Next Steps

Working together for a healthy future

EPiC Practices

Overview

An overview of EPiC•What does EPiC want to achieve?•How will we do it? •What are our outcomes? •What will it mean for people using the service? •Supporting structure•The practice

The five service redesign areas•Extended hours and skill mix•GP triage•Pharmacy•Community Navigation•Redirection of Workflow

What does EPiC want to achieve?

For people using services:

To bring better access, better experience, more choice, better information, safer care, and to put people in

control

For general practice:

To work towards a more sustainable model of general practice

How will we do it?

• By building the skill mix within practices and their community partners to deliver collaborative same day access

• By connecting to pharmacy and voluntary sector partners

• By delivering extended access in terms of location, hours, and the ways people can contact the surgery

What outcome will doctors surgeries achieve?

• Up skilled workforce and sustainable training programmes

• Access and knowledge to Community resources

• Sustainability - Change in skill mix, reduction of A&E and non elective care admissions

• Ability to increase list size without increasing GP numbers

• Time to think – Better clinical decisions through an improved working life

What it will mean for people using the service?

Supporting structure

EPIC Project Board Chair: Jonathan Serjeant

Members: Jessica Sumner (Age UK), Sarah Bartholomew, Lindsay Coleman, Pharmacy, 2 GP practices, Co- chair PC Citizens Board, CCG

clinical lead

Primary Care Citizen’s Board

Representatives from PPGs and Healthwatch

Operational Implementation & Sustainability Group. Chair: Sarah Bartholomew This group will be responsible for the implementation of the project and supporting the 5 service redesign areas.

Action learning sets (Fast Starters Module 1)

1. Care Navigators Lead: Jessica Sumner

2. Pharmacy Lead: Ramiz

5. Redirecting workflow – delivery of central Back office functions Lead: tbc

4. GP Triage

Lead: tbc

Action learning sets (Fast Starters Module 2)

2 More CQG’s will be introduced for early adapters

after 6 months

Action learning sets responsible for 5 service re-design areas. Each of the 5 redesign areas will have as a minimum:

Named GP lead Named Practice Manager lead Citizen Representatives from other service

re-design workstreams as required Project coordinator support

Project Director Project Manager Project Coordinator IM+T Manager IM+T Analyst

3. Extended hours and skill mix Lead: tbc

Cross cutting areas span all 5 service redesign areas and include IM&T, engagement, co -production, training and continuous learning and finance.

ALS’s are made up of Practice leads and pharmacy leads. They are responsible for clinical areas of quality and safety.

Extended hours and skill mix

Throughout September, practices in the Fast Starters will begin a phased implementation of extended hours. This service means that people will be able to access routine primary care in extended hours until 8pm on a M-F evening and for 6 hours on a Saturday and Sunday. Early Adopters will start this roll out at the end of October.

Please note: Individual practices will NOT deliver these extended hours on their own, but as part of a ‘cluster’ or ‘module’.You can find out which module you are in here.

The extended hours service provides pre bookable appointments, face to face (F2F) and telephone, for people who find it difficult to access routine primary care Monday through to Friday. These include:• Working people• School children who may need working parents to accompany them• People who need a carer to come with them

The service also includes education and support groups to be held on a monthly basis, e.g. Diabetes or Asthma, pre-bookable or walk in. People will be able to access their annual review, education and support groups.

Extended hours service

Person using service “I am now able to access routine primary care at a time which suits me, my

family, and my home and working life.”

GPI have oversight and

leadership of the extended hours

service. I also see people with complex

needs, who may need a carer to access the

service

PharmacistI deal with requests for repeat meds, including

contraception. I undertake medication

reviews. I provide appointments for minor infections,

hayfever/asthma, minor skin conditions

Nurse practitioner I support complex

chronic disease management and prescribe for the

nursing team and pharmacist. I carry out routine appointments and see referrals from

NHS 111.

Practice Nurses / HCAs I support chronic disease management. I carry out routine appointments for

annual CDM checks, smears, dressings, NHS

health checks, contraception,

immunisations and phlebotomy etc.

Voluntary sector and specialist nursesWe run education

and support groups. These include

diabetes, asthma and COPD

Community Navigator

I see people with complex social needs

who may need a carer to access my

service.

Extended Hours

What do we need to do?• Work with us to identify staff interested in working for the extended hours service• Nearer the time liaise with practices in your cluster to discuss rotas, sharing of clinical

staff, medical records and practice systems• Prepare to actively recruit people for the extended hours service once the booking

system is available and training complete• Consider which patients will benefit from the education and support groups, e.g.

people who struggle to access their annual reviews in working hours.

