2020 A GP vision of healthcare without walls

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2020 A GP Vision

It is 2020 and I get up with a bounce, as I know my day will be challenging but not stressful with 15-minute appointments, a manageable workload and the ready support of an extended primary care team working in healthcare without walls. As a consultant in family medicine (GP) my work is primarily around diagnosis and the management of complex multi-morbidity and support of our clinical team. Our GP services are national exemplars and have the recognition and support of the population we serve because our patient experience and outcomes are amongst the best in the world. As one of the best-resourced General Practice teams in the country recruitment problems are a thing of the past due to good remuneration, and innovative provision of great healthcare by an enthusiastic multi-skilled workforce from modern facilities. Bureaucracy is almost invisible with performance data largely outcome based, and pulled from routine clinical data entry.

I know if I fall short in any area of clinical care non-judgmental support will be provided to bring me to the standard to which our healthcare system aspires. My practice is still my own but I have given up a degree of autonomy for the benefit of sharing the effort of quality improvement and managing patient demand, although I still recruit my core practice team and own my premises this too is becoming less important. It all seems such a long way from 2016, so how did we get here? It started with our people, our principles and our platforms.It is 2020 and I get up with a bounce, as I know my day will be challenging but not stressful with 15-minute appointments, a manageable workload and the ready support of an extended primary care team working in healthcare without walls. As a consultant in family medicine (GP) my work is primarily around diagnosis and the management of complex multi-morbidity and support of our clinical team. Our GP services are national exemplars and have the recognition and support of the population we serve because our patient experience and outcomes are amongst the best in the world. As one of the best-resourced General Practice teams in the country recruitment problems are a thing of the past due to good remuneration, and innovative provision of great healthcare by an enthusiastic multi-skilled workforce from modern facilities. Bureaucracy is almost invisible with performance data largely outcome based, and pulled from routine clinical data entry.

I know if I fall short in any area of clinical care non-judgmental support will be provided to bring me to the standard to which our healthcare system aspires. My practice is still my own but I have given up a degree of autonomy for the benefit of sharing the effort of quality improvement and managing patient demand, although I still recruit my core practice team and own my premises this too is becoming less important. It all seems such a long way from 2016, so how did we get here? It started with our people, our principles and our platforms.

Principles- we started with ten

  1. Healthcare starts with self-care: from disease prevention to illness-management, patients are supported to take personal responsibility for their healthcare at every point of contact with the care system
  2. Care is provided by the lowest cost, capable, individual, and experts do what experts alone are able to do.
  3. Care is provided in the lowest tech, most local, suitable healthcare facility
  4. The use of telephone, video and email communications are maximized so that patients are only seen face to face when doing so delivers additional value to patients.
  5. All care outside of the hospital ward (including A+E and out-patients) is considered community care and utilizes a single (EMIS Web) computer record for either caseload access or as a practice based population record.
  6. Only those patients who need ward based care are admitted to hospital and low tech nursing care is provided in out-of-hospital community nursing beds
  7. Home working is the norm for managing all health care that does not need face-to-face contact this reduces stress on our environment and the demand on our physical facilities
  8. Any and every member of our health community, hospital or primary care, can be reached directly by any colleague by phone or email using our digital directory to deliver healthcare without walls in a single virtual health community.
  9. We save time and get the best, by together inventing just one wheel that works for all of us. We use our social extranet to enable our entire care community, including patient representatives, to collaborate and construct the healthcare pathways and services our patients need and that our health system delivers.
  10. We expect our team to give their best so their best is recognized in the rewards they receive from their employment

Our entire health community signed up to these principles in a written pledge as a core element of our Sustainability and Transformation Plan this included:

  • Practices (individually and their One Care provider umbrella)
  • Commissioners (CCG and NHSE)
  • Community providers (Sirona/BCH)
  • Specialist providers (Hospital Trusts and AWP)
  • OOH (Brisdoc)
  • Social Care (LA)

Platforms- Our virtual super surgery

We needed an infrastructure to share expertise and resources across our collaboration and have created a virtual super surgery that levels the peaks of demand, lets you reach the people and knowledge you need, when you need it and it is the vehicle that delivers our principles. It is underpinned by three technology platforms managed by One Care.

  • Our integrated patient record system (EMIS Web)-enables patient centric continuity across organisations and to pull together when their are peaks in demand
  • Our cloud based communication system- ensures you can find and reach the people you need by phone or email without delay
  • Our dynamic collaborative knowledge base provides a central source of up-to-date, relevant information, everywhere and anywhere whenever you need it that is built by our collaboration

People- clinical teams transcending practice boundaries

We formed an extended team employed by larger practices or provided for smaller ones by One Care: who see patients in surgeries or their homes and include HCAs, general and specialist nurses, physiotherapists for both diagnosis and treatment, pharmacists and mental health practitioners including counselors and specialist MH nurse prescribers. Where practices are too small to employ more specialist allied health professionals One Care does so on their behalf.

Shared across clusters of practices working from hubs One Care employs optometrists leading on eye care and audiologists for ear care, all our chronic disease areas are supported by specialist community teams of doctors and nurses with the One Care frailty-team also including social care. The old community providers of Sirona and BCH have merged with One Care and many of their district nurses have joined practice teams but One Care has taken on responsibility for managing at scale community services.

Outpatient and A&E attendance has become a virtual extension of our surgeries into hospitals although still largely staffed by secondary care. Our network of acute care centres that include practice and hospital hubs that provide immediate-care and simple diagnostics (X-ray and ultrasound) and where paramedics make both initial clinical assessment and home visits for the acutely ill, in and out of hours. These function as spill over hubs when practices exceed levels of safe demand and where there is access to additional GP and nursing care and the extended teams.All clinicians have full read write access to the patient’s record for seamless care wherever the patient is seen which still allows their usual GP to maintain oversight of their treatment and continuity of their patient's care.

So now in 2020 at the end of the day I get away on time and unstressed, proud to know that my patients have enjoyed receiving care of the highest quality whenever and wherever they needed it, in our system of healthcare without walls.