Posted on: 25 January 2019
Hello my name is Andy.
I’m a local GP, proud to be working in Keighley. I’m also working alongside Carol McKenna and other health and social care colleagues on the primary and community care programme for the West Yorkshire and Harrogate Health and Care Partnership. When we talk about primary care, we are talking about GPs, district nurses, health visitors, midwifes, occupational therapists etc.
Changes to primary care are taking place quickly across our area. The new model for how we care for people being implemented aims to improve people’s health across Bradford District and Craven, Calderdale, Harrogate, Kirklees, Leeds and Wakefield. We’re doing this by increasing the skills of our workforce, using technology and more effective and efficient use of buildings.
The changes are also about thinking outside the traditional ways of working. It’s known that things like the quality of a person’s relationships, whether they have a job, their home and the neighbourhood they live in can all have a big impact on both physical and mental health.
Our work is more than just managing a person’s illness, which we know is important. To really transform care we need to look at the reasons why some illnesses happen in the first place and to work with people, their families, and communities to age well.
Sustainable, healthy communities really are the thing of the future which we need to be part of.
One way we’re making that ambition a reality is by using population data - the information, intelligence and insight that we have about people who live in our communities. By working alongside our public health colleagues, who are very good at predicting people’s health, we can understand the communities where we live better and target the care to those most in need.
Looking at performance data will also help us see where there is any variation in people’s experience of care. We want everyone, no matter where they live, to enjoy the same level of high quality care. This is after all only fair and right.
Our new approach is all about working collaboratively with other practices and healthcare providers, sharing learning and working together with people to deliver health and care in manageable chunks.
In West Yorkshire and Harrogate there are 50 neighbourhoods each made up of about 30,000-50,000 people. We’re making changes so that health care teams, community nurses, voluntary organisations, social workers, GPs and occupational therapists work together to wrap round communities in ways that provide better joined up care.
We are also empowering people to have a voice in their own care (often referred to as personalised care and choice). This will help people to look after themselves and receive the support they need to remain healthy and independent.
One area where we’ve made changes is in training staff. Previously only GPs benefitted from a vocational career scheme. GP practice nurses used to be recruited or ‘poached’ from community care providers or hospitals who had originally trained them. Now, for all clinical staff there are four primary care training hubs that serve every West Yorkshire and Harrogate practice supporting the training of student nurses, general practice nurses, health care assistants, advanced clinical practitioners and physician associates. The West Yorkshire and Harrogate Excellency Centre is now offering training for non-clinical general practice staff.
In such a short period of time an entirely new system of training staff now exists to ensure that primary care has the potential be self-sufficient in terms of building and expanding our future workforce.
You may have read Carol's blog where she talks about the importance of GP recruitment. We are working to increase training numbers of newly qualified GPs and have an ambitious programme to recruit, retain and return existing GPs.
Previously, GPs did most clinical tasks on their own with little help. Now, they will be assisted by allied health care professionals such as clinical pharmacists, physiotherapists, mental health workers and physician associates – all seeing people in their local surgery or communities.
Other colleagues like paramedics, end of life care nurses and community matrons will also help GPs with home visits to housebound and frail patients. This will help people with chronic diseases and long term conditions stay well and independent for as long as possible.
Previously 40% of GP workload was spent working with people experiencing mental health difficulties mostly related to socially determined problems (such as housing problems, debt worries, air pollution, addiction and unemployment). Now, GPs work with care professionals called ‘social prescribers’ to help solve problems and guide people into meaningful occupation, relationships and environments that lead to better social and emotional health.
Of course, creating new roles in primary care benefits our workforce too and opens up new career avenues for healthcare workers to follow. This should also help us recruit and retain talented staff.
This digital transformation is also about using online consultation systems, improving access for people and making best use of clinicians’ time. We are working together across West Yorkshire and Harrogate on adopting this at scale to ensure effectiveness and efficiency. Plans are progressing for a phased roll out in practices from March 2019 onwards. This work will be supported by a dedicated project team who will oversee the rollout from start to finish.
Alongside this we need to make the most of our assets, i.e. buildings. This work is supported by a multi-million National fund to transform general practice facilities and technology across England. Examples range from internal reconfigurations to multi floor extensions that will make better use of existing space and increase space to enable better patient access and new ways of working. Running in parallel are technology schemes that are increasing provision of mobile devices, wireless access and IT that supports extended hours access hubs and shared telephony. We will keep you posted as the work progresses
Advances in medical care mean people are living longer, but many are living with chronic disease and disability. So we need to do more to improve their quality of life. Currently, much of the service capacity of primary care is by patients with multiple and complex illnesses and yet less than 0.1% of the time in a patient’s life is actually spent in front of a healthcare professional.
Primary care will be working with patients to use some of the other 99.9% of time to help them more easily manage their own health and illnesses in the comfort of their own homes or community spaces in new ways, such as using health education support, online and video consulting, remote biosensors, artificial intelligence, digital health coaching and other behaviour support technologies.
This is an exciting time for primary care in West Yorkshire and Harrogate. Rather than working in isolation general practices and community services will be working together. The future looks bright - we are truly transforming to meet people’s needs.
You can read more about how primary care fits in with the wider Local Workforce Action Board Workforce Plan
Have a good weekend
Andy
What else has been happening this week?
Patient and Public Involvement Assurance Group
The Patient and Public Assurance Group of The Joint Committee of Clinical Commissioning Groups (CCGs) met on Monday 21 January 2019. The group agreed its work plan for 2019/20, which is aligned closely to the Joint Committee’s own work plan.
