All posts by MagdaHann

Patient facing wound care videos

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As part of One Care’s communications offer to practices, we are now able to develop animated videos to support accessible, meaningful communications with patients.

In a recent project with Bridge View Medical, lead nurses Lauren Pentony and Kirstie Whitelock proposed developing two videos to support patients experiencing leg ulcers.

The videos are intended to help patients recognise a leg ulcer, know when to seek help, prepare effectively for their appointment and support healing afterwards. They will be shown in waiting rooms and will be available online.

The One Care communications team worked closely with Lauren and Kirstie, providing advice and guidance to develop content that would maximise the impact with patients, and support accessibility.

Viv Munday, Bridge View Medical PCN manager said the team at One Care ‘provided great advice and support to our team and the finished product speaks volumes of their professionalism.’

The two animations are now available and can be shared with patients as a link, or can be embedded on practice websites.

One Care Contacts

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Member practices told us they would like to have a named representative at One Care, who they could contact directly to ask questions, raise issues, or request support or advice.

In response to this, we’ve set up a ‘One Care contacts’ model, which sees members of the One Care team take responsibility for one or more member practices, being on hand to help with anything they may need.

That could be finding out the answer to a question, putting them in touch with a team at One Care who can help solve a problem, or giving direct assistance on something within their own expertise.

The model aims to build stronger, more consistent relationships between One Care and member practices, and enable them to access One Care’s services and programmes quickly and easily.

One Care’s Chief Operating Officer, Rachel Burton, said: “We hope our practice colleagues will find it helpful to be able to contact a specific person at One Care when they need something. Being able to build those personal, trusted relationships with members of our team will help members get the answers and support they want as effectively as possible.”

GPCB 2024 round up and 2025 priorities

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GPCB representation and action

Last year the General Practice Collaborative Board (GPCB) continued to strengthen ties with the wider integrated care system (ICS) to enable One Care-subscribing practices to participate as an equal system partner.

The GPCB represents the diverse make-up of BNSSG general practice; the board includes members from PCN and localities, both clinical and managerial, as well as Avon LMC, BrisDoc and One Care representatives. The Chair and One Care CEO have seats on the Integrated Care Partnership (ICP) Board and the ICB Board, meaning general practice is represented at the most senior level in the system.

The GPCB programmes and clinical leads have been instrumental in bringing practical changes and developments to patient care and practice management.


GPCB achievements in 2024 

In the last year, the GPCB has been a driving force on many issues faced by general practice, including:

  • acute respiratory infection (ARI) funding: annual additional funding brought as business as usual to all practices to support with winter pressures
  • workforce wellbeing, retention and recruitment: the workforce programme initiated workforce nominations, work experience, recruitment schemes and an agreed locum rate with agencies to support controlled workforce rates
  • inappropriate work requests from secondary care: the planned care programme and LMC review inappropriate requests to practices identifying trends and feed back to the requester
  • testing new and emerging technologies: the digital strategy team used local funding and brought in national funding to test technologies through pilots with member practices
  • the primary and secondary care interface: GPCB clinical leads for planned care and urgent care work collaboratively across the system to create principles and ways to improve relationships across providers, and improve patients’ experience


Coming up in 2025 

The GPCB key priority for the next six months is developing ‘future general practice’ plans. This aims to put general practice on the front foot and align with government ambitions to move the NHS from ‘hospital to community’, ‘analogue to digital’ and ‘treatment to prevention’. It will also examine how we support the development of practices to continue to deliver effective care.

The GPCB feels it is important for general practice in BNSSG to have a clear vision for the future. Each locality will use forum meetings in early 2025 to discuss what the future should look like. Every practice is invited to send two representatives to the pan-BNSSG forum meeting in March to further develop these ideas.


