Engaging Health Care Professionals in North Bradford and Airedale PCT.

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Engaging Health Care Professionalsin North
Bradford and Airedale PCT
Andi Ireson Self Care Facilitator
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The start up process within the PCT

• Exec sign off
• Launch at Practice Managers meeting
• Individual practice meetings (by invite)
• Attend Forums
• HV
• District Nurses
• School Nurses
• Consumer Councils
• Clinical Leads
• Mixed responses!

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Incentives for practices

• Major driver for achievement of targets ( and
  therefore rewards) GPs as commissioners seeking
  efficiencies by
• Demand management
• Linking minor ailments schemes
• Long term conditions management
• Choice giving patients the skills to choose.

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Financial incentives

• Scheme already in place
• No real outcome targets linked to payment
• Difficult to change existing arrangements

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Numbers

• 16 groups 14 practices, 1 Community
  Intervention Team, 1 PCT Clinical Leads group.
• 39 sessions.
• 2 non-starters - other time demands.
• 1 practice pulled out after session 2.
• 1 practice demanded shortened sessions x 2.

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The broad approach

• Three facilitated sessions offered.
• Account Manager relationship with each practice.
• Identified practice lead.
• Facilitation not self care expertise.
• Acknowledgement of building on existing
• Based on gaining ownership, focussing on high
  demand low complexity top time takers.
• Led into mini projects to problem solve areas
  identified.
• ALL practice team involved.

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What we got!

• Mixed responses.
• Different paces required.
• Often cold start but usually warm finish to
  sessions!
• Reception staff most likely to disengage.
• Session feel reflected the culture of the
  practice overall. ( not surprisingly!)

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What worked well.

• Account Manager relationship.
• Flexing pace to suit.
• Flexing in sessions.
• Mixing staff groups.
• Sharing ideas across staff groups.
• Helping staff groups understand shared problems
  from different perspectives.
• Using data to inform decisions.

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What else would have helped?

• Learning to share.. but then it was a pilot!!!
• Specific ideas for them to try.. earlier.
• Possibly using the Circle of Influence during the
  Sales pitch.
• More focus on financial incentives for
  completion.
• Clearer links to other practice targets.

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Tools used

• Circle of control, influence, concern.
• High demand, low complexity, top time taker
  matrix.
• Care pathways
• Basic project management action plan.

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Circle of Influence
Circle of Control
Circle of Influence
Circle of Concern

• Remember - You need to keep expanding your
  Circle of Influence

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Working up a plan

• Now use the template flip chart and decide
• What, specifically a good result looks like for
  this piece of work.
• Who needs to be involved to make the work a
  success internal and external.
• Who should sponsor and who should lead the work.
  
• What you will have achieved in relation to this
  by the next session.
• How youll know that youve been successful in
  what youve achieved.
• ( Sponsor the person in the practice who can
  unblock any blockages as necessary)

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Outcomes from the sessions (1)

• Mini surveys amongst patients who attended
  between eight and 11 times a year to get a
  clearer picture of why they attended.
• Exploring whether the practice could provide
  other services that would help patients and
  whether they needed to be redirected to more
  appropriate services. E.g. setting up a support
  group for patients who shared a common problem
  e.g. multiple sclerosis.
•  

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Outcomes from the sessions (2)

• Review of the appointments system to highlight
  inappropriate appointments
• Trial telephone consultations with GP's
• District Nurses in the process of identifying
  cases where the DN visit has been inappropriate
  or not required
• Educate patients to understand that test results
  won't be available until after 4 weeks.
• Support and information to people suffering from
  depression from staff who are based at the
  practice.
• Practice website developed to offer personalised
  self-help information from GPs on various common
  conditions.

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Outcomes from the sessions (3)

• Review of repeat prescription process resulting
  in less wasted time and more responsive service
  for patients.
• Better understanding of presenting conditions of
  high practice users.
• Redesigned reception facility to give greater
  responsiveness and confidentiality.
• Extended receptionist role to include health care
  advice.
• Introduction of group education sessions to
  educate patients with long term conditions to
  self care.
• Redesigned patient information to support a shift
  in emphasis towards self-care
• Elderly Care Workshop organised for patients
  55yrs plus

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Outcomes from the sessions (4)

• Advice from pharmacy to patients via the practice
  on how best to use pharmacy services
• Engagement of the Patient Council in promoting
  Self Care within the practice
• Better understanding of the requirements of care
  homes of GPs and alternative ways to manage the
  same.
• Reduction in unnecessary home visits to deliver
  equipment.
• Audit and review of appropriateness of referrals
  to the Community Intervention Team leading to a
  re-education exercise on how to make best use of
  the service.
• Introduction into the practice of Citizens
  Advice

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Where are we now?

• Aiming to resource roll out.
• Receiving lots of requests for input.
• Still learning.