Energising Primary Care Posters 629 – 635
629 Initiation of a deanery-wide mentorship scheme to promote General Practice to medical students and junior doctors
Anna Harrison, Meg Rowlands
Introduction/Aims: General Practice is in crisis with increasing workload and an inability to recruit and retain doctors. The RCGP estimates that 10,000 more GPs are needed yet training applications are at an all-time low. Mentorship schemes are widely recognised as beneficial and evidence shows juniors who engage in mentoring obtain more satisfying career choices.“GP Careers Champions” is a deanery-wide scheme implemented in February 2016 by two GPSTs. It aims to promote General Practice by facilitating mentorship and taster experiences for medical students and junior doctors with enthusiastic GPs and GPSTs.
Methods: 130 GPs were recruited from across the deanery to the “GP Champions” database. Using a single point of access email address, medical students and junior doctors are matched to a Champion with similar interests. This facilitates a mentoring relationship, careers advice and the option of taster experiences. Champions’ knowledge is supplemented with a specifically designed information pack on GP training. The scheme is advertised locally via the GP School, Foundation School and University.
Results: There have been 31 matches with formal feedback received from 27% of participants. Feedback is extremely positive: 100% of mentees stated the experience encouraged them to pursue a career in GP and all Champions agreed to remain on the database for future matches.
ConclusionGP Careers Champions has received excellent feedback demonstrating a beneficial experience for both Champions and mentees. The scheme is promoting GP in a positive light at a much-needed time and shows great potential to be expanded on a larger scale.
630 Educating pharmacy students in a GP Practice: Innovation in workforce development and energising recruitment in general practice
Introduction: The General Practice Forward View identifies pharmacists playing an integral role in primary care. To encourage the uptake of these roles, primary care needs to provide exposure to future pharmacists.Aims: Pharmacy undergraduate education develops student communication and clinical skills while instilling patient values, but these have yet to be tested or demonstrated in General Practice.
Method: An innovative learning course for ten final year pharmacy undergraduates was developed. The course focussed on the application of evidence based practice using experiential learning and reflection, in a GP setting. Students were given opportunities to observe patient consultations, interview patients, conduct medication reviews, use medicines reconciliation techniques and produce patient care plans. Analysis of student pre-course and post-course questionnaires along with staff feedback was undertaken.
Outcomes: Students scored eight learning outcomes (LO) on a scale of 1-5 (1=little understanding and 5=great deal of understanding).Wilcoxon signed rank test confirmed statistically significant median results between pre and post-course questions with p<0.05 in all domains. The most significant change was in students’ ability to demonstrate what is meant by evidence-based medicine and its implications on safe prescribing with p=0.0035. Analysis of student comments identified patient consultations as a positive experience and the staff survey reinforced added value with all reporting that they would engage in the process again.
Relevance/Impact: The course demonstrates the value of collaborative learning with GPs and pharmacy undergraduates. Integration of student activity was in line with current pharmacy education and, with suitable funding could galvanise students into considering a future career in general practice.
631 Workflow worries: Making documents more relevant
Frustrations were expressed at the practice over the distribution of documents within docman workflow. It was felt that the referring GP was not receiving the relevant follow-up documentation from clinics, which affected patient care continuity and doctor education. Documents were simply being work-flowed to the GPs in the surgery the following day rather than considering relevance or urgency.
This audit analysed whether the hospital clinic letters received at the practice were correctly addressed to the referring GP and were being appropriately work-flowed within the practice.This retrospective audit evaluated 100 clinic letters received over 2 month time frame. We recorded the referring GP, the speciality referred to, whether the reply letter was addressed to referring GP and to which doctor in the practice the documents were work-flowed.80% of letters received from secondary care were correctly addressed to the referring GP.
Of these, only 45% were work-flowed by the practice to the GP named on the hospital letter.We worked on methods to improve the efficiency of document workflow within the practice by working in multi-disciplinary teams to come up with solutions. Reception needed training in identifying differences between clinic letters and other less doctor specific documents. A buddy system needed developing to cover annual leave. Processes to ensure doctors received equal numbers of documents and methods of identifying urgent and routine documents were developed.
Following these changes a re-audit performed 3 months later revealed an improvement where 95% of the clinic letters were correctly work-flowed to the relevant GP within the practice. This change in process has improved continuity of care, doctor ongoing education and given reception more confidence in differentiating documents.
632 Improving the working life of general practitioners through collaboration with secondary care
In April 2015 a Foundation Trust launched a new organisation in partnership with local GPs, with the aim of providing support to help practices meet the challenges of our times. This organisation has now taken over the management of 5 practices with a patient population of 37,000. All GPs are salaried to the not for profit organisation. Through support from the Foundation Trust and innovative working including employing clinical pharmacists and nurse practitioners, the experience of both patients and GPs has improved.
