Action BCCG Response 2016/17 2017/18 2018/19 2019/20 2020/21 1. Active Signposting Provide patients with a first point of contact which directs them to the most appropriate source of help. Web and app-based portals can provide self-help and self-management resources as well as signposting to the most appropriate professional. Receptionists acting as care navigators can ensure the patient is booked with the right person first time. Roll out Point of Call programme and develop a Receptionist Care Navigators programme. Increase use of Sound Doctor tools across all practices. Universal Information and Advice in conjunction with the Local Authority development. Continue to enhance the RightCare Barnsley brokerage service. The CCG established a training programme with Sheffield Hallam University to deliver training in active signposting for general practice reception staff. To date 50% of Barnsley practices have taken part in the course. Dementia Champions established in each GP practice. Sound Doctor offered to all practice which enables patients to specific conditions. The remaining 50% of practices staff have completed the training. Taking the learning from vanguard site on care navigation and by engaging with the local federation and practices the CCG will build on the learning and create a bespoke training programme to be rolled out across Barnsley practices in 2018/19. Social Prescribing commences on 01 April 2017 and actively signposting patients to the right service. Exploration of technologies to sign post patients to the right services. Evaluate the impact of the care navigation training programme and the impact of Social Prescribers within practice. Improved use of the Social Prescribing service. Utilising new technologies and developments to actively sign post patients to the most appropriate service. Roll out of bespoke programme to Care Navigators to further enhance this resource. Build on the feedback received on the Care Navigation Service and embed the Social Prescribing service in practices. Evaluate: Increase in for patient with Long Term Conditions and the impact on productive workflows – freeing up GP capacity (measures) reduction in DNA’s. Practices and patients aware of the right services to access. Services are embedded within Barnsley ultimately releasing time for care for more complex patients in General Practices and have effect on health and social care system. 2. New Consultation Types
Introduce new communication methods for some consultations, such as email and video consultations. Where clinically appropriate, these can improve continuity and convenience for the patient, and reduce clinical time per contact. Email, and video conferencing have been piloted as part of innovation fund and iHeart development. Plan to role out different methods across practices. Pilots within I HEART Hubs for email and video appointments have been trialled and the right technology to support these new developments have been sourced. LDR baseline position established and a 5 year implementation plan to be paper-free at the point of care’ by 2020. LDR Vision is to support patients to maintain their own health and wellbeing through technology solutions. 35 out of 36 GP Practices signed up to the Medical Interoperability Gateway (MIG) which allows practices and other local health partners to share patient records as part of the LDR 5 Year Plan. Respond locally to new technology and innovations. Evaluate the effectiveness of the I HEART email and video pilot and learn best practice. Role this initiative out to other local practices who are keen to this new way of working. Explore areas to offer e-consultations such as Apps or online portals. Continue to roll out the LRD 5 year plan which involves 100% of GP Practices and all health partners signing up to the MIG. Two ways text messaging system for patients to contact the GP Practice. Practices Nurses to offer group consultations for patients managing Long Tem Conditions. All practices to offer a telehealth service. Role-out and Video appointments to all Barnsley practices. The CCG to develop other consultation types in line with technology and best practice in other areas to best suite Barnsley Patients and practices. Continue to roll out the LDR 5 year plan. 100% of practices are offering two way texting and telehealth appointments. LDR successful in achieving a interoperable electronic health records so that patient’s records are paperless. All Health and Social Care Partners, where appropriate are fully utilizing the MIG. All Barnsley practices offer effective email and video consultations which have improved continuity and convenience and are open to trailing new technologies and e-consultations. Continue to embed and enhance the success of the LDR and paperless patient records. 3. Reduce DNA'S
attenders and its application to frequent GP defaulters. Widening the Practice Team to include appointments with the Clinical Pharmacists, HCA or patients being re-directed to other service through the Care Navigators or Social Prescribers. 4. Develop the Team Broaden the workforce, to reduce demand for GP time and connect the patient more directly with the most appropriate professional. This may include training a senior nurse to provide a minor illness service, employing a community pharmacist or providing direct access to physiotherapy, counselling or welfare rights advice. HCA Apprenticeship Programme. Clinical Pharmacists. Community Pharmacists. Minor Ailment Service. GP Fellowship and Nurse Training. Social prescribing (My Best Life). Extension of VTS training scheme. Alcohol workers in practices. Future developments of receptionist roles re care navigation. The CCG has appointed 15 Pharmacists with a strategic support team of 6 (1 Manager and 5 Administrators) employed to work within GP practices across Barnsley. They have received a induction and development programme. The development of a primary care training / Health Care Assistant Apprenticeship programme has seen 16 new apprentice placements have The commissioned social prescribing service (My Best Life) commences 01.04.2017. Reception staff (as described in Active Signposting) to be trained as Care Navigators. Roll out the Primary Care Apprenticeships programme to ensure that all practices wishing to host an Apprentice are allocated one. Embed and enhance the working arrangements between the Care Navigators and Social Prescribers in practice to ensure the services are working in conjunction. Evaluate the implementation of the Clinical Pharmacists and Apprenticeships Programme to identify best practice, areas for improvement and any requirement of additional resources. Evaluate the GP Fellowship model and look at ways to ensure successful recruitment at the end of the 2 year placements. Barnsley practices have a multidisciplinary Primary Care Team which has reduced the demand on GP’s and ensures that a patient is accessing the right clinician.
