All posts by Ed Lewis

Medical Director for the GPCB announced

We are pleased to announce that Dr Geeta Iyer will be taking up the role of Medical Director for the GP Collaborative Board (GPCB) from 1 April 2022.

Geeta has been working closely with the GP Collaborative Board since its inception in her role as Clinical Lead for Primary Care Development for Bristol, North Somerset and South Gloucestershire (BNSSG) CCG and alongside her role as a GP at Gloucester Road Medical Centre. Geeta will continue in both these roles alongside her new GPCB position, which will mean she is uniquely placed to strengthen the GPCB’s working relationships with both the wider system and BNSSG practices.

Geeta will be working for the GPCB one day a week. Please join us in giving her a warm welcome to her new GP Collaborative Board role over the coming weeks and months.

Speaking about her appointment, Geeta said: “I’m really looking forward to working on behalf of the GP Collaborative Board to strengthen the relationships between general practice providers and our colleagues across the system. I’ll be working closely with the Chair, Vice-Chair and Board members to make sure the board truly understands and represents the views of our constituent practices. The GPCB has already established itself as the representative body for general practice in our developing Integrated Care System and we can build on this solid foundation over the coming years.”

Geeta’s initial priorities will be to coordinate general practice input to system planning for next year, offer clinical leadership for key areas of work in our ICB and support the role of the GP Collaborative Board in implementing the BNSSG Primary Care Strategy.

Missing GP information for vulnerable groups to be available in Connecting Care

One Care is working in partnership with Connecting Care to provide better integrated services and safer care for vulnerable groups in Bristol, North Somerset and South Gloucestershire (BNSSG).


General practice data is shared in Connecting Care via the Medical Interoperability Gateway (MIG), which collects data when a patient is fully registered to a surgery. This means there is a risk vital information is not captured about temporary registered patients and members of the BNSSG homeless community.


To help reduce the clinical risk and provide better care for these groups, Connecting Care proposed to work in collaboration with One Care on a digital solution using the EMIS-X Analytics platform (EXA).


This system is being piloted at the homeless health centre enabling information to be shared about temporary registered patients. This is a new way of working that will provide learning both locally and nationally.


EXA provides a database which contains a full and up to date copy of all the data held in EMIS general practice and community systems. The data is synchronized on a regular basis. One Care’s role is to extract the general practice data using data extraction queries, then import it into the data warehouse where it is formatted and transferred securely to Connecting Care.


The lack of information about temporary registered patients poses a clinical risk. By removing this, we can enable better and safer care for vulnerable groups, offer a more integrated services across different health and care teams and reduce duplication.


Rus Clark, One Care’s IT manager commented on the project saying: “One Care is proud to be part of such an important project. We are contributing to new ways of working that will have a positive and direct impact on our patients, which is what we are here to do.”


For further information on this project, please email

One Care support for our practices: October-December 2021

We have published our latest quarterly round-up of strategic changes, information about new One Care projects and a one page infographic showing the direct support we’ve provided to practices.

The last three months have continued to present general practice with extreme challenges and pressures. The highly transmissible Omicron variant of Covid-19 has driven unprecedented levels of infections globally, resulting in NHS England and the government asking general practice, along with the wider system, to focus on vaccinations and urgent care.

In mid-December, to support practices with their booster rollout targets, One Care staff temporarily stood down from normal duties to provide extra resourcing to practices. One Care staff offered their services to PCNs, helping with various administrative, marshalling and reception tasks. In total, 57 shifts were covered at 14 venues and the feedback we received from practices about our staff was fantastic. Similarly, members of the team enjoyed going into the surgeries and vaccination centres, meeting new people, gaining new experiences, and witnessing first-hand the demands of the booster programme.

Click here to enlarge infographic.

At the same time, One Care worked alongside NBT and VANS to create a more efficient process for PCNs and practices to request staff and volunteers for the mass vaccination programme. The newly-launched model sees One Care act as a single point of access for mass vaccination staffing requests rather than there being multiple avenues to request cover from, which often resulted in double bookings. This makes the process more efficient and time effective for general practice, staff, volunteers and system partners. This process was enabled by the staff sharing agreements One Care contributed to during the pandemic, which allow healthcare professionals to work across the different organisations in our region.

To help practices prepare for the potential impact of Omicron, One Care established an escalation framework to assist practices with a pragmatic checklist of operational considerations during the surge. To ensure general practice was well represented and involved in system decisions during this period of system pressure, we relaunched the SitRep to get a better understanding of the issues faced by practices. We used this information alongside the general practice activity report to represent general practice at all system bronze, silver and gold meetings.

