Rising GP workload pressures are widely recognised in England. Managing GP services that are at or beyond capacity risks locking those practices into responding reactively and inhibits effective strategic leadership and practice management. Recruitment challenges exacerbate these difficulties. In addition, practices do not exist in isolation and the impact of these pressures can have a ‘domino effect’ in local areas. One or two local problems can quickly impact on otherwise functioning and stable practices.
NHS England, recognising the impact of rising workloads within Primary Care, has established a national General Practice Resilience Programme (GPRP). This Programme was announced as part of the General Practice Forward View. The programme will provide £40 million over four years (until 2020) to support GP practices and to build resilience into the system.
General practice is facing significant challenges and the demands on practices, coupled with workforce issues and financial pressures means that the traditional model of a general practice as a standalone businesses is unlikely to be sustainable in the longer term.SCW has been commissioned by NHS England (Wessex) to work with circa 60 practices identified by the CCGs or through the self referral process to be in a position to benefit from the available funding to address a range of business challenges. These practices include those that have recently merged or are considering mergers in addition to those with the insight to know that unless they start to do things differently their business model will be at risk.
Our role is to support practices to understand their challenges and identify the opportunities to build practice resilience. Starting with a data pack approach, we worked with the senior team at each practice to help them understand and think about their patient population and practice issues.
The initial conversation-based session is supported by the practice specific data pack and this data is used to stimulate discussions. We work with the practice leadership team to explore the challenges they face, consider the impact of staffing and patient population changes on workload, workforce and infrastructure.
The output following this meeting is a co-developed practice report with an action plan focussed on actions targeted at practice sustainability. Typically the action plans identify solutions including specialist advice and guidance e.g. human resources, IT, coaching / supervision / mentorship, Practice Management capacity support, rapid Intervention and management support for Practices at risk of closure, co-ordinated support to help practices struggling with workforce issues and change management and improvement support to individual practices or group of practices
We also provide follow up visits to support the ongoing delivery of the plans using this as an opportunity to identify impact and to review and revise the plans as appropriate.
Examples of the actions that we have supported are facilitated away-days for protected time to explore challenges and opportunities; support for practice mergers; review of admin and nursing teams and development of new ways of working; support to the implementation of signposting in general practice; supporting a recently merged practice to harmonise their GP contracts; aligning back office processes across a number different practices; Clarity 4D training for team building, and practice culture development.
As a result of our work between 2016/17 and 17/18, 58 practice action plans have been completed and spend in the region of £1.2m approved by the relevant CCGs
A programme of follow up visits is in progress to support practices to identify impact of plan delivery and review and revise the plans as necessary
Work with practices during 2018/19 is underway under a 12 month rolling programme of support.
Our knowledge and professional expertise enabled a quick turnaround with the average time from practice meeting to action plan delivered in seven working days.
Although delivery against this programme is in its early stages, we acknowledge that this work forms the foundations required to meet the fast changing pressures facing the healthcare system today.