Issues with access to GPs and timely treatment in A&E are rarely far from newspaper headlines, with accounts of lengthy waits for appointments causing worry for patients and increased strain on beleaguered NHS professionals.
To address this, the National Association of Primary Care (NAPC) is delivering a patient-centric, bespoke approach, where integrated neighbourhood teams focus on an area’s health needs. These needs are dictated by the geography and demography of that population.
Fostering community collaboration
“You create capacity by removing pointless handoffs,” says Katrina Percy, deputy CEO, NAPC. She highlights how barriers often arise when teams operate in isolation. “You’ll hear things like ‘Oh, you sent it to this team – it should have been that team’, or, ‘I’m not allowed to refer to the speech and language service because it’s got to go through a system’.” She adds that staff can’t then discuss a case with a colleague in another speciality to help resolve these issues because everything’s anonymous.
“We heard about a patient dying of colon cancer, who needed an enema,” says Percy. “The GP asked the nurse to do the enema, as the patient was in severe pain, but the nurse said, ‘No, you haven’t done a rectal examination.’ The doctor explained that it was the right thing to do, but her guidelines told her she couldn’t.
Imagine – this person is dying and we are just not doing the right thing for them.” In contrast, integrated health teams collaborate rather than operating in silos. They share insights and best practice, making necessary adjustments and interventions jointly across health and social care, leading to better patient outcomes.
Percy says: “We want the NHS to take a viewpoint that solving population health issues, activating and enabling people to manage their own health and supporting the out-of-hospital space is the solution to all the headlines you read at the moment. It’s outrageous that people sit in ambulances for hours on end.”
She believes the answer is to build a sustainable, robust out-of-hospital system. For example, communities could have a group for new parents with young children, where a team of trusted professionals can teach them how to care for common childhood illnesses and when to worry. With that support and guidance, people are more likely to recognise the symptoms of severe medical issues, such as meningitis. Communities could also have similar groups for the elderly and for those with mental health concerns.
Empowering employees and patients
Percy believes the current system makes it harder for the public to manage their health. “We are deskilling patients and making it even less likely that we might manage our own healthcare,” she says. “All the evidence tells us you get worse outcomes as a result of that.”
GPs, says Percy, have become “like a postbox” for the NHS, with doctors unable to spend time with patients whose needs are often complex, belying the oft-cited image of them simply handing out medication.
You make earlier diagnoses; you change the relationships between specialists and generalists
She says there’s a need for high-performance teams of GPs, nurses, therapists, receptionists, operational managers and pharmacists. This reduces bureaucracy and time spent on handovers, creating capacity for teams to identify and prioritise health needs. Also, employees – empowered to do the job they trained for – are happier at work. Percy claims the result is around 25% of time freed up, according to estimates from existing teams.
NAPC acknowledges that the transition to this new model and approach “will be challenging to achieve and is likely to take time to fully implement and deliver the desired outcomes,” which is not without risk. But the association believes that the current fragmented delivery model with its “clunky bureaucratic referrals, handovers and processes, is arguably a greater risk”.
Percy surmises: “This is the solution to the GP access issue – and it’s the solution to the ambulance waits, people sitting in beds for months on end. You make earlier diagnoses; you change the relationships between specialists and generalists. Even if this is only the answer to GP access, you’re creating additional capacity by allowing teams to flourish by investing time in them – to allow them to find time to care for that population and its needs.”
To find out more, visit napc.co.uk
