After an excellent case-study session by a local GP at our shareholders’ event in November, a number of practices expressed interest in using text messages to send patients results of investigations and tests. We are now working with the three pilot practices to embed the texting results project and to develop information, create training materials and refine the process for others. These materials will then be shared with all practices as part of a package that they can pick up and integrate into their own way of working. It is estimated that approximately 70% of tests are satisfactory and require no further action, meaning that this way of working can drastically reduce the number of phone calls a practice receives, which improves access for all.

The final paper from the research our practices participated in during the One Care Consortium e-consultation pilot has been published this week in BMJ Open. The CLAHRC West has published a really useful article on their website that summarises the findings across all three papers (with links to them) and lists some guidance to help commissioners and practices choose and implement an online consultation system.

The CLAHRC have also produced some other easy-to-digest materials that give an overview of the recommendations. Firstly, you can see the highlights in a printable A5 format in this CLAHRC BITE. Watching the video abstract below, presented by one of the researchers, is another way to find out more.

We are so excited that this work means that we have been able to add to the national evidence-base around the use of e-consultations. Online consultations are one of a number of innovative ways to address the sustainability of general practice, and understanding more about the environment and conditions in which they function well allows us to offer best-value to practices and patients.

This graphic shows Bristol, North Somerset and South Gloucestershire split into the three CCGs, six localities and finally the 16 clusters with deprivation levels shown for each. Deprivation (measured here by IMD 2015) is associated with increased utilisation of local health services.

We can evidence through the stock take project we were part of last year that deprivation is significantly associated with increased A&E attendance and emergency admissions.

We are currently working on a ‘refresh’ of last year’s stock take, now called the General Practice Analytics Review. Reports are being published to practices shortly. Practices will be able to see their position compared to their local and national peers on a huge amount of metrics (practice activity, secondary care, telephony, out of hours, QOF, prescribing metrics, surveys, workforce metrics and more). We also have the ability to deep dive into certain metrics that may be of interest to practices, such as the relationship between deprivation (as seen above) and secondary care activity or practice activity.

Understanding practice activity and demand can inform how they deploy their staff, which in turn can contribute to improved patient access. Clusters and localities will also be given the opportunity to request collective reports. Understanding the similarities and differences between practices can inform collaborative working.

We are working with PhysioNet Bristol, a local partnership of 26 well-established physiotherapy clinics, to offer an MSK assessment service in the early mornings, evenings and weekends. It is now available to every One Care practice across Bristol, North Somerset and South Gloucestershire. Following clinical triage from a GP or nurse or non-clinical triage from a receptionist, patients can be booked in to receive a 30 minute face-to-face consultation with a physiotherapist at a location close to their registered practice. The service is suitable for patients with acute muscle, joint or spine pain who are 18 and over. Their appointment will take place within five working days.

Did you know that one in seven GP consultations are related to MSK conditions? This service means that patients can access services quickly and be seen by a specialist who can give targeted advice. It also releases resources and frees up appointments in GP practices.

In January, there were a total of 855 bookings made into this service. We expect numbers for February to increase further, as a number of practices began offering this service after 1 January.  We are currently visiting our practices with a physiotherapist from PhysioNet to explain the service and the benefits for patients and staff.

Patient feedback for the service has been very good so far and we have recently launched a new survey to ensure we are able to monitor patient experience more effectively.

“Seen within a few days. I could attend after work which was perfect and the physio was excellent.”

On 2 January 2018, Healthcare Leader News published an article written by Rick Stern of the Primary Care Foundation that gives an overview of a project we were involved in last year when NHS England commissioned a stock take of primary care in the area.

General practice captures more data than elsewhere in the NHS. The aim was to bring together all the available information in one place, so that each practice can see how it is doing compared with its peers on indicators it feels are important. In turn, practice-level data could be aggregated to inform conversations with other local practices, across clinical commissioning groups (CCGs) and to support the emerging sustainability and transformation plans (STPs).

This project came to an end in June 2017, but One Care is continuing to develop our thinking around this as part of our analytics work stream. Our Medical Director Dr Jacob Lee commented: “As well as carrying out a refresh of this process, we are building our own business intelligence platform, looking at patient stratification and analysing telephony data. We are also engaging and supporting practices to standardise their data quality and management. We are building a culture that recognises the role information has to play in the transformation of general practice.”

Read the full article here.

On 30 November 2017, we held our shareholders’ event at Ashton Gate stadium and all our shareholding practices were invited to attend. It was a fantastic afternoon and we had some very positive conversations about One Care’s current and future projects. We also discussed emerging arrangements for practices to come together to work as localities (with a patient population of at least 100,000) to support the development of an integrated model of community care across Bristol, North Somerset and South Gloucestershire.

There were also a number of brilliant showcases presented by practice representatives, who shared information about innovations or new ways of working they have successfully implemented. Two of the presentations covered practice implementation of initiatives supported by One Care: care navigation and optimisation of document management processes. These were very enthusiastically received by practices and we look forward to doing something similar again in the future.