It has been widely recognised that Covid-19, and the wider effects of the pandemic, have significantly impacted mental health, aggravating pre-existing conditions as well as affecting people who have not previously experienced poor mental health. One Care has been working with a PCN in South Bristol to identify patients with an active mental health condition who might benefit from a tailored intervention. The practice has provided us with great feedback about this piece of work, so please do get in touch if you would be interested in looking at something similar in your PCN.

Our business intelligence team have also added a Serious Mental Illness (SMI) dashboard to the General Practice Intelligence Dashboard. The dashboard shows what proportion of people on practices’ SMI register, who should receive a set of six physical health checks, have had each of the health checks and how many have had the full set. Easy access to this data supports practices to focus on where uptake of physical health checks can be improved, which will help maximise on available income and improve patient outcomes.

A key priority for One Care in recent months has seen the successful rollout of community phlebotomy – a new process for taking bloods in community settings. For many years, general practice has taken outpatient bloods on behalf of secondary care, despite not being contracted for the work. But the community phlebotomy programme has addressed the governance of this work, ensuring blood results are returned to the requester in secondary care and general practices are resourced for this programme.

One Care have further saved general practice time by creating, updating and sharing templates to the latest referral forms through Resource Publisher, meaning practices don’t need to maintain these templates themselves. To publish resources to a practice, technical data sharing agreements are needed. One Care now has these in place with 99 per cent of practices, as well as most PCNs and localities.

During this period, our subscription model for the next three years was signed off by our Board. We had intended to start meeting with PCNs in December to discuss this, but these meetings were postponed due to the booster programme and have been taking place throughout January and February. Many of you will have now responded to us regarding your intentions for next year. We’ve found these discussions really valuable and will be looking at how we can continue these discussions at more regular intervals moving forward.

We’re also inviting all practices to join us to hear about the work we’ve done throughout 2021/22 and our plans for 2022/23 onwards at our shareholder event on the afternoon of Thursday 28 April 2022. For now, please hold the date and we will share more details in due course.

We’re pleased to say that the One Care team has continued to grow in recent months in line with our development, and all current staff can be found on our website. In recent months, this has included particular growth of our project management capacity in our transformation team. As always, a huge thanks for your continued support. If you would me or a member of the team to visit your practice or attend a locality meeting to talk more about our work and how we can support you, please get in touch.

One Care helping practices benchmark telephony demand

One Care has updated the telephony information available to practices in their General Practice Intelligence Dashboard (GPID).

The dashboard enables practices to benchmark themselves against other anonymised practices in BNSSG on incoming and unanswered call volumes, as well as the overall percentage of calls unanswered. The data can be tracked and measured over a week, month, quarter and year.

Practices will be able to see where they sit in comparison to each other, including in relation to patient demand and how it is being dealt with (using a rate per 1,000 patients).

This information may inspire a deep dive into practice call volume and how calls are being handled. It could also highlight specific time frames where demand has increased or decreased.

One Care’s business intelligence support analyst Kelly Hawkes commented on the new dashboard saying: “The analytics teams are incredibly excited to launch this dashboard as it offers something to practices that previously they’ve been unable to see.

“Practices are inundated with calls on a daily basis and this dashboard enables them to track this data in line with other practices. This dashboard is available to all Bistech practices and PCNs that have provided consent for One Care to process their telephony data.

“We would encourage as many practices to utilise this dashboard as possible as it offers a further insight into their practice.”

If you would like more information on the dashboard and how to use it, please contact

One Care supports practices with learning disability health checks

GP surgeries are required to deliver free health checks once a year to anyone aged 14 or over who is on their doctor’s learning disability register.

To help practices identify eligible patients, keep track of health check completion percentages, and visualise insights, One Care launched a dashboard in January 2022, using data exported from EMIS.

Going forward, practices will be able to use the dashboard and its useful features to keep a record of patient information and invite them for their annual health check when appropriate.

While the dashboard enables practices to calculate how many of their patients are eligible for these checks, and how many have been completed, there are other benefits too. Users can sort the data by a range of criteria, for example: ethnicity, deprivation, age and gender – which can highlight inequalities and where targeted support is most required. The dashboard also enables practices to compare different patient groups using the built-in filters, which will offer a greater overview of the BNSSG population and potentially inform future studies.

