the LMC.
- The ability to stand for election to represent your colleagues on the LMC Committee.
- Reduced rates for some education events run by the Education and Training Department of Wessex LMCs - Wessex LEad - click here ??????.
- Support through Wessex Insight - click here.
The more Locums we have have as fully paid up members of the LMC the more services we can develop for this important group of GPs.
How do I join my LMC?
Wessex LMCs now offer a new online membership for Locums at a reduced cost of £50 per year, which is usually tax deductible (compared to £100 if payment is by cheque).
For the first year of GP qualification this is free.
If you have not yet registered with a login please click here to create your account: click here
One you have logged in and clicked on the ‘My profile’ button in the top right hand corner you will see an option at the bottom of the page under the heading 'Account Linking' to ‘Pay membership’. Once you click on this you will be able to pay for your annual membership.
If you have not yet linked your account to Wessex LMCs, click on the 'Link to an Organisation' button and select Wessex LMCs from the drop down options. You will then be able to pay for your membership.
The Wessex LMCs website has a national reputation for being a good source of information. We have been working with our Sessional GP colleagues to update the Sessional GP section of the website - click here to review the changes.
The latest GPC Sessional GP newsletter is available - click here.
Pension and performer list issues for sessional GPs.
The GPC's Sessional Committee have been meeting monthly with Capita and NHSE with regards to Sessional issues, predominately Pensions and Performers List issues.
There have been updates previously in the sessional newsletter, below a link to the latest blog from one of the Session GP leads following a recent meeting with Capita.
Click here - for access to the blog.
4. GP Trainee timetable
From the 1st August all Practices need to ensure they are compliant with the new Junior Doctor contract that is based on the European Working Time Directive.
Attached is a timetable I am going to use in my practice.
5. Does having an Urgent Care team in your practice really work - a personal view?
I have been a GP partner in the Arnewood Practice in the New Forest for over 30 years and almost from my first day in the practice we have been discussing how we deal with the demand of same day appointments and home visits. Both of these have increased significantly over the years and we have tried various different solutions over that period of time with a varying degree of success.
I work in an area that has twice the national average of patients who are aged 65 or more (over 30%), 75 or more (over 17%) and over 85. This means that the demand for home visits is high and we have a large number of Care Homes.
Some time ago we were finding our working days unmanageable, as within an hour of opening all our appointments had be used, reception were asking for additional appointment, waiting times were getting longer for routine care and the home visit numbers were also increasing. So we tried a system of having a duty doctor and at busy time such as Monday, we had two duty doctors. The duty doctors were then responsible for the telephone triage screen, carrying out the same day home visits and seeing some of the patients who needed to be seen on the day. We also had nurse practitioners that supported GPs in terms of home visits and minor illness clinics.
To start with this system worked well, we were able to get home visits completed earlier in the day and we managed the workload quite well. Over time the telephone screen grew, often with more than 70 telephone calls required. The workload once again had become unmanageable.
In April, my practice introduced a concept of having an urgent care team for the day. We created this by converting a room and kited it out with the necessary computers and telephones etc. There Urgent Care Team Works from there and so act as a team rather than individuals. The team includes GPs, Nurse Practitioners and an Admin person to support the team. The team changes at lunchtime and a different team will cover the afternoon. The number of GPs working in the urgent care team will depend of the day - more on a Monday and Friday (as these are busier times).
Reception undertake the first level of triage - if it is clear the person needs to be seen they can book the patients directly into urgent care slots that are available in each GPs surgery. If they are unsure or believe the problem may be sorted out over the phone then they are put on the triage screen.
The GPs and Nurse Practitioners will then triage the patients and decide if the person needs telephone advice, if they need to be seen the patient can be booked into a urgent care surgery that occurs during the day and delivered by the urgent care team.
All requests for home visits also go through the Urgent Care Team who will speak to the patients and see if the patient can attend the surgery, appropriate for advice or arrange a planned visit on another day. This is particularly important for Care Home where the locality have agreed on a single practice approach for each care home. Within the practice we have 2 GPs, a Nurse Practitioner and our clinical Pharmacist as a team for each care home.
This has now been running for about 3 months - what have we learnt?
- The system works well and is managing on the day demand much better - mindful that this is not the winter where things will get busier. We intend to increase the numbers working in the urgent care team between November and March.
- Some GPs we skeptical if this would work, but now all GPs think it is an improvement on what we had before and many like working as a team, esp. the GP Registrars and Nurse Practitioners who feel well supported.
- The admin person is a great help because as they get more experienced and they are present in the room with you, they can undertake more and more complex tasks for the clinicians.
- The telephone screen is getting longer and routine stuff is getting put on the triage screen - so we are reviewing this and pushing some of this back to reception.