At the end of the afternoon, we asked practices to vote to give One Care a mandate to change to reflect future locality arrangements and received an overwhelmingly positive response.

Practices also had the opportunity to ask questions to the Executive Directors and understand a bit more about two of our current projects: the development of a collaborative intranet platform and a recruitment microsite for general practice in the area.

It was a great afternoon and we look forward to the next one in 2018!

Exciting news! The qualitative element of the research our practices participated in during the One Care Consortium e-consultation pilot has been published today in the online version of the British Journal of General Practice, and will appear in the January print version of this respected journal. You can find the article here. The CLAHRC West and University of Bristol have published stories on their websites that summarise the findings.

See the news story we published in August for more information about the e-consultation pilot.

This work means that we have been able to add to the national evidence-base around the use of e-consultations. Online consultations are one of a number of innovative ways to address the sustainability of general practice, and understanding more about the environment and conditions in which they function well allows us to offer best-value to practices and patients.

The findings from this research can influence implementation guidelines for alternative consultation methods,which is especially timely now that the NHS England GP Forward View funding for e-consultation software has recently been released.

One Care is providing an intranet solution for Bristol, North Somerset and South Gloucestershire (BNSSG) to enable collaboration and offer one central place where key information, documents, and contacts can be stored.  All practices across BNSSG are able to have access to their own portals which are powered by GPTeamNet.  The practice portal can be used as the internal resource management system but can also be used as an interactive platform to share information with their cluster and locality and to access information from One Care and other organisations.

The team at One Care have been developing our portal to include information and documentation on all One Care projects.  The One Care portal is now live and can be accessed by searching ‘One Care portal’ on GPTeamNet or through the useful links tab.  Practices are able to find and search for information on One Care projects, look for key contacts and documentation and other relevant information.  These pages are accessible through the search function or by looking through the topic pages that can be found on the One Care portal home page.

Our information is shareable, and can be accessed by colleagues without a portal, if they have a link to the relevant page.

The team will be working on including more information on the portal and will be speaking to various partners over the coming weeks.  Should you have any feedback or would like a portal, please get in touch!

In August 2017, it was announced that a number of GP practices in the South West, including those who were part of a bid coordinated by One Care, had been successful in securing funds to support the employment of clinical pharmacists in general practice. On 7 September 2017, ITV West Country broadcast a feature around the benefits of introducing this skill set into practices.

For this piece they interviewed Dr Tharsha Sivayokan, a GP in South Gloucestershire and One Care Board member, and Frances Loftus, a senior clinical pharmacist working at his practice. They were part of the nationwide pilot that was conducted to evaluate the impact of bringing more clinical pharmacists into practices.

Read the full story and listen to Tharsha and Frances talk about the benefits they feel clinical pharmacists have brought to their practice.

As part of the GP Access Fund programme, One Care had the opportunity to test a number of innovations that were said to improve access to appointments while reducing the demand on general practice. There was keen interest in using online consultation software across the primary care sector, so we worked directly with practices to identify their priorities around this. This led to a pilot involving 36 practices across BNSSG. The aim was to assess the impact, effectiveness, acceptability and costs of web-based access to primary care. The product chosen was called eConsult (previously, webGP).

Given the significance of technological innovation, and the fact some evidence suggests that non-traditional modes of contact have yet to offer significant benefit, One Care asked external researchers to evaluate the pilot. The evaluation analysed data from nearly 36,000 eConsultations, patient feedback, and undertook in-depth interviews with 23 practice staff involved in the pilot.

The study has been published by the Society for Academic Primary Care (SAPC) and was presented to the SAPC annual scientific meeting in Warwick this month. It was funded by One Care Consortium and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust. Pulse have also published an article about the research.

It was found that use of eConsult was low and the system was mostly used during traditional surgery opening hours. The most common reason for an e-consultation was for administrative reasons (e.g. requesting fit notes, repeat prescriptions). 38% of e-consultations resulted in a face-to-face consultation, and a further 32% were telephoned by a clinician, suggesting that the impact on reducing demand was limited during the pilot perido. Better marketing of the system may help, but practices were understandably wary of promoting a system to their patients when the impact and its continued availability was uncertain.

Patients gave feedback that they valued the system. Clinicians said eConsult works best for simple, routine enquiries. When complex or new symptoms were presented, clinicians wanted to see the patient. The lack of integration of the platform with existing systems also created complications in work flow within practices.

Therefore, while the results indicated that there is an appetite to engage with digital communication, the study did highlight difficulties. The challenge for the future is to test the system once technical developments are available.

With thanks to the One Care project team, researchers from the local Collaboration for Leadership in Applied Health Research & Care, funded by NIHR. https://clahrc-west.nihr.ac.uk/, and especially to the patients and practices who generously took part in this study.