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Management in Practice Awards 2008 – the winners!

15 December 2008

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Practice Finance – RBS Award: Dr John Thompson’s Seven Brooks Medical Centre, Manchester
Dr John Thompson’s Seven Brooks Medical Centre was the winner of the Practice Finance Award, sponsored by the Royal Bank of Scotland (RBS).

Last year, the practice, which has 4,800 registered patients, underwent the painstaking process of rechecking all of the practice’s disease prevalence registers to ensure all patient data were coded correctly against the Quality and Outcomes Framework (QOF) criteria.

The process not only meant conducting a thorough search of the surgery’s database and re-entering correct Read codes, but also involved telephoning and screening patients to make sure that health conditions were correctly attributed.

“The project was conducted in a very planned way, like a military operation,” said Toni Cooper, the practice manager at medical centre. “For instance, one day we’d look at the prevalence data for diabetes, then the next day we’d move on. It did work and I was amazed by the results.”

The practice’s efforts paid off as they received a certificate of achievement from their PCT. For the practice team, though, the most important outcome was the increase in quality of service, as patients were now monitored more rigorously and given the most appropriate medication.

“With just a little bit of effort and hard work, patients we were theoretically missing or hadn’t originally coded right were now getting a better service,” said Mrs Cooper.

Award judge Jane Gamble, a practice manager with more than 20 years’ prior experience of banking, explained: “We were looking for a practice that was making the most of its income and expenditure, but also looking at how this affected the whole team and the patients.”

Seven Brooks’ patient-focused approach is reflected in Mrs Cooper’s decision to send out birthday cards to every patient who reaches 65. These patients are also given an appointment with the practice nurse for a pneumonia injection as well as a full health check and blood test with the healthcare assistant.

Winning the Practice Finance – Royal Bank of Scotland Award means recognition for the surgery’s hard work, says Mrs Cooper. “We’ve tried hard as a team and we do work as a team. It’s recognition of your achievements and it’s make you feel, ‘we are doing something good, maybe we should continue and do something else’. It makes us think: ‘What can we do next year?'”

Customer Care Award and Innovation in Training – AMSPAR Award: Hunter Family Practice, Craigavon
An inspiring double winner, The Hunter Family Practice – in Craigavon, Northern Ireland – took home the Customer Care Award and the Innovation in Training Award (sponsored by AMSPAR).

The practice team went beyond statutory disability law to improve access and support for their deaf and hard-of-hearing patients, to the extent that they became the only GP surgery in the UK to be awarded a “Louder than Words” charter by the Royal National Institute for Deaf People (RNID).

Achieving this required motivated teamwork, as practice staff were encouraged to learn new skills. All members of the team attended an “Introduction to Signing” course. Two members of staff commenced a one-year British Sign Language (BSL) course at a local college. Seven members of the reception and switchboard staff completed Typetalk/Textphone training.

Practice manager Lorraine Hughes collected the two awards on behalf of her team. “I can’t tell you how much this means to us,” she said. “The feedback we got from our patients was wonderful, and the project also increased team motivation and morale.”

In Northern Ireland, there are upwards of 250,000 deaf or hard-of-hearing people – this figure is set to rise as the population lives longer. The practice therefore decided to introduce a number of initiatives to improve access and services for these patients.

In addition to the staff training, the practice also installed:

  • Flashing lights linked to the practice’s alarm system to alert deaf people if evacuation of the health centre is necessary due to fire or other danger.
  • Induction loops in all consulting rooms and for both reception areas.
  • A visual patient-call system in the waiting room.

Furthermore, a deaf/hard-of-hearing register was compiled, with computerised flagging of patient records to alert staff if a patient has a hearing problem. A card-call system was introduced for deaf patients attending the treatment room so the nurse could easily identify and call the patient without causing embarrassment.

Practice manager and partner Sonia Clark, who teaches courses that promote awareness of customer service across the frontline of general practice, was one of the judges of the Customer Card Award. She explained: “We were looking for innovation, for practices who listen to and represent their patients.

“We have moved from a time where we were all about numbers and statistics to one where we want to earn our patients’ respect. I believe that customer care is the future of primary care.”

The Innovation in Training – AMSPAR Award was presented to Ms Hughes by  Elaine Guy, President of AMSPAR, who said: “We were looking for something that involved and motivated the entire team and that also improved patient care.”

She added that the Hunter Practice had “showed a real interest in training and development to improve the whole team approach to patient care and the services offered by the practice”.

Ms Hughes said: “As practice manager, I am very proud of the practice team, which has shown commitment and loyalty to the practice and gone the extra mile to ensure that we achieved our goals”.

Design and Facilities Award: Polkyth Surgery, St Austell
Dr Paul Travis and Dr Pernell Tempest, partners at Polkyth Surgery in St Austell, Cornwall, had long recognised that their outdated 1980s practice premises were in need of expansion in order to keep up with their growing patient list and increased services.

However, primary care trust (PCT) funding for enlarging the building was not forthcoming so, as an alternative solution, the partners themselves decided to invest in a total refurbishment of the surgery’s interior.

The old waiting room and reception areas were rearranged, and the new reception is now in an open, enlarged space. The new waiting room also allows more light and room for patients. Furniture was replaced throughout the entire building.

To increase the number of appointments offered, the practice took the unusual step of actually reducing the number of consulting rooms from five to four. The GPs now “hot-desk” across each of the four rooms.