been created in GP practices. Workforce summit held in November 2016 to look at additional ways to develop the practice workforce. Minor Ailments scheme currently rolled out in conjunction with community pharmacies. A scoping exercise will be undertaken to identify the potential for the development of a Practice Nurse and Advanced Nurse Practitioner training programme. The CCG will implement with partners, a GP Fellowship Scheme, initially for up to 6 newly qualified and new to Barnsley GPs. Develop the minor ailments intuitive to include more technology e.g mobile app, online portal or triage portal operated by the care navigators. Implement for all Barnsley Practice Nurses and ANP’s a development programme. Direct Access to therapists on site such as physiotherapist or mental health practitioner. 5. Productive Work Flows Introduce new ways of working which enable staff to work smarter, not just harder. These can reduce wasted time, reduce queues, ensure more problems are dealt with first time and that uncomplicated follow-ups are less reliant on GPs consultations. Productive Primary Care to address smarter working practices. 4 practices have up the capacity and demand audit to identify new ways of working. BHF have worked with the CCG to develop a proposal to provide a full Increase to 50% of practices taken capacity and demand audit to gain baseline. The CCG and partners offer “The Practice Doctor” initiative. Ensure all Barnsley practices have completed a capacity and demand audit. Continue to share best practice and where possible corporate policies, processes and An increase in capacity and GP demand with demand being shared across the wider practice team. Staff working smarter utilising technology and all initiates
programme of Productive Primary Care across all practices, this has been offered to all Barnsley Practices. The CCG is developing proposals to deliver increased collaboration and alignment between practices and Care Homes. Development of 2017/18 Health Inequalities Targeted Scheme (HITS). Implementation of Map of Medicine in all GP Practices. Development of Lean principles to measure, understand and improve common processors to be rolled out across GP Practices. on the First Port of Call training to ensure the reception area is a productive environment. Widening the practice team to ensure that the patients is accessing the right clinician e.g. clinical pharmacists and HCA’s. procedures across practices to minimise the administration workload. Ensure practices are utilising all technologies available such as the Sound Doctor, Map of Medicine and Social Prescribers to reduce unnecessary appointments. introduced over the GPFV. 6. Personal Productivity Support to develop their personal resilience, as well as specific skills to allow them to work in the most efficient way possible. This may include improving the environment, reducing waste in routine processes, streamlining information systems and enhancing skills such as reading and typing speed. Productive Primary Care to address smarter working practices. CCG to offer, through eMBED Project Manager training to Practice Managers. Development of a programme to develop Practice Nurses. FPOC training rolled out to 50% of practices reception staff. Identify Learning and Development needs of Primary Care staff to enable training packages to be developed. Ensure Clinical Pharmacists and HCA’s newly appointed to practice have their learning and Ensure all practices have sent at least 2 members of staff on the touch typing courses. BEST Tutors to lead on the learning and developing for Primary Care embedding these Re-evaluate training and development needs of Practice staff and successful programmes. Broadened the skills of the Primary Care Workforce with HCA’s, Clinical Pharmacists and Care Navigators .
The CCG held a BEST event in December 2016 for speed reading in which 73 GPs attended. Ensuring all practices are aware of and can access The NHS GP Health Service – providing individual support to manage personal resilience, stress and burnout. development needs and ambitions mapped and support is in place within the practice and CCG to progress these. Mentoring and Peer support schemes to be offered through-out the CCG and Primary Care to develop Primary Care BEST events planned to on training needs identified for clinical members of staff. Touch typing courses offered to all Primary Care Administration staff. Streamlining systems, policies and processors to enable practices to adapt ‘off the shelf’ policies to their practice. into BEST events where possible. Utilising technology to reduce administration time. 7. Partnership Working Create partnerships and collaborations with other practices and other providers in the local health and social care system. This offers benefits in terms Locality in development. BHF - partnership to deliver back office efficiencies. Care Home model in development. PDA - encourages Locality model to reflect the electoral wards of the local authority. Links to BMBC Area Councils to support Neighbourhood hubs. Neighbourhood hubs and locality model enabling multidisciplinary teams out in the community Build on the PDA success to develop and inform future PDA’s. Services wrapped around patient needs with no boundaries between organisations.
