Pickering Medical Practice

A Message from Lord Pickles and Lord Blunkett, followed by Pickering Medical Practice's best practice article

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 Pickering Medical Practice is an attempt to do just that. We would welcome your thoughts on this or any other Parliamentary Review article.

Blunkett signature Rt Hon The Lord David Blunkett
Pickles signature Rt Hon The Lord Eric Pickles

www.pickeringmedicalpractice.co.uk

THE PARLIAMENTARY REVIEW
Highlighting best practice
THE PARLIAMENTARY REVIEW
Highlighting best practice
48 | PICKERING MEDICAL PRACTICE
Lead Nurse Kirstie Vincer, now
in her second year of advanced
nurse practitioner training
Left to right: GP partners Dr James Coppack, Dr Helena
Ebbs, Dr Swaminathan Thiagarajan and Dr Nicola Buchan
Pickering Medical Practice has 10,600 registered patients
and serves an area of over 200 square miles at the
lower edge of the North Yorkshire Moors. It has six GPs,
four advanced nurse practitioners and a growing team of
pharmacists, physiotherapists and nurses. Its rural location
alongside a high proportion of elderly patients means that
demand for clinical care is consistently high. Helena Ebbs, one
of five GP partners at the practice, explains how mounting
demand and pressure drove the team to find new ways of
working and futureproofing the organisation for generations
tocome.
Investing in leadership skills is hugely important at a time of great pressure in
primary care. The Time For Care programme, funded by NHS England, seeks to
train GPs in leadership skills, with a particular emphasis on managing change.
Using the Time For Care models of change, our practice team identified both
our values and potential barriers to development, allowing us to appropriately
concentrate on the things we had the power to change.
The model focused us on measuring the structure, process, outcomes and
unintended consequences of the changes we were making. This challenged some
erroneous beliefs, permitted more rapid adjustments to our system and helped
embed change when it was working.
FACTS ABOUT
PICKERING MEDICAL PRACTICE
»GP partners: Dr James
Coppack, Dr Swaminathan
Thiagarajan, Dr Helena Ebbs,
Dr Anthony Bishop and
Dr Nicola Buchan
»Established in 1999
»Based in Pickering, North
Yorkshire
»Services: NHS GMS primary
care provider
»No. of employees: 51
»Member practice of the South
Hambleton and Ryedale
Primary Care Network
Pickering Medical
Practice
BEST PRACTICE SPONSOR 2020
THE PARLIAMENTARY REVIEW
Highlighting best practice
48 | PICKERING MEDICAL PRACTICE
Lead Nurse Kirstie Vincer, now
in her second year of advanced
nurse practitioner training
Left to right: GP partners Dr James Coppack, Dr Helena
Ebbs, Dr Swaminathan Thiagarajan and Dr Nicola Buchan
Pickering Medical Practice has 10,600 registered patients
and serves an area of over 200 square miles at the
lower edge of the North Yorkshire Moors. It has six GPs,
four advanced nurse practitioners and a growing team of
pharmacists, physiotherapists and nurses. Its rural location
alongside a high proportion of elderly patients means that
demand for clinical care is consistently high. Helena Ebbs, one
of five GP partners at the practice, explains how mounting
demand and pressure drove the team to find new ways of
working and futureproofing the organisation for generations
tocome.
Investing in leadership skills is hugely important at a time of great pressure in
primary care. The Time For Care programme, funded by NHS England, seeks to
train GPs in leadership skills, with a particular emphasis on managing change.
Using the Time For Care models of change, our practice team identified both
our values and potential barriers to development, allowing us to appropriately
concentrate on the things we had the power to change.
The model focused us on measuring the structure, process, outcomes and
unintended consequences of the changes we were making. This challenged some
erroneous beliefs, permitted more rapid adjustments to our system and helped
embed change when it was working.
FACTS ABOUT
PICKERING MEDICAL PRACTICE
»GP partners: Dr James
Coppack, Dr Swaminathan
Thiagarajan, Dr Helena Ebbs,
Dr Anthony Bishop and
Dr Nicola Buchan
»Established in 1999
»Based in Pickering, North
Yorkshire
»Services: NHS GMS primary
care provider
»No. of employees: 51
»Member practice of the South
Hambleton and Ryedale
Primary Care Network
Pickering Medical
Practice
49PICKERING MEDICAL PRACTICE |
HEALTH & SOCIAL WORK
Examples of change
Our collective aim as a practice was
to increase capacity to manage high
demand from our patients for clinical
care. We needed to do this in a
cost-neutral way and maintain highly
effective care, provided by a strong
and resilient workforce.
It is important to note that many
primary care providers do not measure
themselves, rather relying on external
organisations to judge by other metrics.
We, however, wanted to focus on
streamlining on an internal level to meet
targets we had establishedourselves.
In doing so, we identified areas where
we could improve and did so with a
few key workstreams:
»Introducing a practice pharmacist to
manage medication-related work
»Increasing telephone appointments
»Reducing interruptions and
inefficiencies in the working day
»Increasing access to allied health
