As a highly experienced GP and LMC chief executive, Dr Nigel Watson probably knows as much as anyone about the difficulties facing general practice.
But he also believes that a possible solution lies in GPs working at scale and delivering a new model of integrated care.
Dr Watson adds: ‘People worry about change but I do think it will lead to a better future for patients and sustainable general practice.’
It is a concept NHS England is also committed to through its new models of care programme and one Dr Watson and colleagues are taking the lead on as one of 29 vanguard areas for that programme.
Dr Watson is clinical lead for the South West New Forest vanguard which is one of three GP groups in Hampshire which have joined together with the local community provider Southern Health NHS Foundation Trust to work as the South Hampshire multispecialty community provider (MCP). Other ‘fast follower’ areas in Hampshire are expected to join the MCP soon.
What is an MCP?
An MCP is one of two models of care for general practice outlined by the government in its Five Year Forward view in 2014. Under this model practices will work in groups covering at least 30,000 patients and deliver more integrated care with community and social care partners and hospitals.
The South Hampshire Vanguard has identified four goals which cover access for long terms condition and urgent care, joined up care via extended primary care teams, delivering specialist care closer to home and a focus on prevention.
Improving patient access
On primary care access the seven practices in the South West New Forest vanguard have set up a separate ‘branch surgery’ at Lymington New Forest Hospital which shared by all seven practices. Patients from each of the seven practices in the MCP can choose to book an appointment at their existing practice or at the surgery in the hospital.
This surgery offers same day and routine appointments seven days a week 8am-8pm. The practice has access to the same records used by all the practices via TPP’s SystmOne and EMISWeb and also uses WebGP technology to help patients self manage their conditions and provide e-consultations.
‘It works as a single organisation,’ says Dr Watson. The aim is that as well as improving access for patients it will release more time for GPs to focus on patients with complex care needs and reduce A&E attendances.
A second strand of the work in the New Forest is to join up and extend the primary care team to provide more integrated working for patients. Progress on this has included the introduction of a common health record across practices, community nurses and therapy teams and the hospice. The vanguard hopes this will enable better integrated care, for example on end-of-life care and care for patients with long-term conditions.
The MCP also wants to bring extra skills into practices. For example it has been running a pilot with a consultant physiotherapist who is based in a practice and triages patients with musculoskeletal conditions before treatment or onwards referral.
This model, which could be extended to other professionals such as community psychiatric nurses, aims to cut waiting times and onwards referrals and crucially tackle workload, particularly where partners are leaving practices. ‘By using this model we can add capacity and support GPs,’ says Dr Watson.
Access to specialists
The third goal for the MCP is to ‘de-layer’ specialist support. This is the MCP’s description of its plans to redesign pathways for services such as diabetes and respiratory conditions, including delivering locality-based services with teams including GPs, practice nurses, specialist nurses and consultants and bringing consultants to work in GP surgeries.
‘The plan is to make consultants part of the service with their care plans within our records,’ explains Dr Watson.
Tackling the care of the frail elderly population is a particular priority for the South West New Forest group as it has one of the highest elderly populations in Europe. To improve care for this group the vanguard won money from the £200m national Transformation Fund.
The funding is paying for ‘care navigators’ and additional GP time to focus on the housebound and care homes. The group is also hoping to set up a multidisciplinary acute visiting service for the elderly.
Prevention and self care
The MCP’s fourth goal is focused on prevention and self-management. Here the ideas intersect with some of the MCP’s other goals. For example greater self-management through WebGP and earlier detection of long-term conditions, as well as involvement of patients in care pathways redesign and the use of care navigators who would be part of the extended primary care team.
Although all that sounds like a lot to have achieved and planned so far it looks like there is more ahead. ‘We want to do things at pace, fail and fail quickly, implement, evaluate and redo,’ says Dr Watson.
Having established a system which the MCP feels is making general practice a better place to work, removing barriers to integrated care and delivering a change in culture, it has no plans to stop now.