We aimed to assess the impact of working within the new organisation on GP’s workload and morale. We undertook a survey of all GPs working for practices that joined the organisation in 2015, and we asked them about how their experience as a GP had changed over the last year. 91% agreed the team ethos had improved. 91% stated that quality of care had improved. 82% stated that work load had improved. 82% felt they were more motivated in their role and able to influence positive change in the organisation.
The organisation offers monthly protected education sessions and 55% of GPs stated there had been an improvement in personal development and training opportunities as a result.Impressively 100% of GPs felt that the workforce is more capable of dealing with the demands of primary care compared with 12 months ago. At a time when the traditional model of General Practice is struggling, we have demonstrated that through innovative working and collaboration with secondary care the working life for GPs can be improved.
633 What do foundation year one doctors think about a career in general practice? A focus group study
Background: A key element of the NHS is universal access to a GP. Recently UK general practice has been described as ‘in crisis’ with training places unfilled and multiplepractices reporting vacancies or facing closure. The recruitment of GPs continues to be akey focus for both the Royal College of General Practitioners and the government.
Aim: To understand the attitudes of newly qualified doctors towards a career in generalpractice, to appreciate potential reasons for the crisis and recommend ways to improve recruitment.
Design and Setting: A qualitative study comprising five focus groups with 74 foundation year one doctors from one Yorkshire deanery.
Method: Audio recordings were transcribed verbatim and thematic analysis undertaken.
Results: Foundation year 1 doctors’ thoughts towards a career in general practice were summarised in four themes. Participants felt that general practice could provide quality of life, with a good work life balance, fair pay and job stability. Job satisfaction, with the ability to provide care from cradle to grave and to work within a community was viewed positively. The uncertainties surrounding the future of general practice and the negative perceptions towards the specialty, experienced in medical schools and in hospitals, were viewed as deterrents to a career as a GP.
Conclusion: This study has gathered the opinions of doctors at a critical point in theircareers before they choose a future specialty, as well as highlighting areas of concern and potential deterrents to a career in general practice.
634 Delivering primary care into nursing homes: changing the profile of A&E attendances and admissions – avoiding the avoidable
In July 2013, as a specially commissioned service, we began to take on the enhanced GP care of nursing home residents locally, aiming to improve primary care for these vulnerable patients. By implementing regular routine GP care including chronic disease management, and covering our own urgent care 8am-8pm 365 days per year, alongside active medicines management, we have increased continuity of care for these patients and staff and markedly reduced avoidable A&E attendances and hospital admissions.
After the initial six months where numbers of homes and patients registered steadily increased, we now have on average approximately 870 active registrations of residents in 18 nursing homes, with an average age of 80.5 years (range 20 – 104). In 2010/11 there were 747 non-elective admissions from the nursing homes subsequently covered by the service; in 2014/15 this had fallen by 14% to 645.
Over the 3 months to January 2014, just 39% of A&E attendances by nursing home patients resulted in admission. Over the 3 months to January 2016 this proportion had increased to 74% (with a peak of 87% in November 2015).Alongside this reduction in avoidable A&E attendances, analysis of the profile of diagnoses also shows a shift towards the unavoidable – increases in the proportion of falls, chest pain, collapse and sepsis and falls in the proportion of UTI and chest infections (most of these had been seen and treated at home prior to admission).
635 Working in remote and rural general practice: a medical student’s reflections
Aims/Objectives The challenges of remote and rural general practice are well recognised, but what attracts GPs and nurses to consider this career path? How can we encourage medical students and junior doctors to train and work in remote areas? I used an elective to immerse myself in life as an island GP in order to find answers to these questions.
Content of Presentation I present the common themes that emerged during semi-structured interviews with GPs and nurses working on an island archipelago. They discussed the rewards and challenges of successfully establishing themselves at the heart of their remote island communities. I used coded transcripts and my own reflections upon island life to define themes that seemed to be of particular significance.
Relevance/Impact As a final year medical student looking to a future career in general practice, I have sought to achieve an authentic understanding of life in remote and rural practice from those who are actually doing the job and am keen to share my findings with as wide an audience as possible.
Outcomes The key themes that arose during my semi-structured interviews were ‘Island Life’, ‘Community’, ‘A Vocation’, ‘More Time’, and ‘Pre-Hospital Care’. There were also several suggestions as to how we can enthuse the future generation of GPs. DiscussionI have been inspired by my conversations with island colleagues and am convinced that celebrating the breadth of opportunity offered by a career in general practice is fundamental to energising primary care.