Supporting NHS Tayside in Delivery of Primary Care Improvement Plan

The 2018 Scottish GMS Contract and Primary Care Improvement Plans (PCIP) aims to create a better resourced, person centred primary care service which supports other healthcare professions to grow and develop while easing pressure within General Practice. Underpinning this model is the move to shared care services across a wide area to provide patients with faster access to services while reducing the GP burden.

NHS Tayside’s PCIP Digital Programme Lead, Tracey Wyness explains, “The challenge was to provide a system design that allowed clinical teams to support multiple practices from a single system while ensuring the mature Primary Care E.H.R was maintained in near to realtime as practical. In addition the need to recognise additional requirements specific to the service e.g. prescribing had to be brought to the fore”

To successfully shift care from general practice to a shared service, NHS Tayside needed to provide immediate access to patient information from any location and ensure every patient interaction is quickly available within the GP system, to avoid duplicate recording. Furthermore, creating the right service model was key to minimise travel for healthcare professionals and improve patient access while also releasing GP time.

Building on Community Nurse Success

Creating the right federated model raises a number of questions, from determining the best location of services in order to minimise travel and increase access to ensuring healthcare professionals are empowered with immediate access to patient information and creating a shared appointment system that can be accessed by all stakeholders.

While NHS boards in Scotland were given three years to design and implement the new shared care service model, for NHS Tayside the existing community nurse service in the rural village of Letham – which has no GP practice - provided an excellent template. Having provided community nurses with access to patient records through Vision Anywhere, led to a 400% increase in activity at a dedicated Health and Wellbeing centre, reducing the number of home visits required, cutting nurses’ travel time and releasing more time to care for patients. Using the shared appointments module, patients can be booked into appointment slots from all of the seven nearby GP practices – which means nurses’ time is effectively managed.

“The challenge for the PCIP Digital Programme was to deliver a solution that allowed clinical teams to support multiple practices from a single system while ensuring the mature Primary Care electronic health record is maintained in near to real-time,” explains the PCIP Digital Programme Lead. “The success of Letham provided NHS Tayside with confidence in the shared care model and we thought that approach, with Cegedim providing both secure and up to date patient information and shared appointments, would work.”

Shared Patient Record

NHS Tayside embarked upon a test of change programme to evaluate how this federated model could be deployed – assessing the different service options, the potential benefits and feedback from both patients and practitioners. Service provision has been split across three regions: Angus, Dundee and Perth & Kinross, encompassing around 63 GP practices in total. The initial test of change services deployed were First Contact Physiotherapy, Urgent Care, Care & Treatment and the Vaccination Transformation Programme, with health care practitioners using Vision Anywhere federated solution to achieve secure access to patient records from multiple practices, supported by data sharing agreements.

This means that every health care professional has access to up to date information for those patients registered at a Vision 3 practice, including medical history and medications, and the base GP system updated automatically following every patient interaction. With a shared appointment facility for each service across locations, irrespective of GP practice, patients also have wider access to services – and the ability to opt for the most suitable time and place for the interaction.

As the PCIP Digital Programme Lead confirms, “One federated service can support patients from as many as 23 practices in one area – something that would have been impractical without Vision Anywhere. From a patient’s perspective, the single shared record and shared appointments module provides a far smoother pathway to the right services.”

Federated Service Delivery

From vaccinations to first contact physio, the new model has been successfully deployed across NHS Tayside. Vaccinations have, of course, been headline news during 2021 – and NHS Tayside’s experience using a federated vaccination model for flu vaccines was hugely beneficial when new ways of working had to be deployed as a result of Covid-19 restrictions. “NHS Tayside have been able to make use of the Cegedim Shared Appointments module for elements of our COVID-19 vaccination programme, which worked really well.”

In addition, First Contact Physio is enabling NHS Tayside to provide far broader access to musculoskeletal (MSK) expertise. Matt Perrott, Integrated Manager, Occupational Therapy / Physiotherapy – Outpatients, Dundee Health & Social Care Partnership, is in charge of the First Contact Physio service in Dundee which is provided via a hub model by members of the MSK physio team. “It has been a huge success,” he says. It has streamlined the pathway for patients to access expert MSK triage and advice. The patient no longer needs to see a GP and be placed on a Physio MSK waiting list to receive the timely intervention they require. Patients registered at the 24 GP practices in the region can now access the First Contact Physio service at whichever local hub is most convenient. In order for FCP to function as a First Contact service, patients need to be offered an appointment within a few days of contacting their GP surgery; the federated appointment system supports this.

