Service Delivery Posters 3007 – 3013
3007 Primary care workforce crisis: how many more GPs do we need?
Background Responding to concerns about declining GP numbers and increasing workload pressures, the UK Conservative Party made a manifesto promise in 2015 to increase the GP workforce by 5000 by 2020, a pledge that has been reaffirmed in Government. However, the rationale for selection of this target figure has not been made clear.
Aim We sought to estimate the number of GPs required to meet demand in the NHS in England by 2020.
Methods The QResearch database estimates annual GP consultation rates based on rates observed in sampled GP practices and national population estimates. Using linear projection of these figures, and accounting for different types of consultations (clinic, home visit, telephone, other) and relative times taken for each, we were able to produce an estimate of the number of GPs required in the NHS by 2020.
Results The most conservative of our models, which based its estimate on 5-year stratified age and gender bands for consultation rates, leads us to believe that over 12000 additional GPs will be required by 2020, more than double the number pledged by the Government. Alternative modelling, providing for the possibility of an increased GP consultation length, leads to significantly higher estimates.
Discussion Modelling indicates that the 5000 NHS GPs promised is likely to be significantly below the number required to provide a sustainable service in 2020. With this figure already criticised by professional bodies as unachievable, novel solutions will need to be sought to address workload and access in this setting.
3008 Developing a practice-based community parenteral antibiotic service to reduce hospital stays
A remote, rural practice aimed to work in partnership with the local secondary care team to develop the capacity to provide a parenteral antibiotic therapy service at the practice to reduce hospital in-patient stay, reduce the impact of travel on patients and the environment and provide a service in the local community.
Patients were fitted with an indwelling intravenous catheter in the ambulatory care unit of the local hospital and then discharged home. The acute medical team were able to provide training for the practice and community nurses in management of the indwelling intravenous line and administration of the antibiotics. Patients attended the practice for their antibiotics to be administered.
Monitoring blood tests were taken by the practice and clinical oversight was provided by the hospital consultants, who liaised with the GP to adjust antibiotic doses and also determine the length of treatment and manage any complications.
Since the inception of the service, two patients have been treated for prosthetic joint infections. This has saved approximately 10 weeks of hospital bed occupancy and the need to travel a 60 mile round trip for each dose of antibiotics had they been administered in the outpatient department at the hospital. The clinical staff have benefited from acquiring new skills and there has been the opportunity for close working between generalist and specialist care settings. Given appropriate resources, parenteral antibiotic therapy can be delivered safely and cost effectively in the community setting, providing benefits for patients, clinicians and the wider NHS.
3009 Systematic Review of Use of Unscheduled Care by Patients with Terminal Cancer
Aim To conduct a systematic review of factors which influence use of unscheduled care (Accident & Emergency and GP Out-of-Hours) by patients with cancer towards the end of life.
Method The search comprised five databases: MEDLINE, PubMed, Web-of-Science, Cochrane Database and CENTRAL. Search terms were determined by MeSH terms and expert consensus. Two reviewers independently reviewed all titles, abstracts and full texts. Article inclusion was by consensus with strong concordance.
Relevance/Impact For patients dying of cancer, unscheduled care use can be distressing, exhausting, and disruptive and may lead to poor-quality care. Minimising unscheduled care use is desirable for patients and families and from a health economics standpoint.
Outcomes Database searches yielded 122 titles, of which 79 were included for abstract searching, and 38 were included for full text article review. Eighteen studies were included in the full thematic synthesis, of which 16 were quantitative, 1 qualitative and 1 mixed methods.
Discussion Factors associated with either greater or lesser use of unscheduled care were: demographic factors, clinical factors, cancer type, system factors and prescribed medication. Themes which were associated with less use of unscheduled care were: A&E referrals to palliative care, enrolment in hospice, good communication, GP continuity of care, home care nursing, home visit by GP time before death, training or education of patients and carers and having a written palliative care plans. Themes which were associated with greater use of unscheduled care were: clinical follow-up, emotional distress (patient or carers), metastatic disease, non-business hours, pain, and previous use of unscheduled care.
3010 Children’s Flu Immunisations
Pippa Le Page
Aims/Objectives To improve uptake, ease and accessibility of children’s flu immunisations for the Surgery, in line with the government target (40-60%). Content of Presentation During a clinical review meeting in 2015, it was apparent that local uptake for the children’s flu vaccine was poor. The practice needed to be more proactive and a suggestion was made to vaccinate children at school. The five local schools/preschools were all interested and the surgery sent a covering letter, information leaflet and consent form to give parents. Copies of ‘Peek a Flu’ book were provided for teachers to educate children about flu and having the vaccine.