“We anonymised the consulting rooms so they’re completely identical,” explained Mrs Clemes. “By doing that, we now have a much more flexible rota and make better use of the space.”

Two small back rooms were converted into one “Management Suite” for nonclinical staff, and a new “Notes Room” was created for the practice’s medical records.

The changes have meant the practice has been truly transformed. “We have a trainer who comes in once a year,” said Mrs Clemes. “He came in prior to the renovation and afterwards. He said: ‘It’s a completely different surgery. It’s like walking into a new building’.”

The project succeeded in the practice’s aim of improving patient experience. The practice’s latest general practice assessment questionnaire (GPAQ) results showed vast improvements in all areas.

“Patient satisfaction has improved immensely,” said Mrs Clemes. “We’re getting lots of comments that ‘things are so much better now’. Patients are a lot happier and it’s made a big impact.”

Dr Travis said: “This award means a lot to us and I’d like to thank all members of the team. We underwent a complete refurbishment, putting the customer – our patients – first.”

Mrs Clemes added: “We were overwhelmed and overjoyed to win. Dr Travis and Dr Tempest were absolutely thrilled that someone had recognised what they had done and that all the blood, sweat and tears were worth it.”

Innovative Use of Technology Award: Sara Trow, Heart Failure Community Matron, Blackpool
Sara Trow, a heart failure community matron at the Lancashire Cardiac Centre, Blackpool, won the Innovative Use of Technology Award for her inspiring work helping patients with chronic ill health to regain control over their lives.

She was nominated for this award by Elina Dupres, a senior commissioning manager at Blackpool PCT who told Management in Practice how Ms Trow had enabled her patients to “regain a quality of life and independence that they assumed was beyond them”.

Ms Trow has a caseload of approximately 60 patients with long-term conditions that can lead to heart failure – the conditions she sees range from chronic obstructive pulmonary disease to diabetes and renal failure.

She won the award for work in two areas, both of which help patients to stay out of hospital: the use subcutaneous diuretics, and adopting telehealth technology to monitor her patients.

Piloting the use of subcutaneous diuretics, Ms Trow successfully treated an elderly patient with chronic ill health. Clinicians had previously struggled to keep this patient’s weight stable, to the extent that hospital admission for intravenous diuretics was required.

However, through the use of subcutaneous diuretics, Ms Trow was able to stabilise the patient’s renal function and weight, controlling her symptoms and enabling her to stay out of hospital.

For the last year, she has also been using telehealth technology closely to monitor her heart failure patients, who use a monitoring device set up in their homes to record their blood pressure, heart rate and oxygen levels every few hours, at the touch of a button.

“These daily readings mean we can treat patients before crisis points, therefore stopping hospital admissions,” Ms Trow explains. This preventive approach not only gives patients reassurance, but also allows Ms Trow to focus her time on patients that require the most urgent attention.

She said: “I hope that winning this award can help raise the profile of these kinds of technology, and encourage more practices and practitioners to adopt this approach to help their patients.”

Judge Barbara Stuttle, National Clinical Lead for Nursing at Connecting for Health, explained why Sara won: “We were looking at how people making technology work for them and moving patient care forward”. As well as the award and prize money, Mrs Stuttle also handed Ms Trow the surprise gift of a laptop computer to help her in her work.

Practice of the Year – Wesleyan Medical Sickness Award:
Limes Medical Centre, Epping
A question posed to Tony Blair on the BBC’s Question Time in 2005 was the trigger for change at the Limes Medical Centre in Epping, Essex, the winner of the “Practice of the Year” award, sponsored by Wesleyan Medical Sickness.

During the last general election campaign, a question concerning booking a GP appointment was asked of the then prime minister. The question was put by a patient at the Limes Medical Centre, and the practice suddenly found itself “thrust into the spotlight”, in the words of practice manager Debbie Bodhanya.

Galvanised by the incident, the practice, which cares for 16,000 patients, went on radically to improve patient access by creating a robust triaged access system that took 18 months to research, develop and then implement.

Key to the new system was the practice’s desire to provide “the right service to the right patient at the right time”. A dedicated project group was set up, detailed interviews were conducted with patients – asking how they would like to see the service evolve – and research data and information from access models used elsewhere were analysed.

The result was a triaged access system that enabled the team to identify acute and chronic care pathways quickly, providing excellent continuity of care and enhanced satisfaction for patients, as well as improving staff motivation.

The enterprise involved the entire practice team, including a coordinating role for the healthcare assistants. New training needs were identified, and new working rotas and team structures introduced.

Furthermore, the practice’s entire operational procedures had to be altered, as access hardware and documentation needed to facilitate the process were introduced, and the telephone support system was upgraded.

As a result of the project, the practice has seen vast improvements across all areas – from positive patient feedback and clearly identified patient pathways to an increased skill mix and greater staff satisfaction. “We are now ready to face the increased competition in the marketplace knowing that we have robust and safe systems for our patients,” said Mrs Bodhanya.

Announcing the winner of the Practice of the Year – Wesleyan Medical Sickness Award at the October ceremony, Judith Harvey, a GP and coauthor of The Handbook of Practice Management, said: “Judging this award was an inspiring experience. We were looking for a practice that was thinking outside the tickbox and had done something innovative.”

Mrs Bodhanya added: “We were really pleased to win this award. It’s a recognition of all the work we’ve been doing around the access project. And it’s a nice boost and a morale-lifter for our team.”