Radically revamping primary care model

Jackie Butler discovers how local GP practices will evolve with the integration of health and social care provision in Cornwall and the Isles of Scilly
GP practices sit at the heart of healthcare in Cornwall and the Isles of Scilly. The role of these health stalwarts – and our expectation of them – has changed very little since the NHS was set up 71 years ago.

Traditionally we have always wanted a face to face appointment with a GP who knows us. We want to be offered physical care and psycho-logical support when we need it, and to get at least some professional reassurance, if not a prescription for medication or a referral to a special-ist.

In more rural and remote commu-nities in Cornwall the historical norm, even in the more recent past, was frequently a Doc Martin-style set-up, with a GP as sole practitioner seeing patients in a village consult-ing room, sometimes with the radio blaring in the waiting room to give doctor and patient a little privacy from eavesdroppers.

While the county’s 59 practices have developed over the decades, there hasn’t been a really radical shake-up of the primary care front-line – until now.

Big, positive changes will be hap-pening in Cornwall over the next five years. With ever-rising demands and pressures on GPs – and patients increasingly frustrated in their quest to see their own doctor when they want to – the old model is being rethought to make sure people get the attention they need, when and where they want it. And it might not always be your doctor providing it.

There’s a growing recognition that our GPs are just one important part of the picture. A very different prac-tice workforce is emerging with pharmacists, social prescribers, emergency contact practitioners and urgent care physician associates coming into the mix.

“We have a fair bit of that happen-ing now,” explains Dr Tamsyn Ander-son, Newquay GP, Director of Prima-ry Care for the Cornwall Partnership NHS Foundation Trust and system clinical lead for Cornwall and the Isles of Scilly.

“People do sometimes say they would prefer to see the doctor, but using this team model brings a wealth of expertise and experience.”

means any service that is your first port of call when you have a health problem. Traditionally people think of this as going to see your GP, or a pharmacist, optometrist or dentist if you have a minor ailment, eye or teeth troubles. The new thinking is a more planned approach to include other practitioners will provide the best outcome for individuals.

Some 30 per cent of GP consultations nationally are for musculoskel-etal problems – like back and neck pain, arthritis and some auto immune disorders. For these, you could be fast-tracked to a physio-therapist who can give you the treat-ment straight away without waiting for a GP referral.

One in four people see their GP for mild depression or anxiety. You could go straight to mental health support such as Outlook South West psychological therapy service.

There is increasing understanding that a range of health problems are linked to loneliness, isolation or lack of activity, for instance. A social pre-scriber could introduce you to vol-untary and community services locally – maybe a walking group or a regular singing session.

There are a range of practitioners other than a medical professional to assess your needs and receptionists in some practices have been trained as patient advisers.
Dr Anderson says: “The reception staff can signpost people to the right practitioner. People are sometimes uncomfortable giving information over the phone, but it is really help-ful to us because we can make sure you get the right access route.”

Andrew Abbott, Director of Prima-ry Care for NHS Kernow Clinical Commissioning Group, says that although there is some resistance to the new model of care, patient expectations are changing in response to their increasing under-standing of the challenges facing GPs.

A recent survey of 2,000 people in Cornwall and the Isles of Scilly showed that the majority would be willing to see an alternative member of the practice team, rather than their GP, when appropriate. Key to most people, however, was continui-ty of care, so that the member of the practice team they see has access to their records and they don’t have to explain all their history over and over again.

“Overall a national MORI survey around GP practice shows Cornwall patients report a better than average experience compared with the UK average. People do report some difficulties, such as getting through on the phone, but the majority report very positively about their GP prac-tice and this is a great reflection on our GP teams,” he adds.

Another reason for Cornwall’s urgent need for change is the rising number of the county’s 350 GPs reaching retirement age. Younger doctors entering the GP field are favouring a more flexible career path – rather than a commitment-heavy partnership – as illustrated recently by the difficulties faced by the Meva-gissey practice in attracting new GP partners.

GPs are forming primary care net-works with other practices in their neighbourhoods to work together. The aim is that every area or locality has one of these networks, covering populations from 30,000 people to some larger ones of 105,000. They will be funded to recruit additional practitioners such as clinical phar-macists, social prescribers, and physiotherapists and, over time, new services will be commissioned nationally to improve medicines usage, care of the frail and those with complex needs, and providing enhanced support for people resi-dent in care homes. Successful net-works will also need to work closely with others in their community, including mental health teams, com-munity nurses, social workers and a plethora of community organisa-tions and voluntary services.

In future practice buildings could be places where you can access all kinds of health and social care, including public health inspired ini-tiatives to keep yourself well, minor surgery, specialist clinics and even housing and benefit advice.

Technology will have a major impact too, with e-consulting fast becoming a popular way to talk to your doctor, and the new NHS App set to enable people to interact with their practice via their smart phone.
Dr Anderson says: “You can send an email to your GP. That is great for quick queries and many people just want to check what they need to do about a symptom. Also, e-consulting is a really good way to follow up with your GP.”

The changes will also gave a knock-on effect on demand for emergency care and avoidable hos-pital admission.

By getting it consistently right at grassroots level, the aim is to reduce demand for urgent and out of hours care, as well as keeping people close to their homes and healthier and happier all round. It will point peo-ple directly towards the specialist help in the local community hospi-tals and targeted services rather than ending up in an ambulance to A&E.

Kernow Health is the community interest company owned by all the GPs in Cornwall and the Isles of Scil-ly. It works closely with practices to support them in their everyday work and to develop new, sustainable community-based healthcare options. It also runs 111 out of hours services and school immunisations programme locally.

CEO Carolyn Andrews says: “Pri-mary care networks are now very important parts of the system. NHS England are giving them tasks to pursue and funding.

“People in Cornwall get a good service. The clinicians who deal with them are local clinicians. They are not in a call centre – they are local GPs invested in doing a good job.”
Taking more responsibility for your own health is an integral part of the wider holistic vision.

Andrew Abbott says: “It’s a reminder for people to think about way to access the care and support needed. GP practices are facing growing demand and if we want the keep the experience high and target our GPs at those who need their help the most, then we can all take responsibility and choose well.”

There are lots of ways you can help yourself. The local pharmacy can advise on symptomatic relief of a sore throat or conjunctivitis, or if you have hay fever you can buy “own brand” over-the-counter antihista-mines quite cheaply, and for mild to moderate pain relief, a packet of par-acetamol from the supermarket is more cost effective than getting it on prescription.

With long-term conditions like hypertension, collecting information the surgery can use to regularly assess your health is also important.
Dr Anderson says: “We encourage people to get their own monitors and keep an eye on what their readings are looking like.”

Added on 13/08/2019, in News - News