Many practices in England will have heard of NHS England’s 10 High Impact Actions. The actions are all aimed at helping to free up GP time to enable them to deliver more clinical care.
They form part of NHS England’s General Practice Development Programme, which is headed up by Manchester GP Dr Robert Varnam, which has developed out of the GP Forward View.
Dr Varnam explains that these actions are a quick route into how practices can make improvements and make themselves mores sustainable. They are all based on real-life successes and one of the aims of the initiative is to highlight and spread innovations so practices can learn from what has worked elsewhere.
What are the 10 High Impact Actions?
1. Active signposting – providing patients with a first point of contact that directs them to the most appropriate source of help. Web and app-based portals can also be used for this.
2. New consultation types - Introducing phone and email consultations, for example, to help improve continuity and convenience for the patient, and reducing clinical contact time
3. Reduce DNAs
4. Develop the team – Broaden the workforce in order to reduce demand for GP time and connect the patient directly with the most appropriate professional.
5. Productive work flows – Introduce new ways of working which enable staff to work smarter, not harder.
6. Personal productivity – Support staff to develop their personal resilience and learn skills that enable them to work in the most efficient way possible.
7. Partnership working – Create partnerships and collaborations with other practices and providers in the local health and social care system.
8. Social prescribing – Use referral and signposting to non-medical services in the community that increase wellbeing and independence.
9. Support self care – Take every opportunity to support people to play a greater role in their own health and care.
10. Develop quality improvement expertise – Develop a specialist team of facilitators to support service redesign and continuous quality improvement.
Support for practices
To support these actions, NHS England has developed an online forum where practices can access case studies and examples of how each of the actions can work in real life and the results they can achieve (see below for link).
Many CCGs are choosing to work on one or more of the actions across their local area, but practices can also choose to get involved with this work on their own, with a neighbouring practice or via their federation if they think any of the initiatives could help them. According to Dr Varnam by March 2017 nearly 40% of CCGs had expressed an interest in obtaining help from NHS England to implement one or more of the actions.
There is central funding from the GP Forward View available to support some of this work, which generally would be accessed via your CCG. If funding is available, that may determine which of these actions your practice becomes involved with. The GP Forward View funding streams that might apply include:
- Releasing time for care. A £30m programme to help practices release capacity and work together at scale, enable self-care, introduce new technologies, and make best use of the wider workforce.
- Building capability for improvement. NHS England has said it will provide free training and coaching for clinicians and managers to grow confidence and skills in using improvement science and leading change.
- Training for reception and clerical staff. National investment of £45m for every practice to support the training of current reception staff to play a greater role in care navigation and clerical staff to handle clinical paperwork.
- Practice manager development. £6m investment in practice manager development. The programme will support networking between managers at a local and national level, to share successful ways of managing workload and provide peer-to-peer encouragement and support.
- Online consultation systems - A £45m fund has been created to contribute towards the costs for practices to purchase online consultation systems.
Do the actions work and where should you start?
‘We’re seeing that every single one of the actions has an impact,’ Dr Varnam says. ‘It varies between about 5% of GP time up to about 15% or maybe more.’
So, if practices are interested in trying the actions, where should they begin?
‘The first thing I say is to try and get yourself some quick wins,’ Dr Varnam says. ‘And often only you will know your circumstances well enough to choose the best quick win.
‘The second good idea is not starting from scratch, but building on what you’ve already got. So sometimes people say we’ve tried a little bit of that before but looking at some of the case studies I can see we could get an awful lot more out of this idea.
‘The third one is to not despise the small things if that’s where you can get rapid movement. It’s really easy to assume that every solution has got to be really big but frankly most days if I had one or two fewer appointments the day would feel better and I’d do a better job.
‘For some GPs if you save 20 or 30 minutes a day all sorts of other things can become feasible. So I often say to people, that might guide your choice of where to start.’
Dr Varnam also says working with your neighbours is the key to making change happen more quickly and seeing a better result.
‘Some of these things work very well as a practice on your own, but pick one that you can do together because you can get things done more quickly and make your federation way more meaningful.’
He says that this can be particularly important if you are looking at developing the practice team and introducing new roles into general practice.
‘As soon as you bring a group of practices together and start to measure the work they’re doing – how many people see a GP and how many people could have been seen better by someone else – practices themselves are coming up with figures between 15% and 45% of GP appointments that could have been dealt with differently,’ he says.
‘And they’re coming to the conclusion that if they did things together they could share a physio, or two or three pharmacists, or train their receptionists in actively signposting.’
Example case studies and useful information on Medeconomics
- Active signposting – Training receptionists to be care navigators
- Productive workflows – Training administrative staff to deal with clinical letters
- Productive workflows – Using data to tackle workload
- New consultation types - How GP practices are using video consultations
- New consultation types – Group consultations in general practice
- Social prescribing – How social prescribing can help practices
- Develop the team – Employing paramedics in general practice
- Develop the team – How physician associates can help general practice
- Self care – How to support self care in your practice