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Profile: Wait and see

30 August 2013

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Working as both a practice manager and programme manager of innovation at BHR CCGs, Colleen Atkinson talks about how the two roles complement each other

Although practice managers are notable by their absence in the literature surrounding the reforms, some are stepping forward to deploy their skills on behalf of clinical commissioning groups (CCGs).

Colleen Atkinson, one of two practice managers at Trap’s Hill Surgery in Essex, is a great example having taken on the role of programme manager for innovation for BHR CCGs, which covers Barking and Dagenham, Redbridge and Havering.

Colleen says her two roles complement each other. As a practice manager, she can swiftly assess how realistic CCGs plans are in terms of their implementation in general practice. 

On the other hand, her role in the CCG means that she ensures Trap’s Hill Surgery is at the forefront of innovations and the new directed enhanced services (DES).

“Being rooted in the grassroots of general practice two days a week and trying to help GPs lead change in the health service three days a week works very well,” said Colleen.

Trap’s Hill surgery is currently run under an alternative provider medical services (APMS) contract, and comes under Essex CCG. 

The surgery has a somewhat tumultuous history. Originally ran single-handedly by a GP, it was taken over by Essex primary care trust (PCT) in 2004, before being tendered out in 2009 when government regulations changed to prohibit PCTs from providing and commissioning services at the same time. 

The contract was won by a group of local GPs, who got together in an entrepreneurial move to form Loughton Community Health Limited.

Among the spate of polyclinics which opened up following recommendations to improve patient access in the Darzi report published in 2008, Trap’s Hill surgery had been tendered out to provide both GP services and a walk-in centre under one roof. 

However, when the walk-in centre proved to be not value for money, it was decommissioned, leaving just the GP services, with the one remaining GP, Dr Sevastos Moutafi, as the director of services.  

Working two days a week at the practice, Colleen undertakes a variety of duties including managing finances, working with IT systems and dealing with human resources. Laughing that she has become somewhat of an employment guru since working there, Colleen says, “It’s a generalists job. You’ve got to be a generalist to work as a practice manager.”

Colleen describes her work at the CCG as prototyping prior to QIPP (quality, innovation, productivity and prevention) where business intelligence is derived from a variety of databases and used in devising interventions to improve care and make more efficient use of resources. The interventions are then first piloted on a small scale before directives at the national level are announced.

With Colleen’s CCG role also requiring involvement in specifications sent out to general practices, she is already familiar with what to expect when the directives are received at the surgery, giving them a head start as her practice CCG is similar to the CCG she works on.

Referring to the online appointment system they have in place at the surgery, Colleen said that she had read the paperwork concerning the corresponding DES for it “line by line” before even thinking about it for the practice.

In a bold move, Trap’s Hill Surgery is planning on signing up to all four new DES’s which will be offered to Essex CCG after June 30, in addition to those that they have already taken up in the 2012/2013 roll out, such as extended hours and patient participation. 

The new DESs include a risk profiling scheme to anticipate the needs of physically and mentally vulnerable patients; testing for dementia in at-risk groups; supporting people with long-term conditions to monitor their health remotely and on-line access to practice services such as booking, ordering, prescriptions, test results and medical records.

While many general practices already have systems in place for online access to practice services, the first three DES’s are relatively new. 

However, having already been involved in supporting providers of telehealth services and piloting risk stratification initiatives, which involves identifying those most in need of integrated health services in her CCG role, Colleen is quietly confident about what to expect. 

As well as Colleen’s innovative spirit, which carries from her CCG role, financial viability has also been a key driver of innovation at the practice in this era of austerity.

With constraints to budgets in the face of an increasing number of patients and workload, Colleen said that the key was to work “smarter and leaner.” 

Her fellow practice manager Donna Richardson, who also works for BHR CCG in a similar role to Colleen, discusses some measures the surgery has taken to make the best use of resources and prevent wastage.

These include using an automated messaging service to send out reminders about appointments, to inform patients when appointments have been missed, and to inform patients of blood test results in incidences where the results are normal.

A change to patient access via telephone triaging, which has been in place since September 2012, has also led to an increase in patient access from 33 to 47 slots per day, with half of the patients not requiring face-to-face medical attention.

“This shifts the emphasis to what clinicians think is urgent as opposed to what the patients think is urgent” Colleen said.

Among the innovations that Colleen has been involved in through her CCG work is the patient checklist for those with chronic obstructive pulmonary disorder (COPD), which won a health innovation award in 2012. 

Drawing on data from information systems, the checklist provides an individualised scorecard specific to each patient, outlining checks which have been completed and those yet to be completed. 

The checks included on the scorecard are based on best practice guides for COPD. 

With COPD being one of the categories included in the much debated quality outcomes framework (QOF) where financial incentives are offered, provided certain indicators are met, the checklist offers a tailor made approach to providing care for COPD patients.

Colleen is also working on the development of a patient satisfaction mobile application that was proposed by a GP colleague.

This is particularly relevant in light of the continuing debate about standard of care following the Francis inquiry into the Mid Staffordshire scandal.

The app will provide instant feedback, which allows patients to rate the quality of care in a number of settings as and when it happens across the NHS including after being admitted to a hospital bed for an operation, a visit to the practice or receiving a visit by the nurse. 

“That’s another fascinating area for development. It provides instant feedback. It’s a brilliant idea,” said Colleen “As soon as we get that [up and running], we will be saying can we have it over here in the practice.”

The practice currently scores below average in patient satisfaction on NHS Choices, so there is a drive to improve performance in this area for which the first step is getting more patients involved in providing feedback on services. 

The surgery plans to achieve this through the distribution of surveys manually as well as through online initiatives. Key to understanding patient satisfaction will be feedback from patient participation groups, which the practice is seeking to expand to include a more representative sample through sending out quarterly newsletters and plans to develop virtual forums. 

“Currently, those in the participation group are from an older age group. Young people don’t come. We need a range of views because what suits a group of 10 people over 65 won’t necessary suit the needs of young mums. They’re going to have different issues,” said Colleen. They are also working with The Primary Care Foundation to identify changes that can be made to improve access.

Forever the objective analyst, Colleen is also keen to find ways to measure compassion, which is currently high on the agenda in healthcare.

“I think key in general practice is compassion, and while a surgery may have bucketloads of compassion, you can’t measure it,” Colleen said.

Sharing an example of compassionate care. Reception supervisor Francis Kruse tells how she and another member of staff, Daisy Saunders, went to check up on an elderly patient at his home after he had missed an appointment at the practice to get a bandage change. 

“Even though he’d just been to see us the day before, when I didn’t see him come for his appointment on his little scooter, I just had the strongest feeling that something was wrong,” Frances said. “I never had such a strong feeling in my life.”

When the staff arrived, they found that the elderly gentleman, who had been registered with the surgery for 56 years, had unfortunately already passed away. 

Though the surgery had been unable to reach the elderly gentleman in time in this instance, this is an example of a surgery caring enough about its patients to go out of their way to check on their welfare after just one missed appointment. 

In the face of the largest upheaval in the NHS since it was established, which has led to the instatement of GPs and others in the frontline of medical care as key decision makers in commissioning medical services, how things will turn out remains to be seen.  

However, with involvement in their local CCG and two practice managers who have roles within it, Trap’s Hill Surgery is a prime example of how the reforms have affected the structure within general practices. Optimistic that involving GPs and frontline medical practitioners in commissioning roles is a step in the right direction, Colleen said: “Time will tell. I guess we just have to wait and see.”