- Our visit load has decreased and we are developing much more constructive relationships with fewer care homes.
Ultimately this sort of approach could cover a lager population and include other healthcare professionals such as community nurses and physiotherapists - both of whom are part of the Same Day Access Centre in Gosport.
I thought I would share this and I am sure you are doing things which are equally good and make a difference - if so please share these experience and I will put them on the LMC website and send some out with my regular emails.
6. Bradford on Avon Leg Club
There are a number of leg clubs set up around the country and have used the help and support of the "Lindsey Leg Club Foundation". Click here for more details.
The Lindsay Leg Club Foundation (the Foundation) was established in December 2004 with the main objective of facilitating and managing the coordinated growth of the network of the Leg Clubs and to provide the Clubs with any information and support that they may require. The Foundation achieved charitable status in September 2005.
Individual Clubs are members of the central Foundation and operate according to the Lindsay Leg Club Model. The model is set out in a practical Handbook which details how Clubs can be established and which defines the procedures, policies and standards that the Clubs must adhere to, including a model branch constitution.
The Foundation operates a central website for Clubs, their members and other interested parties as well as issuing a quarterly newsletter and running a helpline to respond to operational and clinical enquiries. It also organises and runs leg ulcer national awareness campaigns.
Systematic demographic, clinical and financial audit via standard templates is a key feature of Leg Club practice. Protecting members' anonymity through a simple referencing system, the information is collated and analysed, and key measures and trends reported to the Foundation. The UK currently has no means of auditing standards of care, costs, infection or demographics in a sector that is estimated to cost the NHS £1 billion per year. It is intended that the Foundation will use the data collected at the Leg Clubs as a tool to:
Accurately assess the social cost of leg ulcers to sufferers and carers and the financial cost of leg ulcers to the NHS so that funding can be deployed as efficiently as possible.
Raise the priority of leg ulcer prevention and treatment within the health care community and NHS.
Analyse the effectiveness of different methods and approaches to treatment and feed the results back to members, carers, district nurses, GPs and the health care Industry in order to develop the service that patients receive. The Foundation recognises the benefits to patients and carers of innovation in the health care Industry and the need to share information and work with them where appropriate. A Code of Practice contained within the Handbook aims to establish clear and ethical rules of engagement between Leg Clubs and Industry.
Educate the public generally about how common leg ulcers are, how detrimental they can be to your quality of life and how they can be diagnosed, prevented and treated.
Ensure that staff involved in the Leg Clubs are trained to an excellent and efficient standard in wound management.
Ensure that care can be provided equally to patients regardless of condition, age, wealth, sex, race or geographical location.
The overriding objective of the Foundation is to protect and preserve health amongst those experiencing, or at risk of experiencing, leg ulcers and/or associated conditions.
I am aware that there several leg clubs that have been set up and are working really well. The one I know most about was set up by the practice in Bradford on Avon - watch this video to be inspired - click here .
Hi Nigel - looks good, text from the Lindsay Leg Club Foundation - all true, happy to share. Ellie has a team of experts who can visit and give presentations to interested Practices.
I discussed the Leg Club with Amanda Brookes, Locality/Projects Manager - Bradford on Avon and Melksham she said "we now have a second Club in Melksham although this isn't an Ellie Lindsay Club, but is drop-in and with a social aspect set up in a local sports club. We have added a Falls Clinic, Podiatrist and Carers Café and see 25-30 people from three GP Practices every Thursday morning".
7. Digital technology - should patients pay?
At a recent event that I was speaking at about the management of long term conditions we discussed the use of health apps and tools to help support patients with a long term condition.
One of the difficult areas is who should pay.
So take an average CCG of 200,000 patients there would be about 12,000 patients with diabetes. If as part of their management the CCG purchased an App that costs £10/year the annual additional cost for the local health economy would be £120,000. This is unlikely to happen and could this be justified?
Over the last couple of years I have been aware of some work that has been undertaken by some local Respiratory Physicians and a company called my mHealth who have been developing a product call my COPD. This is a web application that will better enable patients to manage their LTC.
I have recently looked at the suite of similar produces they have developed including:
- My Asthma
- My Diabetes
- My COPD
- my Heart - about to be launched
For some patients my COPD is free but my Diabetes cost £20 for a lifetime subscription.
It is well worth looking at the video of this produce - click here.
I am going to suggest to a few patients that they might consider trying these Apps!
Dr Nigel Watson
Churchill House, 122-124 Hursley Rd
Chandler's Ford, Eastleigh
Hants. SO53 1JB (Registered Office)
Attached file: WPC Project Summary Report AW DIGITAL.pdf
Attached file: Proposed GP Trainee Timetable from 1st August 2017 v2.docx