Promoting self care in your practice

Andi Ireson Self Care Facilitator

Engaging Health Care Professionals

in North Bradford and Airedale PCT

The start up process within the PCT

• Exec sign off• Launch at Practice Managers meeting • Individual practice meetings (by invite)• Attend Forums

– HV

– District Nurses

– School Nurses

– Consumer Councils

– Clinical Leads

• Mixed responses!

Incentives for practices

• Major driver for achievement of targets ( and therefore rewards) GPs as commissioners seeking efficiencies by:

– Demand management

– Linking minor ailments schemes

– Long term conditions management

– Choice – giving patients the skills to choose.

Financial incentives

• Scheme already in place

• No real outcome targets linked to payment

• Difficult to change existing arrangements

Numbers

• 16 groups – 14 practices, 1 Community Intervention Team, 1 PCT Clinical Leads group.

• 39 sessions.• 2 non-starters - other time demands.• 1 practice pulled out after session 2.• 1 practice demanded shortened sessions x 2.

The broad approach

• Three facilitated sessions offered. • Account Manager relationship with each practice.• Identified practice lead. • Facilitation not self care expertise. • Acknowledgement of building on existing……• Based on gaining ownership, focussing on high demand

low complexity top time takers. • Led into mini projects to problem solve areas identified. • ALL practice team involved.

What we got!

• Mixed responses.• Different paces required. • Often cold start but usually warm finish to sessions! • Reception staff most likely to disengage.• Session feel reflected the culture of the practice overall. (

not surprisingly!)

What worked well.

• Account Manager relationship. • Flexing pace to suit. • Flexing in sessions.• Mixing staff groups.• Sharing ideas across staff groups. • Helping staff groups understand shared problems

from different perspectives. • Using data to inform decisions.

What else would have helped?

• Learning to share….. but then it was a pilot!!!• Specific ideas for them to try….. earlier. • Possibly using the Circle of Influence during the ‘Sales’

pitch. • More focus on financial incentives for completion. • Clearer links to other practice targets.

Tools used

• Circle of control, influence, concern.• High demand, low complexity, top time taker matrix.• Care pathways • Basic project management action plan.

Circle of Influence

Remember: - You need to keep expanding your ‘Circle of Influence’

Circle of Control

Circle of Influence

Circle of Concern

Working up a plan

• Now use the template flip chart and decide

– What, specifically a good result looks like for this piece of work.

– Who needs to be involved to make the work a success – internal and external.

– Who should sponsor and who should lead the work.

– What you will have achieved in relation to this by the next session.

– How you’ll know that you’ve been successful in what you’ve achieved.

( Sponsor = the person in the practice who can unblock any blockages as necessary)

Outcomes from the sessions (1)

• Mini surveys amongst patients who attended between eight and 11 times a year to get a clearer picture of why they attended.

• Exploring whether the practice could provide other services that would help patients and whether they needed to be redirected to more appropriate services. E.g. setting up a support group for patients who shared a common problem e.g. multiple sclerosis.

 

Outcomes from the sessions (2)

• Review of the appointments system to highlight inappropriate appointments

• Trial telephone consultations with GP's• District Nurses in the process of identifying cases where

the DN visit has been inappropriate or not required• Educate patients to understand that test results won't be

available until after 4 weeks.• Support and information to people suffering from

depression from staff who are based at the practice. • Practice website developed to offer personalised self-

help information from GPs on various common conditions.

Outcomes from the sessions (3)

• Review of repeat prescription process resulting in less wasted time and more responsive service for patients.

• Better understanding of presenting conditions of high practice users.

• Redesigned reception facility to give greater responsiveness and confidentiality.

• Extended receptionist role to include health care advice. • Introduction of group education sessions to educate

patients with long term conditions to self care. • Redesigned patient information to support a shift in

emphasis towards self-care • Elderly Care Workshop organised for patients 55yrs plus

Outcomes from the sessions (4)

• Advice from pharmacy to patients via the practice on how best to use pharmacy services

• Engagement of the Patient Council in promoting Self Care within the practice

• Better understanding of the requirements of care homes of GP’s and alternative ways to manage the same.

• Reduction in unnecessary home visits to deliver equipment.

• Audit and review of appropriateness of referrals to the Community Intervention Team leading to a re-education exercise on how to make best use of the service.

• Introduction into the practice of Citizen’s Advice

Where are we now?

• Aiming to resource roll out. • Receiving lots of requests for input. • Still learning.