The challenge
The 2018 Scottish GMS Contract and Primary Care Improvement Plans (PCIP) aims to create a better-resourced, person-centred primary care service which supports healthcare professions to grow and develop while easing pressure within General Practice.
Underpinning this model is the move to shared care services across a wide area to provide patients with faster access to services while reducing the GP burden.
NHS Tayside’s digital directorate primary and secondary care service delivery manager, Tracey Wyness, explains: “The challenge was to provide a system design that allowed clinical teams to support multiple practices from a single system while ensuring the mature primary care EHR was maintained in as near to real time as practical.
“In addition, the need to recognise additional requirements specific to the service had to be brought to the fore.”
To successfully shift care from general practice to a shared service, NHS Tayside needed to provide immediate access to patient information from any location and ensure every patient interaction was quickly available within the GP system, to avoid duplicate recording.
Furthermore, creating the right service model was key to minimise travel for healthcare professionals and improve patient access while also releasing GP time.
Building on community nurse success
Creating the right federated model raises a number of questions, from determining the best location for services in order to minimise travel and increase access, to ensuring healthcare professionals are empowered with immediate access to patient information and creating a shared appointment system that can be accessed by all stakeholders.
While NHS boards in Scotland were given three years to design and implement the new shared care service model, for NHS Tayside the existing community nurse service in the rural village of Letham – which has no GP practice – provided an excellent template.
The challenge was to provide a system design that allowed clinical teams to support multiple practices from a single system while ensuring the mature primary care EHR was maintained in as near to real time as practical
Providing community nurses with access to patient records through Vision Anywhere led to a 400% increase in activity at a dedicated health and wellbeing centre, reducing the number of home visits required, cutting nurses’ travel time, and releasing more time to care.
Using the shared appointments module, patients can be booked into appointment slots from any of the seven nearby GP practices – which means nurses’ time is more effectively managed.
“The success of Letham provided NHS Tayside with confidence in the shared care model and we thought that approach, with Cegedim providing both secure and up-to-date patient information and shared appointments, would work,” Wyness explains.
A shared patient record
NHS Tayside embarked on a test of change programme to evaluate how this federated model could be deployed – assessing the different service options, the potential benefits, and feedback from both patients and practitioners.
Service provision has been split across three regions: Angus, Dundee and Perth & Kinross, encompassing around 60 GP practices in total.
The initial test of change services deployed were first contact physiotherapy, urgent care, care and treatment, and the vaccination transformation programme, with health care practitioners using Vision Anywhere to securely access patient records from multiple practices, supported by data sharing agreements.
This means that every healthcare professional has access to information for those patients registered at a Vision practice, including medical history and medications, and the base GP system is updated automatically following every patient interaction.
With a shared appointment facility for each service across locations, irrespective of GP practice, patients also have wider access to services – and the ability to opt for the most-suitable time and place for the interaction.
Wyness said: “One federated service can support patients from as many as 23 practices in one area – something that would have been impractical without Vision Anywhere.
“From a patient’s perspective, the single shared record and shared appointments module provides a far-smoother pathway to the right services.”
The Outcome Manager is supporting first contact physiotherapy services, helping with resource planning and management
Federated service delivery
From vaccinations to first contact physio, the new model has been successfully deployed across NHS Tayside.
Vaccinations have been headline news during 2021 and 2022 – and NHS Tayside’s experience using a federated vaccination model for flu vaccines was hugely beneficial when new ways of working had to be deployed as a result of COVID-19 restrictions.
One federated service can support patients from as many as 23 practices in one area – something that would have been impractical before
In addition, first contact physio is enabling NHS Tayside to provide far-broader access to musculoskeletal (MSK) expertise.
Matt Perrott, integrated manager for occupational therapy and physiotherapy outpatient services at Dundee Health & Social Care Partnership, said. “It has streamlined the pathway for patients to access expert MSK triage and advice.
“The patient no longer needs to see a GP and be placed on a physio MSK waiting list to receive the timely intervention they require.
“Patients registered at the 24 GP practices in the region can now access the service at whichever local hub is most convenient.
“In order for service to function, patients need to be offered an appointment within a few days of contacting their GP surgery; and the federated appointment system supports this.”
The model allows the physiotherapist to access appropriate patient information without having to be present in the patient’s GP practice.
And, as referrals can often have limited background information, utilising Vision Anywhere means physios can check the patient’s medical history and discover if they have consulted on the issue before and what investigations have been performed. This supports a comprehensive and holistic approach, as well as maximising the time physios spend assessing patients as data gathering time is reduced.
While some UK shared service models have recruited dedicated first contact physio staff, NHS Tayside decided to use the same physios for both the MSK outpatients service and first contact physio, with both services running in parallel.
Perrott said: “We anticipate that the service will reduce the numbers being referred to MSK over time and we might therefore be able to release more staff to undertake first contact physio sessions, which will further expand the capacity available.”
Proven case
NHS Tayside’s test of change review confirmed the value of the federated service model.
Feedback from healthcare professionals confirmed ease of use and the ability to record patient contact information – with 70% of those surveyed saying access to the patient record via Vision Anywhere has improved patient care.
Other benefits for healthcare providers have included reduced travel, freeing up more time for patient care.
The Vision Anywhere app is supporting the goal of releasing more time for GP care.
We anticipate that the service will reduce the numbers being referred to MSK over time and we might therefore be able to release more staff to undertake first contact physio sessions, which will further expand the capacity available
Grove Health Centre is part of a cluster of four practices within NHS Tayside running an urgent care model and nurse practitioners work with a care home team and paramedics work with an urgent care visiting team.
Providing practitioners with immediate access to patient information through Vision Anywhere has transformed the speed with which the cluster can respond to patients’ urgent care needs.
Dr Shawkat Hasan, GP partner at Grove Health Centre and clinical lead for out-of-hours services at NHS Tayside, said: “The cluster supports more than 30,000 patients across a fairly-wide geographic area.
“Using Vision Anywhere, practitioners have access to all the information they need, including medical history, medications, and allergies at the point of care.
“There is no need to return to the practice or rely on scant information provided over the phone: urgent care can be delivered more safely and more quickly, with practitioners moving from one patient to the next.”
Building on a federated model
NHS Tayside continues to push forward with the rollout of federated services.
There are currently 1,350 service users across Angus, Dundee, and Perth, comprising clinicians and admin staff across care and treatment services (including phlebotomy, woundcare and ear care); community link workers (social prescribers); first contact physiotherapy; urgent care (paramedics and care home teams); and the vaccination transformation programme. A total of 63 practices also have staff able to book patients into available services.
In addition to continually expanding the services, NHS Tayside is beginning to explore the population data collected within Outcomes Manager to better understand health trends, support clinicians, and ensure services are configured to match patient needs.
Using Vision Anywhere, practitioners have access to all the information they need, including medical history, medications, and allergies at the point of care
Wayless said: “We have not fully implemented the Outcomes Manager reporting tool. However, we hope that this will provide information to help ascertain the value of shared services and the reduction in workload on GPs.”
Perrott adds: “Since implementation we have had to manually record detailed data for every first contact physio consultation, such as self-management advice, investigations ordered, and onward referral location. The Outcome Manager reporting data that can be provided by Vision software will therefore be really interesting and help to support ongoing resource planning and management.”
In conclusion
NHS Tayside has made a significant change in the way patient services are delivered and is firmly on track to meet the objectives of the new GP contract.
The team continues to work with Cegedim to enhance the solution, deliver staff training, and plan for further improvements