Speaking about the new dashboard, One Care’s Head of Business Intelligence Rhys Lewis, said: “People with learning disabilities have poorer physical and mental health than others and this has been particularly highlighted by the Covid-19 pandemic. Annual health checks can improve their outcomes by spotting problems early, enabling appropriate treatment and management, and preventing premature and avoidable death.

“The learning disability dashboard provides clinicians and managers with up to date information on how many of their eligible patients have received a health check and how many are outstanding, ensuring maximum uptake by the end of the financial year.”

Eligible patients do not have to be ill to have their health check – in fact, most are well when they accept it. The annual health check can help patients stay well by talking to a doctor or other healthcare professional about their health and medication, and if any concerns are spotted, treatment can be administered before any condition worsens.

If you would like more information on the learning disability health check dashboard and how to use it, please contact To learn more about these health checks, visit the NHS website.

One Care assist in NHS soup-and-shake diet

Over 2,000 people with Type 2 diabetes have now improved their health through the NHS Soups and Shakes diet programme – with participants losing an average of 13kg (over two stone) in three months.

From this month, the diet programme will be accessible in Bristol, North Somerset and South Gloucestershire (BNSSG) as NHS Soups and Shakes is rolled out across 11 more regions following the early and life-changing success.

In conjunction with the programme’s second wave rollout, 500 spaces are initially being made available for referrals in BNSSG over the next two years.

One Care have helped the mobilisation of this low-calorie diet pilot in BNSSG by supporting the planning of the project, communications, practice engagement and creating EMIS resources. This improves the process for practices identifying and contacting eligible patients to see if they would be interested in engaging with the programme.

One Care’s Project Manager Bex Tilling said: “This pilot has seen excellent results in other parts of the country so it’s really exciting to help practices offer this life changing programme to patients in BNSSG.

“We’re looking forward to seeing the programme grow and to be involved in such an exciting and worthwhile project has been really enjoyable.”

Helping people diagnosed with diabetes to lose weight, and make better decisions about their health through the NHS low calorie diet programme, enables them to better control their blood sugar levels. This reduces the need for diabetes-related medication and potentially achieving remission of their Type 2 diabetes when their levels return to a healthy range.

Early data from the NHS programme shows participants losing on average 7.2kg (over one stone) after one month, and 13.4kg (over two stone) after three months.

New data shows people on the programme who are eating and drinking the low calorie alternatives not only lose weight but keep it off over time. These real-world findings are a significant step forward and come after trials showed that around half of people who had similar weight loss were able to achieve remission of their Type 2 diabetes after one year.

Diabetes is estimated to cost the NHS £10 billion a year, with treatment making up one in 20 prescriptions written by GPs. Projections also show that with the number of people being treated for diabetes continuing to grow – nearly 39,000 more people could suffer a heart attack in 2035, and over 50,000 could experience a stroke.

The year-long programme, which is fully supported and monitored by expert clinicians and coaches throughout, kickstarts weight loss through low calorie, diet replacement products such as shakes and soups for the first three months. After this, a carefully managed plan reintroduces healthy, nutritious food and participants can track their progress through virtual one-to-ones, group sessions and digital support – to help them maintain a healthier weight.

The NHS low calorie diet programme may be suitable for some adults aged 18-65 years, diagnosed with Type 2 diabetes in the last six years and living with overweight or obesity who also meet other eligibility criteria.

If your PCN or practice would like more information on the programme or be able to refer patients to the low-calorie diet, please contact

Wellbeing service available for health and care staff

Clinical and non-clinical staff in general practice settings across Bristol, North Somerset and South Gloucestershire (BNSSG) can access a Healthier Together Support Network – a recently-launched health and wellbeing service for all NHS staff.  

As a result of the extraordinary pressure health professionals have been put under by the Covid-19 pandemic, national funding was awarded to set up a new confidential and free wellbeing service, which is there to help staff manage stress caused by or impacting their work, offering:

To learn more about the services, click here (Healthier Together Support Network) or call 0117 342 4740.

There is also a Team Net page with information regarding all wellbeing support available to general practice staff.

One Care support BNSSG practices with booster rollout

Some One Care staff have temporarily stood down from normal duties in recent weeks to provide extra resourcing for the accelerated booster programme in Bristol, North Somerset and South Gloucestershire (BNSSG). This support has been offered in addition to One Care’s usual role in coordinating elements of the PCN Covid-19 vaccination programme.