The federated model allows the Physiotherapist to access appropriate patient information without actually having to be present in the patient’s GP practice. Referrals can often have limited background information. By utilising Vision Anywhere, physios can check the patient's medical history and discover if they have consulted on the issue before and what investigations have been performed. This supports a comprehensive and holistic approach, as well as maximising the time physios spend assessing patients as data gathering time is reduced.

While some UK shared service models have recruited dedicated First Contact Physio staff, NHS Tayside decided up front to use the same physios for both the MSK outpatients service and First Contact Physio, with both services running in parallel. Matt Perrott explains, “We anticipate that the First Contact Physio service will reduce the numbers being referred to MSK over time and we might therefore be able to release more staff to undertake First Contact Physio sessions, which will further expand the capacity available.”

Proven Case

NHS Tayside’s test of change review confirmed the value of the federated service model. Feedback from healthcare professionals confirming ease of use and the ability to record patient contact information – with 70% saying access to the patient record via Vision Anywhere has improved patient care. Other benefits for healthcare providers have included reduced travel, freeing up more time for patient care.

The Vision Anywhere app is supporting the goal of releasing more time for GP care. Grove Health Centre is part of cluster of four practices within NHS Tayside running an urgent care model - nurse practitioners work with a care home team and paramedics work with an urgent care visiting team. Providing practitioners with immediate access to patient information through Vision Anywhere has transformed the speed with which the cluster can respond to patients’ urgent care needs.

Dr Shawkat Hasan, GP Partner at Grove Health Centre and Clinical lead OOH NHS Tayside, explains, “The cluster supports more than 30,000 patients across a fairly wide geographic area. Using Vision Anywhere, practitioners have access to all the information they need, including medical history, medications and allergies at the point of care. There is no need to return to the practice or rely on scant information provided over the phone: urgent care can be delivered more safely and more quickly, with practitioners moving from one patient to the next.”

Building on a Federated Model

NHS Tayside continues to push forward with the roll out of federated services, despite the inevitable interruptions caused by the COVID-19 pandemic. There are currently 1,350 service users across Angus, Dundee and Perth, comprising clinicians and admin staff across Care & Treatment Services (including phlebotomy, woundcare, ear care), Community Link Workers (social prescribers), First Contact Physiotherapy, Urgent Care (Paramedics & Care Home Teams) and Vaccination Transformation Programme (administering Flu & Covid-19 vaccinations). 63 practices also have staff able to book patients into available services.

In addition to continually expanding the services, NHS Tayside is beginning to explore the population data collected within Outcomes Manager to better understand health trends, support clinicians and ensure services are configured to match patient need. The PCIP Digital Programme Lead says, “we have not fully implemented the Outcomes Manager reporting tool however we hope that this will provide information to help ascertain the value of shared services and the reduction in workload on GPs.”

Matt Perrott adds, “Since implementation we have had to manually record detailed data for every First Contact Physio consultation, such as self-management advice, investigations ordered and onward referral location. The Outcomes Manager reporting data that can be provided will therefore be really interesting and help to support ongoing resource planning and management.”

Conclusion

NHS Tayside has made a significant change in the way patient services are delivered and is firmly on track to meet the objectives of the new GP contract. The team continues to work with Cegedim to enhance the solution, deliver staff training and plan for further improvements.

As the PCIP Digital Programme Lead concludes, “NHS Tayside has a mature relationship with Cegedim. We have been using their systems since 2006 – and the team has been supportive, responding really well to the new challenges presented whilst implementing this shared solution. Meeting the goals of PCIP has meant a lot of ‘firsts’ and NHS Tayside has appreciated Cegedim’s responsiveness during this process. ”

Find out how shared care solutions can be used to prioritise patient care in our webinar from the 14th July 2021 at 12pm, watch the recording.