Alternative Solutions
This initiative is provided in conjunction with Pathways Community Interest Company, a third sector organisation, and covers the whole of the South Cheshire and Vale Royal GP Alliance.
The programme is designed as a single point of access service to wider community provision to support patient’s wellbeing where the issues are of a non-medical nature e.g. social isolation, financial difficulties, housing concerns etc.
GP Practices can refer to this service where patients are assigned an individual case manager who will provide tailored support dependent on their needs, working with the patient to improve their health and wellbeing. Patients can also self-refer.
This service benefits patients as it assists them in focussing on the root cause problem which may previously have resulted in the use of medication at times when people are feeling low and depressed.
Clinical Pharmacy Scheme – Pilot
Howbeck Healthcare worked in partnership with North Staffordshire GP Federation to successfully secure a bid for funding from NHS England to support practices to appoint clinical pharmacists to work in General Practice.
In May 2016, four clinical pharmacists have successfully been appointed to work across 5 GP Practices in North Staffordshire.
Practices in North Staffordshire who have benefited from the appointment of clinical pharmacists are:
- Mayfield Surgery
- Willowbank Surgery
- Werrington Surgery
- Harley Street Medical Centre
- Well Street Medical Centre
This project has helped practices to:
- Sustain primary care;
- Increase the medical workforce numbers in primary care;
- Attract new workforce to the local health economy
- Add skill mix, with standardised minimum expertise, within primary care;
- Act in an enabling role, helping to reduce the primary care healthcare team’s workload;
- Bring new talent to the NHS
GP Careers Plus Scheme
The GP Careers Plus is a national NHS England-led 12 month pilot project for GPs who are looking to retire, or have announced their retirement to their practice, or who may be thinking about leaving the profession.
Howbeck Healthcare, in partnership with two of its Federations; North Staffordshire GP Federation and South Cheshire and Vale Royal GP Alliance successfully secured bids to become pilot sites. There are 11 pilot sites across the country.
Each Federation worked with interested GPs to develop a local scheme that is flexible and retains GPs to work locally in their geographical area.
This project helps practices to
- Retain clinicians on flexible terms
- Sustain primary care;
- Increase the medical workforce numbers in primary care;
- Attract new workforce to our local health economy
- Add skill mix, with standardised minimum expertise, within primary care;
- Act in an enabling role, helping to reduce the primary care healthcare team’s workload.
GP Locum Platform
Howbeck Healthcare has worked in partnership with two of its Federations, South Cheshire & Vale Royal GP Alliance and North Staffordshire GP Federation and Midlands and Lancashire Commissioning Support Unit to design a local GP Locum Bank to fulfil the needs of GP Practices to fill locum sessions.
The GP Locum Bank has been created as follows: https://www.findmealocum.co.uk and launched in January 2018.
Our vision primarily is to develop a local GP Locum Bank to support GP Practices to secure locum sessions to fulfil their needs along with building a supply of high calibre available GP locums.
This project has helped practices to:
- Retain clinicians on flexible terms
- Support the sustainability of primary care;
- Increase the medical workforce numbers in primary care;
- Attract new workforce to our local health economy
- Add skill mix, with standardised minimum expertise, within primary care;
- Act in an enabling role, helping to reduce the primary care healthcare team’s workload.
First Derm Web App – Rapid Consultant Dermatologist Advice for GPs
FirstDerm is a company that crowdsources Consultant Dermatologists (Hospital Specialists in Dermatology) from the U.K. and Europe. They have an app that is freely available to patients who pay privately for an opinion usually about a mole that they are concerned about.
The South Cheshire and Vale Royal GP Alliance with Howbeck Healthcare’s support has worked with FirstDerm to create an application for GPs who need rapid advice. The application is a web app that can be installed on any smartphone or run on a computer in a browser. The easiest way to use it is on a smartphone with a built-in camera, but photos can be transferred to a PC to be uploaded if needed.
How it works – The GP runs the app and takes two pictures of the skin lesion or rash that they want help with, one close up and one from further away to show the distribution or location. Patient consent needs to be taken but they can be reassured the system is secure and meets all the information governance requirements for patient data.
Why we find it useful – The GP may be asking for diagnostic or treatment advice, or both. The service used in South Cheshire and Vale Royal GP Alliance isn’t a referral vetting service, though it could be used as that. We have aimed it as a rapid advice line for GPs who would like help but don’t want the hassle of trying to get hold of a consultant by phone, or where there is no real advice and guidance service operating and where a formal referral would be too expensive or take too long.
The information we input – On the app the GP (or other clinician at GPs recommendation) completes some basic information about the patient and condition e.g. some background, what’s already been tried as treatment and crucially the help they need or advice they want. They then upload the case to the cloud.
Response times are good – Often within an hour, and usually within 24 hours an email comes back to the practice (and if requested the GP) saying the reply is ready. Usually an admin person logs on to the system and downloads the reply and workflows it to the GP via Docman or via the clinical system.
Feedback is positive – We have sent over a hundred cases and the local GPs find it very useful. Occasionally the advice has been to refer into local secondary care services but usually there is either diagnostic advice, treatment advice, or a suggestion that a biopsy is taken for further information – this biopsy to be done in primary care.
Most of the cases sent are for Gross Dermatology problems and the original idea was that every GP has a smart phone and can therefore utilise that in clinic or on home visits. There is the ability to send dermato-scopic images which can be better for helping diagnose moles in particular but other skin lesions too. This of course puts the cost up as although there are dermato-scopic gadgets that can be attached to smartphones these have a cost and the price of the good ones means it isn’t economic for every GP to have one. In one locality we have used some capital funding to purchase each practice a dermatoscope and they are trialling using the practice dermatoscope (either by going to get it – or by bringing the patient back for an image). This is also going well and the learning is to put some training into getting a good image as this reaps benefits.
It’s cost effective and the patient experience is improved – There is a cost per referral that the Federation is currently paying for and we are trying to put the business case together for the CCG to commission the service directly. There is sometimes a concern by commissioners that this type of service raises demand and that costs will increase. Our experience is that this isn’t the case, GPs aren’t sending cases that they would have normally dealt with, they appear to be sending cases for advice that they normally would have referred. The speed of the advice is meaning less appointments in primary care – and less prescriptions for medication that don’t work. The patient’s experience is improved, often receiving feedback within the day from their own GP, without the need for a referral to hospital.
We are exploring the possibility of Nurses using the app to record wounds and link to Tissue Viability services, and for community nurses to use the app to send images either to Tissue Viability or to the on-call GP for review, for example for antibiotics to save a home visit.
We are also looking at using the app as an appointment avoidance system with patients getting an opinion direct without needing an appointment – though we are trying to understand the costs of this.
Howbeck Healthcare and FirstDerm are happy to work with your practice / federation if you want to set the basic service up in your area or if you are interested in some of our future developments.
Freedom to Speak Up Guardian
Howbeck Healthcare has launched a Freedom to Speak Up Guardian Role which has been commissioned by three Federations across North Staffordshire, South Cheshire and Vale Royal and East Staffordshire. Over 100 GP practices have signed up to receive this service initially up to the 31st March 2018. Tina Cookson has commenced in the role of Freedom to Speak Up Guardian, supported by a small team, and will support practices in ensuring the appropriate policies and processes are in place to ensure compliance with the NHS England and CQC requirements.
Tina worked in the NHS for over 34 years; 13 at an Executive Director level and has worked with Howbeck Healthcare since April 2016. Tina is a Registered Nurse and has received training in Freedom to Speak Up / Whistleblowing.