Energising Primary Care Posters 607- 614
607 Population health improvement fellows: energising local primary care
Objectives An innovative fellowship was created by a partnership of two CCGs to tackle the workforce retention crisis locally and train GPs for commissioning roles. The fellowship provides supported career development in population health and commissioning for newly qualified GPs.Content Six fellows were recruited jointly by two CCGs, supported by a Local Education and Training Board and a local university. The fellowship comprises of four sessions in clinical practice, two undertaking a Masters in Public Health, three within the CCGs and one of peer support/leadership development.
Relevance/Impact GP retention, and engagement in commissioning roles, are challenges to the sustainability of General Practice in the UK. The fellows already demonstrate increased depth of knowledge and bring an integrated skill set to their roles. If successful, this innovative programme is a model which could be adopted by other CCGs.
Outcomes By building a strong foundation in public health academia and research, fellows have increased ability to influence clinical commissioning decisions.The fellows, whilst working on projects aligned with the CCGs’ objectives, are acquiring experience in project management.In providing additional clinical sessions, fellows facilitate the release of practice staff to support local federations.Ultimately, the fellowship will provide a cohort of locally trained GPs qualified for leadership roles within the CCG.Following favourable third party evaluation, the CCGs plan to extend the programme for existing fellows and recruit a further cohort.
608 Frailty clinics within integrated healthcare
Frailty and the use of frailty clinics are an emerging model and an opportunity to bid for, and support, integrated care across primary, secondary, community and the voluntary sectors. Healthcare is changing and options for co-ordinated, patient focused, integrated care are emerging.
This presentation aims to outline the existing evidence, current models and impetus for frailty clinics and then indicates how these might be implemented in practice. Frailty identifies a population with multiple needs who are at high risk of further morbidity and admission, which has funding implications for healthcare. Efficient, co-ordinated, integrated care with shared healthcare records can have significant impact both on the individual patient and the costs to the NHS.There is a national focus on frailty with is reflected in regional changes and the opportunity to integrate care under the emerging models such as the multispecialty care provider. There is integration at micro, meso and macro level.
An approach to bid for funding is outlined in the presentation with advice on practical options for a flexible frailty clinic with input from GPs, elderly care consultant, older person mental health consultants, mental health nurses, community care team, physiotherapy, social services and the voluntary sector. This is relevant to all those interested in developing integrated care and considering models such as a frailty clinic. The presentation will conclude with a summary of progress achieved in frailty clinics and the potential direction of development over the next few years.
609 Transforming Intermediate Care
We are part of a jointly commissioned CCG intermediate care project. The contract awarded to our care collaborative late last year including the Acute Trust, GP federation (including 2.5 FTE GPs), local authority and third sector organisations.
Our aims and objectives were to 1) Reducing acute admissions by: Managing patients with multimorbidity, GP referrals and hospital discharges in the community. 2) Empower patients to remain at home with adequate support.3) Reduce social isolation and involve third sector in promoting self care and health promotion.
Our presentation will explore the development and evolution of our service. The multiple teams that were transitioned into the new service and integrated together. We acknowledged GPs are struggling to cope with the increased workload in terms of providing access and juggling multiple complex patients. Working on the principle that a jointly led Acute and GP service would take increased ownership of patients rather than discharge patients and leaving GPs with multiple follow up tasks.
We felt this approach would reduce read mission rates, and enable patients care better. Our outcomes to date have been significant, we have reduced acute admissions by 15% in the space of 6 months, reduced placements in nursing homes by 20%, integrated 5 services into three core teams. In addition to a two and a half time increase in workload and stayed within targets agreed.
610 The fall and rise of generalism: perceptions of generalist practice amongst medical students
Stephanie Tristram, Pareena Patel
Aims/Objectives To understand students experience of training in expert generalist practice (EGP) at a UK medical school. Content of Presentation Normalisation Process Theory informed design of this survey study by examining four domains of work predicted necessary for new ways of working to become embedded into daily practice. The survey was emailed to all students, with 47 responding.
Qualitative data analysed through the constant comparative method, generated codes describing enablers and barriers towards engagement with EGP. Relevance/Impact Shape of Training review emphasises a need to train more generalists to address changing pressures that face today’s health services (e.g. multimorbidity). GPs are the largest number of trained generalists, however evidence suggests GPs experience barriers to the delivery of EGP. Work is underway to address these barriers at postgraduate level. We now need to address undergraduate training.
Outcomes Results show variable student understanding and engagement with EGP. Some students highlighted the importance of these skills to meet today’s complex health needs, and desired to know more. Some revealed lack of specific training, observation and practicing of EGP skills, along with lack of time and resources to ensure ongoing work using EGP. DiscussionEGP is inconsistently understood at an undergraduate level.
Barriers exist, which need to be addressed to integrate EGP into the undergraduate curriculum, thus increasing numbers of trained generalists. Our survey highlights some initial areas of focus, e.g. protected time in the curriculum for teaching, observing and practicing EGP skills and for teaching staff to be taught the importance of EGP.
611 Making frailty a priority
Aims/Objectives Demonstrate the role of GPs within secondary care initiatives for frail, complex elderly patients.
