>>Narrator: GPs in England now have a record 340 million appointments a year With reduced
resources and a government committed to 7 day a week NHS, one group of GPs decided the
only solution was to innovate.
>>Dr Andrew Coward: Locally we felt we've got to do something different. We saw that
the future was General Practice at scale. We saw that the future was multi-speciality
community providers, or accountable care organisations, and we were very keen to work with a scheme
that encouraged GPs to work together.
Hello. we've got an appointment with Dr Shah.
>>Narrator: Their aim was to extend hours and enhance services while relieving pressure
on the urgent care system.
>>Nirmal Vora: We always knew that GP Practices were best at doing what they do for their
patients, and every General Practice has a different cohort and demographic of patients,
so what we wanted to do was keep GPs with their own independence but surround them with
wraparound services seven days a week.
>>Narrator: After securing a £2.4 million grant from the Prime Minister's GP Access
Fund, and match funding from Birmingham South Central CCG, the 'My Healthcare' project began
to take shape.
23 local practices were interested. The plan was that their 124,000 patients would have
access to extra services provided by three main practice hubs.
>>Nirmal Vora: A hub has more of the same in terms of GP appointments but we deliver
them 7 days a week including early morning and late evening. But what we're trying to
do is remove the postcode lottery for patients receiving services. In an individual practice
they might just delivery GMS services, but from a hub you can deliver all the out of
hospital things, all the enhanced services. The patient is always entitled to a service
no matter what GP practice they are registered with.
>>Narrator: While the idea was popular, the practicalities of persuading 23 independent
GP practices to join forces and agree on the detail became a challenge
>>Dr Naresh Chauhan: All GPs are by nature independent-minded people who want to do things
in their own way. And somebody telling them this is a different way is not always easy
to sell.
>>Ann Forletta: The umbrella organisation for My Healthcare is South Doc Services who
come very much from South Birmingham and are therefore well known to the South practices.
But the central practices that are part of My Healthcare come from a different culture
and ethos and therefore have less experiences of working with South Doc Services - and were
slightly nervous.
>>Dr Naresh Chauhan: As a visionary, if you like, you know what you want to do. But selling
it to 50 other people is a very different kettle of fish. And at that stage I think
you need someone who is impartial, who is out of the actual main structure.
>>Narrator: As part of their support package, the group was offered assistance from NHS
England's Sustainable Improvement Team.
>>Rachel Hinde: Our premise is that you have some kind of change you want to make. And
we are about helping you make that change. We aren't about telling you what to do - but
we're about making change happen and making that change sustainable.
>>Ann Forletta: Because we had a very clear vision, we thought we'd got everything sussed.
We thought we knew where we were going and what we wanted. And we possibly might not
have engaged with the Sustainable Improvement Team had they not been part of the offer we
had from NHS England. But their support for us far exceeded, and the value that they brought
to the work exceeded our expectations.
>>Rachel Hinde: Once we've come and met you, we'll understand what you're trying to achieve,
and we will with you design a programme, and it might be a serious of workshops, it might
be other interventions - we might provide quality improvement training which will help
your people make the changes you need to make.
>>Narrator: All 23 Practices eventually bought into the idea that one of the hubs - the West
Heath Medical Centre - would become the base for innovative services that were key to the
whole project. The first is a virtual GP service.
>>Virtual GP: Hi is that Jessica Kenny?
Patient it is yes.
>>Virtual GP: Hi, I'm Dr Barnes I'm calling from My Healthcare
>>Narrator: It's only for patients with non-complex, straightforward conditions. Local surgeries
book the telephone appointments for suitable patients - and the virtual GP calls them back
at a designated time from the virtual hub.
>>Virtual GP: The only thing that's coming up a bit abnormal is that you're a little
bit anaemic.
>>Narrator: Detailed agreements on sharing medical records had to be negotiated with
practices and patients to make the service possible.
The virtual GP and a similar virtual pharmacist service are absorbing some of the pressures
on local surgeries - allowing GPs to concentrate of patients most in need of face-to-face consultations
or continuity of care.
Another service based at West Heath is the roving GP. Urgent home visits are booked by
local surgeries and the dedicated mobile doctor responds with a driver.
The roving GP has access to medical notes and can update them while out on the road.
>>Dr Bipin Champaneri: I work as a general practitioner day to day as well, and I have
cases where there might be quite an unwell patient and I'm in the middle or surgery and
I can't visit them until after surgery finishes.
>>Dispatch: We've got a lady who's 82 - she's chesty and unwell.
>>Dr Bipin Champaneri: This is why this service is here. It's for patients who are not unwell
enough for an ambulance to be called, but can't wait for a routine visit.
>>Narrator: The three hubs are no more than three miles from any of the smaller surgeries.
As well as offering early morning, evening and weekend appointments they provide a range
of enhanced services usually only available in hospitals.
>>Ann Forletta: We have a physio first service for one-off, acute physio problems, we do
an ECG recording and interpreting service, we do a wound care management service, we
do minor surgery we do a whole range of other services.
The patient goes to the surgery, if it's felt the patient needs treatment, they're booked
in and they just come to which ever hub is more suitable for them.
>>Narrator: It's too early for detailed evaluation - but initial findings by the CCG suggest
patients are using and really appreciate the new services.
>>Nirmal Vora: The main reason we developed these services is to improve patient care
and improve accessibility to patient care. But we have seen other bi-products such as
staff morale has improved dramatically because they're able to help patients better.
>>Ann Forletta: Receptionists have found it has eased their load over the winter pressures
- well generally - because they can offer patients something. You know, by 9.30 on a
Monday morning you have nothing left normally, but they have other alternatives they can
offer their patients. And a range of alternatives.
>>Dr Andrew Coward: What the scheme does it allows patients with chronic, long-term conditions,
who really need continuity of care, to see me, their normal GP. And that more transactional
things, like having a routine smear done or a sore throat, or a more transactional approach,
can actually be dealt with on the hub.
>>Rachel Hinde: Often, people think they've got to try really hard to do everything by
themselves - they've got to make change by themselves - they feel like it's their responsibility.
We know we can help. We know we don't have all the answers, but we can definitely help
you achieve what you want to achieve.
>>Ann Forletta: Had we not had the Sustainable Improvement Team on board I think we probably
wouldn't have recognised the importance of bringing everybody with us as much as we did.
>>Nirmal Vora: I don't think we could have done the work without them because we didn't
have the skills within our own team. We would never have got the uptake in the services
that we required and never been able to upscale our own team go out and always be problem
solvers for the rest of the practices.
>>Ann Forletta: The fact that they were un-biased brokers , that were not seen to have an axe
to grind, or be pro one side of the argument of the other was extremely helpful.
>>Dr Naresh Chauhan: I don't think we would have been able to get as far as we have without
the Sustainable Improvement Team working alongside us because I think they provided the glue
that held us all together.
>>Ann Forletta: I also think the practices we worked with felt very secure that we had
someone from the NHS Sustainable Improvement Team with us, they had a certain kudos and
ethos that they admired.
>>Dr Naresh Chauhan: I think the important thing is that at the end of the day, a project
like this requires planning, thinking and the Sustainable Improvement Team has been
key to actually making this a success.