The Group is made up of patient and public involvement lay members from the CCGs which make up the Joint Committee.
Areas of focus for the Group are cancer, elective care and standardisation of commissioning policies, mental health, urgent and emergency care and maternity. The Group welcomed the new ‘do once and share’ approach to quality and equality impact assessments, the outputs of which will be a valuable source of information for the Group. Members discussed the benefits of introducing a similar approach for assuring patient and public engagement.
Finally, the Group received an update on the communications strategy, and discussed their involvement in the development of the five year strategy as part of the long term plan. Members also heard about the new ‘Looking out for our neighbours’ campaign (name to be confirmed) which is about tackling social isolation and loneliness to prevent ill health. The Group agreed to the creation of an infographic explaining the role of PPI lay members, which would sit alongside the Group’s annual report.
West Yorkshire and Harrogate System Oversight and Assurance Group (SOAG)
The System Oversight and Assurance Group (SOAG) met on Monday 21 January 2019. This group has been established to take an overview of progress with our shared priority programmes, and to agree collective action to help tackle shared challenges. The group heard about progress being made around five key Partnership programmes: urgent and emergency care, improving planned care, capital and estates, stroke and innovation/improvement Members heard that we have secured £270m for capital schemes (make link). They also heard how by last autumn more than 2,300 people have benefitted from the atrial fibrillation programme, preventing 122 strokes over 2 years. Members also agreed an approach to providing support to places, programmes, and sectors of the partnership which are experiencing multiple challenges.
Improving planned care
The Improving Planned Care Programme Board met on Tuesday. The meeting was chaired by Matt Walsh, CEO for Calderdale Clinical Commissioning Group and lead for this programme. The Board discussed the following areas of work:
Healthy Hearts
Shane Hayward-Giles, RightCare Delivery Partner, presented the West Yorkshire and Harrogate Healthy Hearts guidance at Programme Board. For more information about the project, which is a simplified medication regime for the treatment of uncomplicated hypertension (high blood pressure) in adults aged below 80, please email: shane.hayward-giles@nhs.net
Musculoskeletal (MSK)
As the process of reviewing MSK (muscles, bones or joints) thresholds progresses, a greater emphasis will be placed on alternative interventions such as exercise and physical therapies. Programme Board noted that such alternative interventions should be detailed within the revised MSK pathways. This shift towards more self-care and self-management links to social prescribing and has the potential to provide opportunities for community based healthcare providers and support groups.
Liothyronine
The West Yorkshire and Harrogate Pharmacy Leadership Group provided an update on the standardisation of the prescribing commissioning policy for liothyronine for the treatment of primary hypothyroidism (underactive thyroid). The draft commissioning statement, which seeks to provide additional clarity to the Regional Medicines Optimisation Committee (RMOC) statement and supports standardisation of practice across WYH, will be presented at the WYH HCP Clinical Forum on 5 February.
Bariatric surgery
Responsibility for the commissioning of Tier 4 bariatric surgery (for severe and complex obesity) was transferred to clinical commission groups (CCGs) from NHS England in 2017. The CCGs in West Yorkshire and Harrogate do not currently have a bariatrics commissioning policy so this has created an opportunity for WYH to review access and eligibility for obesity surgery. The proposed standardised policy will follow NICE guidance with the aim of addressing the current poor access rate to obesity surgery.
West Yorkshire and Harrogate Health and Care Partnership - Housing and Health
The first meeting for housing and health took place on Wednesday. The meeting was chaired by Jacqui Gedman, CEO for Kirklees Council and CEO lead for the Partnership on this programme of work. As the nominated CEO Lead for Housing and Health across the West Yorkshire and Harrogate Partnership Jacqui’s role is to facilitate the sharing of good practice whilst bringing housing partners to the table with new ideas. Sarah Roxby (WDH and Wakefield Clinical Commissioning Group) will be supporting Jacqui as the Health and Housing Strategic Lead with the intention of harnessing the potential of all our housing partners across the whole of the area. Poor housing and the impact on health is one area we have pledged to tackle together across West Yorkshire and Harrogate; it costs the NHS £1.4bn a year but by reducing excess cold to an acceptable level, we could save £848m nationally, more importantly we could improve people’s lives. We will keep you updated as the work develops.
Urgent and emergency care
The Urgent and Emergency Programme Board met on Monday and is chaired by Dr Adam Sheppard. This was a development session where local places (Bradford District and Craven, Calderdale, Harrogate, Kirklees, Leeds and Wakefield) shared their plans for the development of Urgent Treatment Centres (UTCs) and future provision for Minor Injuries Units and Walk in Centres. Not all areas are planning UTCs. This in line with the NHS Long Term Plan which includes plans for the implementation of the UTC model so that there is a consistent offer for out-of hospital care, with the option of appointments booked through a call to NHS 111
West Yorkshire and Harrogate Carers Programme
Fatima Khan-Shah, our programme lead for unpaid carers met with colleagues from local councils and the voluntary and community sector on Thursday. This included colleagues from Dementia UK, Making Space, Carers Count, Carers Wakefield, Carers Resource (Bradford, Craven and Harrogate) and TIDE to name a few. The meetings included an update on work to date and ways in which we can involve the voice of our VCS partners in our carers programme.
What’s happening next week?
- West Yorkshire and Harrogate Five Year planning group meets on Monday.
- There is a meeting with Healthwatch colleagues on Tuesday to discuss the NHS Long Term Plan.
- Communication, engagement and Healthwatch meeting takes place on Tuesday.