Banes Enhanced Medical Services + (BEMS+)

Highlighting best practice as a representative in The Parliamentary Review

The ability to listen and learn from one another has always been vital in parliament, in business and in most aspects of daily life. But at this particular moment in time, as national and global events continue to reiterate, it is uncommonly crucial that we forge new channels of communication and reinforce existing ones. The following article from Banes Enhanced Medical Services + (BEMS+) is an attempt to do just that. We would welcome your thoughts on this or any other Parliamentary Review article.

Chief Executive Dr Andrew Smith
BEMS staff
In order to build bold and resilient primary care, GP practices
need to work together and share resources. BEMS+
understand that primary care has to work hand in hand with
secondary care and community services, and crucially we need
to invest in our current workforce and work hard to inspire
the next generation of clinicians. Based in Bath, they cover the
population and local authority boundary of Bath and north east
Somerset. Chief Executive Dr Andrew Smith elaborates.
As a health and care partner, we support the needs, sustainability and ambition of
general practice in Bath and North East Somerset (B&NES) in line with the national
health agenda and as a membership-based organisation. We provide crucial out-
of-hospital and primary care services to the public and act as the “voice of primary
care” to support system change and integrated service development and to secure
funding, tenders and to share resource and expertise across practices. We are not-
for-profit and our members are all the local GP practices.
People in primary care
The General Practice Forward View launched in 2016, committing extra funding
and support for primary care over five years. In 2017, we launched a Community
Education Provider Network, a forward-thinking initiative that focuses squarely
on education, training and recruitment across general practice in B&NES. A team
of primary care staff working with BEMS staff are now delivering an exciting
18-month programme, which is targeted, local and relevant.
»Chief Executive:
Dr Andrew Smith
»Founded in 2004
»Based in Bath
»No. of employees: 65
»Services: Referral support
service, DVT, fracture clinic,
dermatology, vasectomy,
earlier home visiting service,
urgent treatment centre,
the Community Education
Provider Network and the
CCG-wide Improving Access
to Primary Care service
Banes Enhanced Medical
Services + (BEMS+)
Highlighting best practice
Practice nursing was identified as a
priority area because of recruitment
issues, so we wanted to give existing
nurses access to the latest training.
We launched a nurses conference in
2017, providing training in respiratory,
diabetes and musculoskeletal, divided
into novice and experienced work
Healthcare assistants (HCA) lacked a
dedicated forum or formal education,
as they often work independently
behind closed doors. We launched
a standardised practice nurse
competency framework, alongside a
dedicated bi-monthly HCA Forum. This
demonstrates to HCAs that they can
have career development in primary
care and they will be supported.
The CEPN now upskills HCAs, so that
practice nurses are released to take
on new responsibilities – a win for
everyone and particularly motivating in
practices where there is already a lead
nurse. With the support of universities,
a HCA can be trained to become a
qualified nurse, while still working at
the practice.
Cohesion and integration
Our role as a voice of primary care is
essential, because it isn’t practically
possible for all the practices or groups
to be represented individually. We
benefit hugely from our holistic view to
improve cohesion, economies of scale
and efficiencies. In an integrated care
system, NHS organisations, alongside
local councils and others, take collective
responsibility for managing resources,
delivering high standards and
improving the health of thepopulation.
BEMS+ is a member of the local
Health and Wellbeing Board and the
Integrated Care Alliance on behalf
of B&NES primary care. With a total
view of primary care in B&NES, we can
work with commissioners and other
healthcare providers to identify gaps in
service provision and pressure points
across the system that may be having
an adverse impact on us all. We deliver
a number of crucial support services to
patients that have a significant impact
on reducing GP practice pressures and
that are focused on bringing important
care out into thecommunity.
One such example is the B&NES
Referral Support Service (RSS), which
serves all the GP practices and handles
referrals for 11 of the highest volume
specialities in secondary care, such as
pain management and cardiology.
The RSS offers patients a robust and
safe discussion around appropriate
choices of secondary and community
outpatient services so that the patient
gets to the right place, first time. It also
supports GP practices in using our e-RS
system and gives outpatient clinics the
information they need to continue the
care of the referredpatient.
Nurse and HCA
The CEPN now
up skills HCAs,
so that
practice nurses
are released to
take on new
»BEMS+ launched the Community Education Provider Network
(CEPN) in 2017
»In the period between January and June 2018, many clinicians have
benefited, including:
»35 healthcare assistants, who have attended skills training sessions
»57 practice nurses and 52 practice managers attended training events
»Four additional clinical pharmacists have been employed in B&NES
RSS is well liked by the practices because
it ensures the quality of referrals without
impinging on the clinical autonomy
of clinicians. Patients are happy that
they can discuss their options with
a knowledgeable and helpful team.
The service is viewed as critical by
commissioners in implementing its
funding, health optimisation and
e-referrals initiatives, and RSS data has
influenced commissioning decisions in
several clinical specialities.
Our community-led dermatology service,
introduced in 2017, has resulted in
waiting times for appointments for
common, non-urgent skin conditions
being cut from 20 to four weeks. It
combines the expertise of a specialist
GP with consultant support from the
dermatology team at the Royal United
Hospital (RUH) in central Bath but sits
in the heart of the wider community.
Further training for GPs, including
sharing skills with the RUH, means that
we are also investing in keeping valuable
and skilled GPs, helping us to build
long-term resilience in primarycare.
Skin conditions are the most common
reason for people to consult their GP
and it is estimated that 13 million
people visit their GP with a skin
problem each year in England and
Wales. This service gives the RUH
breathing space for patients who
still need to be seen by a consultant
while ensuring that other patients
are not neglected. “The specialist
GP is effectively part of the hospital
dermatology team, but in a more
convenient location.” Previously, a
patient would be referred by their GP
to the dermatology team at the RUH
if the GP had been unable to treat the
condition directly.
A bright future
Later this year, we are embarking on
an exciting project funded by B&NES
CCG, to address the provision of care
to diabetes patients. Ninety per cent
of diabetic care occurs in a primary
care setting and we want to increase
the availability and flexibility of chronic
disease appointments, while also
reducing the administrative pressures.
The model includes diabetes mapping
and a skills review. The patient’s
health needs will be risk stratified to
ensure that the right person in the
practice with the right skills sees the
patient at the right time. Clinics will
berestricted to reflect these changes
and a diagnostic pathway developed
for diabetes and pre-diabetes.
Combe Down Surgery has already
successfully piloted the project, seeing
cost savings and improved patient
outcomes, including a reduction in
patients with high blood glucose levels
down from 17 to 11 per cent.
The forward view talks about
encouraging practices to work in hubs
or networks. The government wants
to see more GPs and a wider range of
practice staff, better integration with
community and preventive services,
hospital specialists and mental health
care. B&NES primary care is already
showing in new ways that this can be
achieved, as it continues to follow its
own vision of giving the best care to
the people of B&NES.
The specialist
GP is
effectively part
of the hospital
team, but in a
Dermatology expertise

This article was sponsored by Banes Enhanced Medical Services + (BEMS+). The Parliamentary Review is wholly funded by the representatives who write for it.