professionals
»Separating urgent and routine work
»Strengthening our reception
capabilities to signpost patients well
Introducing a part-time pharmacist
to our team was uncomplicated
and well-received by all. In less than
two months, we saw an 80 per cent
reduction in medication-related work
for GPs, amounting to a six-hour
reduction in GP workload per week.
Moreover, we found that medication
tasks were responded to more safely
and quickly than before, improving the
service for patients.
Using Edenbridge Apex software,
we were able to monitor live data on
pharmacist appointment utilisation and
identify rapid changes to increase the
uptake of pharmacist appointments.
Within six months, pharmacist
appointments were 100 per cent
booked, reducing demand for GP
appointments.
We increased telephone appointments
from three to 15 per cent. As
telephone appointments are easier
to provide and generally shorter, we
soon found ourselves able to offer
more appointments in every working
day. Patients were positive about this
change, and clinicians found telephone
appointments to be more flexible.
Importantly, we also made excellent
use of weekly data to ensure that we
were not simply deferring patients
for face-to-face appointments. We
consistently found that 90 per cent
of telephone calls did not require an
appointment in-person.
Measuring simple things, such as how
often clinicians were interrupted mid-
session, led to small but important
changes in the practice. Clear,
straightforward protocols reduced
inappropriate interruptions by two thirds
and redirected a third of interruptions
away from GPs to other appropriately
qualified clinicians. This action alone
reduced GP workload by three hours
a week. Furthermore, the reduction in
interruptions meant that self-measured
stress levels of our clinicians decreased
by an average of 15 per cent.
Health Care Assistant Lucy
Gavigan – part of the
team that has increased
HCA appointments by
50 per cent
Measuring
simple things,
such as how
often clinicians
were
interrupted
mid-session,
led to small
but important
changes in the
THE PARLIAMENTARY REVIEW
Highlighting best practice
THE PARLIAMENTARY REVIEW
Highlighting best practice
50 | PICKERING MEDICAL PRACTICE
The role and skills of allied health
professionals such as advanced
nurse practitioners are often poorly
understood by patients. Appointment
reattendance data on Edenbridge Apex
was used to show that 97 per cent of
patients seeing an ANP did not return to
see a GP. Sharing this information with
patients improved the uptake of their
appointments and led us to expand the
ANP team. Their role in home visiting
elderly housebound patients and in
supporting junior nurses has increased
with highly positivefeedback.
Our reception team undertook
intensive support and training to
understand what services were
available and the skills of our varied
workforce. We used collaborative
working and bottom-up redesign of
signposting systems to strengthen their
work and increase the proportion of
patients seeing the right clinician at
the right time. Crucially, we started
to see meaningful reductions in our
waiting times. Within eight months,
we had experienced a 47 per cent
reduction in our average wait time to
see a GP, and a further 11 per cent
reduction in urgent care appointments
as more patients were able to access
routinecare.
The impact
The impact was always intended to
be twofold: reduced waiting times
for patients and reduced stress for
our practice team. With measurably
reduced stress levels, greater support
from allied health professionals and
slicker systems, we felt confident we
were on the right track. Changes took
several months and we ensured the
whole practice team were involved in
the change process from beginning to
end. Our practice culture evolved and
we embraced a new way of working
together with positive outcomes,
including better staff retention
andrecruitment.
The leadership bug soon spread, and
many more members of our team
started to access Time For Care training.
Having demonstrated that we could
change effectively, we were offered
projects within our local healthcare
system that enhanced our services
and grew our team, for example the
provision of first contact physiotherapy in
conjunction with our local hospital trust.
As primary care networks continue to
develop, our experience of changing
well, collaborating with multiple teams
and measuring outcomes stands us in
good stead. Furthermore, we are fully
aware that without such accessible
training and the implementation of
Edenbridge Apex, our position would
be significantly different and we would
likely not be as well poised to develop
going forward.
We are positive about the future of
our practice and have a clear vision
for the new developments in primary
care, working in an integrated way
with hospital trusts, community teams
and social care. This collaboration
will only work if we, measuring the
before and after both quantitatively
and qualitatively, align our values and
define our aims.
Having
demonstrated
that we could
change
effectively, we
were offered
projects within
our local
healthcare
system that
enhanced our
services and
grew our
team
Patient Support Team
Manager Nicola
Scott, who has led on
improved signposting to
the right appointments