Content Experiences of an innovative GP-led multi-disciplinary approach to frailty within secondary care; highlighting groups involved, the challenges and the successes. Relevance/ImpactFrail elderly patients are vulnerable, complex, prone to dependency and have reduced life expectancy. Primary care can not always meet their complex needs while recurrent and prolonged hospital stays are also detrimental. These factors drive demand for early Comprehensive Geriatric Assessment (CGA), primary/secondary care integration and a multidisciplinary approach to management. Their community-orientated care ethos, shared-decision making approach, management of clinical risk and patient advocacy enable GPs to confidently lead this approach.
Outcomes Preliminary data shows an average 3-day reduced length of stay with 39% discharged on the same day and 65% discharged within 3 days (previously 50%). Patient and carer feedback has been positive, though limited data and patient selection limitations are acknowledged and further evaluation is ongoing. A recent Emergency Care Improvement Programme (ECIP) report states, “The recently created Acute Frailty Team (GP led service in secondary care) appears to be an excellent foundation on which to build a comprehensive service…. a powerful option with energetic staff keen to make a difference…”
Discussion Outcomes suggest patient and cost benefits as a result of collaborative working. Positive early signs and support from the Trust and wider health community have secured funding for ongoing development. Delivery of a timely CGA is key to patient care; who delivers this assessment is worthy of debate.
612 Activating patients, inspiring medical students and enthusing GP tutors; an innovative new undergraduate teaching module
Aim/objectives: to demonstrate how a new teaching module has engaged and enthused patients, students and GP tutors.
Content: the experiences of year 1 and 2 medical students, patients working as educators and GP tutors in the first two years of a new teaching module.
Relevance: With most healthcare carried out in the community and the majority of undergraduate teaching taking place in hospitals, medical students need early exposure to Primary Care to inspire them. Enthusiastic GP’s are role models and can hugely influence career choice. HEE hopes 50% of foundation doctors will enter General practice; we hope this new module with increase numbers doing so. In 2014 an innovative teaching module was introduced bringing small groups of students to general practices, meeting patients with long term conditions.
The sessions were led by GPs and involved both peer learning, where creativity of teaching delivery was encouraged, and spending time with patients with a wide variety of common conditions.
Outcomes: Students see General Practice in a more positive and dynamic way before they enter the world of hospital medicine. Involving GP’s in undergraduate education can invigorate their working lives, helping to re-frame their and their patient’s situations in a positive light, improving morale and focus. Activating patients as educators,with time to tell their story rather than to answer a diagnostic history is beneficial to patients and students alike.Discussion: students fed back very positively, GP’s delighted in their involvement and patients appreciated the opportunity to educate and give something back.
613 The global health exchange fellowship; a novel out of programme experience
Aims The Global Health Exchange Fellowship was a six month pilot project aimed at making global health real through experiential learning for UK and Kenyan trainees in Primary Care.
Content Health needs analysis, using Qualitative methods, was performed in two areas of deprivation – a rural Maasai community in Kenya, and an inner city in the UK. Identified health issues were categorised into themes which were prioritised by the communities, using an innovative voting methodology developed by the fellows. Findings were presented to local health authorities.
Relevance Each fellow experienced remarkable personal and professional development including- transferrable problem-solving skills (working with the populations studied to develop context-specific sustainable solutions); understanding of global health issues, the structure and economic limitations of healthcare systems; community-oriented team-working; leadership; and understanding the roles of other professionals involved in health-related community policies. Outcomes In line with the DH policy document recognising the value of overseas experience, this fellowship is expected to become a standard option for trainees.
Discussion The project is a true exchange between Primary Care professionals practicing in low income and high income countries in terms of location, knowledge and experiences. Research demonstrates that learning is most effective when learners work in groups, challenge ideas and collaborate to achieve solutions. Experiential learning, is the process of “learning through reflection on doing” which focuses on the learning process for the individual, as demonstrated by this novel fellowship. “for the things that we have to learn before we can do them, we learn by doing them” (Aristotle).
614 Expansion is an opportunity for improvement: providing high quality primary care provision for Intermediate Care patients
Our large inner city practice has been involved in providing GP cover to intermediate care for a number of years. We use a proactive model of care at these sites, by visiting each site three times a week, believing that this pre-empts medical problems from escalating thereby reducing re-admission rates, and improving confidence and communication between care staff and the medical team.
Commissioners recognised our high quality service and we were approached to expand our service in early 2015. Our service now covers 100 inpatient intermediate care beds across 4 sites (previously 45 in early 2015), and has in excess of 45-50 patients admitted per month. We recognised expansion as an opportunity to innovate, introducing a pharmacist and prescribing clerks/administrative support to our team, as well as introducing new pathways and remote technology.
These changes have contributed to excellent outcomes throughout significant service expansion eg: Significant improvement in number of patients having admission letters sent out to GP (52% to 92%); Improved number of pharmacist-led medication reviews on admission (37% to 96%); Maintaining high standards of record keeping for risk areas such as transmission of prescriptions between practice and pharmacy; Employing new ways of working by recognising opportunities to provide new or expanded services is crucial in the current primary care climate. It also brings benefits such as opportunity for funded services outside of the core contract and funding for new staff who can improve quality and efficiency of care for the whole practice team through a widened skill mix.