of improved organisational resilience and efficiency, and is essential for implementing many recent innovations in access and enhanced long term conditions care. partnership approach to primary care at scale. Develop an alignment model between practices and Care Homes and a universal offer to care homes. Barnsley Healthcare Federation made up of 28 out of 35 GP practice members. Develop the PDA 2017/18 to encourage Primary Care at LDR and the MIG rolled out to all practices. Developing with partners and Accountable Care Organisation. STP Development. offering care closer to home. Ensure all practices are signed up to deliver the PDA 2017/18. BHF offered a support package to practices for back office and joint administrations functions. Specialists to be hosted within Primary Care environments to cut down the number of referrals out of Primary Care. Clinical and Community Pharmacists to work together to build the relationships between the GP Practice and local pharmacy. Social Prescribers are the key link between GP Practice and Local Authority to direct to social and other services. Accountable Care Organisation takes form. Localities and cluster practices to work collectively on common issues and with patient groups e.g Long Term Conditions. BHF offering a successful programme of support to practice who require additional or administration support. Primary Care Estates built to host multidisciplinary teams. Local ACO established and functioning.
Ensure all Local Health partners are signed upto the MIG. 8. Use Social Prescribing Independence Examples include leisure and social community activities, befriending, carer respite, dementia support, housing, debt management and benefits advice, one to one specialist advocacy and support, employment support and sensory impairment services. Social Prescribing has been in place on a small scale since 2015. A new model has been developed and the new larger scale service 'My Best Life' will commence in April 2017. CCG commissioned a full Social Prescribing Service ‘My Best Life’ to commence 01.04.17. Established Dementia Champion in each GP Practices who receive training and peer support. Care Navigators and Practice staff work effectively and in conjunction with the Social Prescribing Advisors based in practice. Work with the Local Authority to ensure an up to date directory of services is available. Dementia Champions to attend regular training and meetings to share best practice and maintain key contacts. Continued training based on the Wakefield Vanguard model to further develop Care Navigators and other Practice Administration staff. Evaluation of My Best Life by reduced appointments and also patient experience. Social Prescribers embedded as part of the Team with reduced demand for GP appointments and patients accessing the right service. 9. Support Self Care & Management
Take every opportunity to support people to play a greater role in their own health and care. This begins before the consultation, with methods of signposting patients to sources of information, advice and support in the community. Common examples include patient information websites, community pharmacies and patient support groups. For people with long-term conditions, this involves working in partnership to understand patients' mental and social needs as well as physical. Many patients will benefit from training in managing their condition, as well as connections to care and support services in the community. based plan programme to Increase Health Literacy - through universal access to information and advice. Behavioural change training. Year of Care initiative and social prescribing. Sound Doctor system. CCG rolled out Sound Doctor, Self-Care online management system to all practices to raise with patients who meet the criteria of the initiative. Nurses in Primary Care to develop ‘bespoke’ group sessions for patients with Long Term Conditions. Make Every Contact Count initiative established and being progressed to sign post to self-care information. Dementia Champions established in each GP Practice. Behaviour change training with Sheffield Hallam University rolled out across Primary Care. Evaluate how many practices and Barnsley patients are utilising the Sound Doctor system. – Ensure 100% of practices are using the system. Evaluation March 2018. Care Navigators and Social Prescribers referring patients to the universal access to information and advice for patients, appropriate, to Roll out the Patient Activation Tool to all practices. Ensure all practices are equipped with information to display within the practice. Self-Care publication to be developed with the Patient Reference Groups and the Barnsley Patient Council. CCG to promote self-care campaigns through social and practices. Patient Reference Groups and the Barnsley Patient Council to ‘champion’ self care within the practices. Local patient groups established in line with locality models for patients with Long Term Conditions to have peer support. The development of a reliable and endorsed patient information website self care information is available from. Patients aware of and are accessing self care information and feel more empowered to manage their own conditions. A reduced demand for GP appointments and in contacting Primary Care. 10. Build QI Expertise
Develop a specialist team of facilitators to support service redesign and continuous quality improvement. Such a team will enable faster and more sustainable progress to be made on the nine high impact changes. The team could be based in a CCG or federation. They should ideally include clinicians and managers, and have skills in leading change, using recognised improvement tools such as Lean, PDSA and SPC, and coaching GP practice teams. The CCG is currently working in partnership to develop an initiative called the Practice Doctor this will build local Quality improvement expertise. Productive Primary Care will also build this expertise. General Practice Improving Leaders Programme offered to Primary Care Managers, CCG staff and Federation Members. Development of the Practice Doctor initiative. Development of a GP Fellowship Model. Primary Care Development workstream made up of BHF, CCG and Practice Manager Representation to progress the 10 High Impact Actions. Support with continuous learning from CQC inspections, GP patient surveys and patient feedback, Quality and Improvement assurance process and Building capability for improvement . CCG and BHF Team, which are a mixture of Managers and Clinicians, have completed the General Practice Improving Leaders programme and are equipped to lead on the 10 High Impact Actions. CCG to offer development opportunities for Primary Care Nurses. Practice Doctor Initiative in place and offered to any practices who are in need of quality development and support. Leadership Team taking forward quality improvement and the GPFV Action Plan. A high quality Primary Care Service with measurable improved outcomes.