GPCB chair: Dr Jacob Lee 

In December we thanked Dr Jon Hayes for his time as GPCB chair and welcomed Dr Jacob Lee to the role. Jake joined BNSSG general practice in 2011 and has been a GP partner, clinical guardian and out of hours GP for Brisdoc, and medical director for One Care. Since 2018, Jake has been a GP partner at Horfield Health Centre in Bristol and is the clinical lead for the North and West locality and chair of the North and West locality forum. Jake is an advocate of relational continuity of care for patients. He was the clinical lead for the BNSSG element of a Health Foundation continuity of care project, and gave expert evidence on its benefits to the Health and Social Care Parliamentary Select Committee in 2022.

Find out more about the GPCB on the GPCB TeamNet page and watch our short video explainer.

Enhancing proactive care and population health through data analysis

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One Care’s population health management (PHM) team uses data to better understand the health needs of the BNSSG patient population.

The team supports general practices to deliver targeted proactive care to specific patient groups, particularly those facing significant health disparities.

Phil Gladwin, population health analyst at One Care, worked closely with a Primary Care Network (PCN) in South Bristol to identify patients who would benefit most from personalised support.

Through analysis of health and social factors data and talking with practice clinicians, Phil identified patients with a combination of mental health issues, obesity, and diabetes who were at high risk of further ill health. Practices then contacted this group of patients to offer targeted evidence-based support.

In Yate and Frampton PCN, PHM Fellow Dr Brynn Bird developed a similar project with One Care’s PHM team.

NHS data shows spending on both diabetes care and antidepressants is significant – and has increased since before the Covid-19 pandemic – suggesting these are areas where greater support may be needed.

To identify the patient cohort with the greatest potential, the PHM team also considered other conditions including obesity and hypertension.

This data-driven approach enabled the PCN’s care coordinators to contact this patient group, inviting them for appointments and interventions designed to foster improved health outcomes.

Dr Bird said “We wanted to engage with people in the neighbourhood who are likely to suffer poor health in the long-term, due to their current mix of physical and mental health conditions and social circumstances. We were particularly interested in those who would not normally see us to help with their health, aiming to change the trajectory of their health and wellbeing.”

Providing this kind of support enables patients to better manage their health and wellbeing. The PHM service assists practices in identifying these patients, informing them about available services, and intervening before further complications develop.

Dr Bird added, “We are working with a variety of supportive people in the community, led by our health and wellbeing coach, to give those at high risk of poor health the support they need to make interventions in their own lives that are suitable for them. This is an ongoing process, and we are aiming to build on this with further presence in Yate where individuals can turn for guidance.”

These initiatives are just a few examples of how data analysis can focus healthcare provision to improve population health. If you are interested in discussing a population health management project, please email business.intelligence@onecare.org.uk.

One Care helps shape health and wellbeing support for BNSSG primary care

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As part of One Care’s enhanced health and wellbeing programme, One Care programme lead Tailte Breffni and North Bristol Trust staff psychologist Dr Emma Lishman met optometry and general practice staff from BNSSG last month. 

The health and wellbeing programme is a nine-month project that aims to improve understanding of the health and wellbeing needs of staff across dentistry, community pharmacy, optometry, and general practice. It aims to engage with staff to shape effective, fit for purpose support. 

At the meeting, Tailte shared some of the project’s key findings, including results from a health and wellbeing survey completed by more than 500 primary care staff members across BNSSG.  

Dr. Lishman presented ‘Start Well, End Well’, an initiative that aims to facilitate team connections to improve staff health and wellbeing within healthcare settings.  

There were productive discussions about how teams can build positive connections, and how time can be found to do this in the face of pressures such as workload and staff shortages.  

The attendees also looked at ways to culturally shift how health and wellbeing is viewed in their organisations. For example, through practical changes such as regular breaks for patient facing staff and collaborating with leaders and managers to make health and wellbeing a common priority for all.  

Participants in the health and wellbeing project will be supported to use a health and wellbeing bursary to implement ideas into their organisation, and measure the effectiveness of their interventions. The results will be shared across primary care in BNSSG, helping to embed health and wellbeing in the area. 

More ideas to support staff health and wellbeing can be found in the June primary care health and wellbeing newsletter.

Contact health.wellbeing@onecare.org.uk if you work in a primary care organisation in BNSSG and would like to learn more about the programme.