www.pickeringmedicalpractice.co.uk

This article was sponsored by Pickering Medical Practice. The Parliamentary Review is wholly funded by the representatives who write for it. The publication in which this article originally appeared contained the following foreword from Rt Hon Elizabeth Truss.

Rt Hon Elizabeth Truss's Foreword For The Parliamentary Review

By Rt Hon Elizabeth Truss

Even by the standards of the day –this has been one of the most exciting and unpredictable years in British politics.

The leadership election we’ve just seen marks a huge moment in our country’s history. This government is taking a decisive new direction, embracing the opportunities of Brexit and preparing our country to flourish outside the EU.

As international trade secretary, I’ll be driving forward work on the free trade agreements that are going to be a priority for the government. Free trade isn’t just an abstract concept bandied around by technocrats. It is crucial for a strong economy and for the ability of families to make ends meet. Free trade benefits people in every part of our country, as British firms export to new markets and people doing the weekly shop have access to a wider choice of goods at lower prices.

The essence of free trade is in the title: freedom. It’s about giving people the power to exchange their goods without heavy government taxation or interference. Commerce and free exchange are the engine room of prosperity and social mobility. I’m determined to tackle the forces who want to hold that back.

One of my priorities is agreeing an exciting new free trade deal with the US, building on the great relationship between our two countries and the Prime Minister and US President. But I’ll also be talking to other partners including New Zealand, Australia and fast-growing Asian markets.

And with the EU too, we want a friendly and constructive relationship, as constitutional equals, and as friends and partners in facing the challenges that lie ahead – a relationship based on a deep free trade agreement. Our country produces some of the world’s most successful exports, and the opportunity to bring these to the rest of the world should make us all excited about the future. It is this excitement, optimism and ambition which I believe will come to define this government.

For too long now, we have been told Britain isn’t big or important enough to survive outside the EU – that we have to accept a deal that reflects our reduced circumstances. I say that’s rubbish. With the right policies in place, we can be the most competitive, free-thinking, prosperous nation on Earth exporting to the world and leading in new developments like AI. To do that, we’ll give the brilliant next generation of entrepreneurs the tools they need to succeed. Since 2015, there has been a staggering 85 per cent rise in the number of businesses set up by 18 to 24 year olds – twice the level set up by the same age group in France and Germany. We’ll help them flourish by championing enterprise, cutting taxes and making regulation flexible and responsive to their needs.

As we do that, we’ll level up and unite all parts of the UK with great transport links, fibre broadband in every home and proper school funding, so everyone shares in our country’s success.

2019 has been the year of brewing economic and political revolution. 2020 will be the year when a revitalised Conservative government turbo charges the economy, boosts prospects for people across the country, and catapults Britain back to the forefront of the world stage.



Rt Hon Elizabeth Truss
Secretary of State for International Development