From the week commencing 13 December, staff have been offering their services to Primary Care Networks (PCNs), helping with various administrative, marshalling and reception tasks. To date, 56 shifts have been covered by One Care staff at 14 venues.

Eighty per cent of eligible patients have now received their booster jabs across BNSSG. Just shy of 200,000 vaccinations were given between 12 December 2021 – 4 January 2022, with more than half administered by PCNs.

One Care’s Chief Operating Officer Scott Godley, said: “It’s been fantastic seeing so many of our staff volunteer with the booster rollout programme.

“The feedback we’ve received from practices about our staff has been fantastic and similarly, members of the team have enjoyed going into the surgeries and vaccination centres, meeting new people, gaining new experiences, and witnessing first-hand the demands of the booster programme.”

“The vaccination figures are truly remarkable, particularly in the last few weeks, so a huge thank you and well done to everyone involved,” he continued.

“One Care will continue to make its staff available to volunteer at practices across BNSSG for the next couple of weeks, when it will then be reviewed, and I would encourage practices to take up the offer of support as it’s proven to make a positive difference.”

If your PCN would like to request additional help, please click here.

All adults are reminded they are eligible for their booster jabs, with 12-15 year olds able to receive their second doses.

If you’re yet to receive your first, second or booster vaccination, please visit or call 119. Vaccinations and boosters are the best way to protect you, your friends and family.

Get healthier this New Year

The Department of Health and Social Care have today (4 January) launched the latest instalment of the Better Health campaign to offer support and guidance to those working towards a healthier lifestyle.

Running until the end of March, the campaign looks to motivate and encourage adults across the nation to lose excess weight, eat healthier and get more active.

Better Health is working in partnership with 15 weight management and physical activity partners who are providing both free and discounted offers and the website will also signpost to local weight management support.

The new campaign highlights some of the benefits a healthier weight can have on an individual’s life:

  1. Decreased risk of common cancers (colon, liver, pancreas, kidney)
  2. Reduced risk of increased blood pressure
  3. Lowered risk of heart disease
  4. Less chance of developing diabetes
  5. Reduced strain from chronic back and joint pain
  6. Decreased risk of being hospitalised or becoming seriously ill with Covid-19

For more information and to get involved, visit the Better Health website to access a wealth of material on exercise, mental wellbeing and meal prep. The NHS weight loss plan and various fitness Apps are also available for free download.

Bristol City support Covid-19 booster programme

One Care and our local vaccination programme teamed up with Bristol City Football Club today (20 December) as the Sky Bet Championship outfit visited Tyntesfield Medical Group’s Brockway Medical Centre.


City’s players and staff arrived in Nailsea on their branded team coach to receive their Covid-19 boosters and lend their support to the vaccination programme, helping encourage people in Bristol, North Somerset and South Gloucestershire (BNSSG) to have their Covid booster as soon as possible.


In BNSSG – as with the rest of the country – there’s a real drive to scale-up booster vaccinations in response to the Omicron variant by increasing the capacity of booked appointments in existing vaccination sites.


With 65% of total vaccinations administered through Primary Care Networks (PCNs) in BNSSG to date, Brockway Medical Centre’s lead GP Dr. Jon Rees said: “We’re delighted to have boosted the Robins today. We hope the team making such a strong public statement about having their boosters, will help encourage others to have their Covid-19 booster vaccination as soon as possible.


“Bristol City and other local sports teams have been fantastic advocates since the start of the Covid-19 vaccination campaign. It’s great that our local sports teams are encouraging vaccine uptake in Bristol, North Somerset and South Gloucestershire.”


Bristol City’s Chief Executive Offer Richard Gould added: “I’m really pleased that so many of the team have had their booster today. A lot of football games were cancelled over the weekend, and we wanted to come down today to help keep football going. I’d like to give credit to the NHS and to our players for being so informed and making the choice to have their Covid-19 booster.”


If they haven’t already, your GP surgery will be in touch very soon to offer you an appointment. It’s extremely important to accept your invitation to receive the booster, rather than wait.



Alternatively, you can use the online National Booking Service, call 119 or visit for more vaccination options in your area.


Vaccines are the best way to protect yourself, friends, and family from this dangerous virus. Do not put it off until the New Year. Getting your booster is a quick a pain free process.


With focus being on vaccinations in the coming weeks, general practice staff are focusing on delivering booster appointments. While you may need to wait until the New Year to get a routine appointment, please be assured that practice teams are still available to look after your urgent care needs, including symptoms that may indicate cancer.