Relevance/Impact Clinics took place in October 2015. Prior to each, a talk was given, highlighting the importance of children receiving all relevant vaccinations and answering queries to help overcome parental anxiety. Another challenge faced included delivering the first local community clinic, ensuring a safe, smooth service in a remote environment. Outcomes Flu immunisation uptake was increased from 22% to 57% with increased uptake being from the school vaccination programme. Feedback was positive; “the afternoon was well coordinated and parents felt informed.”
Discussion The findings were presented and the plan is to continue the project this year, building on the current model. This will be done by starting the campaign earlier to improve consent form return rates and give more time for parental concerns to be addressed. Teachers will also accompany children with prior parental consent to ensure children of working parents can be vaccinated.
3011 Email consultations – thoughts from the coal face
Aims/Objectives Improving access to general practice and stimulating innovative ways of providing services is a key government priority. Email consultations offer an alternative consultation model, but are not yet in widespread use by GPs and a high degree of scepticism persists about their widespread use. This study aims to explore the perceived benefits and disadvantages of email consultations by GPs who are using them routinely, and identify key practical issues with implementation.
Setting Our practice is one of two practices within an ‘e-consultation pilot’ funded by the Prime Minister’s GP Access Fund. An email consultation service has been implemented, offering an urgent service outside practice opening hours during the week and on Saturday mornings with a response target of 2 hours. A routine service is also available, aiming to respond within 24 hours. It therefore provides an ideal setting to explore issues surrounding e-consultations in more depth.
Design Qualitative interview study of GPs using a maximum variation sample with thematic analysis through constant comparison
Participants GPs have a range of characteristics, including age, gender and duration of practice.
Relevance/Impact Previous studies have sought opinions from healthcare professionals about whether and how they would use email consultations, but this study is based on realised experience rather than hypothetical opinions.
Outcomes This study explores perceived benefits and identifies key problems with e-consultations.
Discussion It is crucial that we understand the experience of ‘early adopters’ before email consultations can be recommended or implemented as a routine part of primary care. This in depth, qualitative analysis of interviews with GPs working ‘at the coal face’ provides a unique insight to understand and learn from.
3012 Proactive Project: A prospective review of access, time management and workload to improve efficiency
Background: As the demand for Primary Care increases, matching access to capacity is becoming increasingly relevant. This project seeks to review demand, access, capacity and workload across six surgeries within a practice group, with the aim to develop a model to help distribute workload dynamically to meet the needs of the patients.
Methods: Over a six-month period, data was compiled from across the six surgeries, including the demand and the number of appointments offered of all types, how appointments were booked, the number of appointments utilised and the number unused, according to the population of the practice. The data was placed into a monthly dashboard and analysed to show linear trends and patterns over time.
Results: The analysis revealed that the format of data collection was sensitive to identify reproducible variations in demand, access and capacity across sites. This has enabled specific changes to be made: Delegation of administration to non-medical workforce; Delegation of blood test results to Healthcare Assistants; Increased delegation of chronic disease management to Pharmacy team; Development of an Advanced Clinical Practitioner-led, urgent care system; Increased promotion of online environment.
Implications: The data has led to increased understanding of how the practice works and has also highlighted areas for service re-design. We believe the dashboard can effectively project our ability to meet the demands of the patients, ensuring greater efficiency, increased utilisation and evolution of the non-medical GP workforce through accurate distribution of a sustainable workload across sites, increasing GP time to manage the more complex cases.
3013 Being ‘AIR MINDED’ – the future of RAF General Practice
Aims/Objectives Nearly 100 years after the formation of the Royal Air Force (RAF) in 1918, the bond between man and machine in service in the skies has not changed. Neither has the requirement for General Practitioners (GPs) who understand the Air environment. With the end of UK combat operations in Iraq and Afghanistan, senior non-medical RAF Commanders co-produced a new model to help RAF GPs remain focused on delivering high quality care for Aviators and patients being aeromedically evacuated in the face of emerging and future challenges.
Content of Presentation RAF GPs support deployed Operations, maximise RAF personnel’s fitness for task, and advise UK military Commanders and politicians. Like their NHS peers, RAF GPs must pass MRCGP before entering independent practice. RAF GPs also acquire military-specific aviation medicine, pre-hospital care, occupational medicine, sports and exercise medicine, community mental health and travel medicine competencies. A focus group of 26 future RAF Commanders considered what other attributes RAF GPs require moving forwards.
Relevance/Impact The rise of ISIS and other strategic challenges require RAF GPs to maintain a forward-looking philosophy in order to provide the best possible patient care.
Outcomes In addition to maintaining their clinical CPD and annual appraisals, the focus group felt RAF GPs should adopt an ‘AIR MINDED’ model to ensure they remain: Accessible, Informed, Responsive, Multidisciplinary, Innovative, Networked, Doctrinal, Excellent & Developed.
Discussion The AIR MINDED model helps RAF GPs to remain focused on their raison d’être of providing high quality ‘Care for Air, and Care in the Air’.