EPiC team will provide:• Simple template/questions (called Encounter) for admin and reception staff to follow.

This will help staff signpost people to the right health care professional and the right service and will provide a simple way of logging the outcome of the conversation

• Training on the extended hours booking system• Training for GPs on SystmOne and EMIS• Training for admin and reception staff• Posters and leaflets

GP triage –What is it?

There are three parts to GP triage:• GP Access- a different way of working• E-consultation and the Hurley Group website• GP triage and the extended hours service

GP Access

If you have agreed to implement ‘GP Access’.

How does GP Access work?• GP Access is a new and different way of working.• In a GP Access practice, Receptionist takes the call of which 20% are admin queries and dealt with

there and then and 20% are redirected to the nurse• The remaining 60% are directed to the GP who calls the patient back and discusses their needs. GP

Access has shown that of these calls, 60% can be managed there and then, 10% directed to the nurse with only 30% converting to a GP appointment.

What do we need to do?• Brief all members of the practice about GP Access, why you decided to sign up for it, what it will mean

for the practice and your staff • Point them to the GP Access presentation if they want more information.

EPiC team will provide:• Name of GP Access member who will be project manager/ support• Training for GPs• Engagement with people using your service• Data capture and on- going support

E-Consultation-Hurley Group

If you have expressed an interest in the Hurley Group website, a tool developed by GPs in East London that delivers e-consultation.How does it work?• It provides electronic consultation across 100 common conditions• Approved by the 3 GP defence unions• Once person has completed the questionnaire, they press submit and a PDF is

logged in practice• Practice makes contact the next working day.What do we need to do?• Nothing yet unless you change your mind about having the toolEPiC team will provide:• Name of member of the Hurley Group team who will work with you to upload the

banner to the practice website, provide you with the template letter for your medical defence union and all marketing materials

• Training support• Further detail will be provided at the next ALS or can be sent to a person of your

choice.

GP triage

GP pathways include:• Long term conditions-scheduled care• Long term conditions- urgent care• New illness-not urgent• Acute social need• Acute illness• Palliative careWhat do we need to do?• Pathways to be shared with the practice teamEPiC team will provide:• The pathways at the next ALS or they can be sent to a person of your choice• Training in capturing GP triage in practice systems• Training in booking into the extended hours service• Joint training with EPiC Pharmacists to support familiarisation with the pathways,

systems, access to person’s medical record and the operational requirements of the extended hours service.

Pharmacy

Pharmacists will have a key role to play supporting general practice to manage the routine, non urgent case mix and those people who struggle to access primary care in working hours.Pharmacists will offer an enhanced service supported with access to the person’s medical record, patient group directives (PGDs) and training.There will be more opportunities for people to access this enhanced service in places that are already familiar to them.

Three levels of service:• Level 1: Pharmacist has access to person’s medical record and is trained to use

them and answer medication queries• Level 2: Trained Pharmacists work with PGDs and offer appointments to

manage common ailments. There will be 3-4 Pharmacists per module/cluster of practices

• Level 3: Independent Prescriber provides clinical consultations

EPiC will focus on Levels 1 and 2.

Pharmacy

Pathways in first wave:• Minor infections, e.g. eyes• UTIs and thrush• Minor skin conditions e.g. infection, bites and stings• Rescue inhalers to counter flare ups• Medication reviews and queries• Contraception

To find out the EPiC Pharmacies in your module, click here.

Pharmacy

EPiC team will provide:• A joint training session to introduce you to the EPiC

Pharmacists in your module. Training to include Information Governance (IG), IM&T (booking system, accessing the medical record, metrics) and clinical issues (a list of ailments and conditions the Pharmacist can treat, the PGDs and how the Pharmacist will refer back to the GP if this is indicated)

• Please note one GP per practice will need to sign off the PGDs on behalf of their practice

• Ongoing advice and support

Community Navigators

Social and other non-medical issues can have an impact on a person’s health.

Trained volunteer Community Navigators will work with people referred to the service to understand the person’s social, emotional and practical support needs.

Their role will be one of assisted sign posting to the full range of community based services, accompanying the person to the service for the first time if this is indicated.

By assisting access the aim is that the person experiences a reduction in their feelings of isolation and loneliness

Community Navigators

There will be two ways to access the service:• Proactive case finding by GPs• Via GP triage

The navigators will make contact with the person to agree a way forward and whether the person is able to discuss their personal circumstances via the telephone or whether F2F or home visit is indicated.

The maximum number of visits per person will be limited to three to counter dependency issues

Navigators will feedback to the practice on the outcomes

Community Navigators

We will let you know as soon as the service is available together with the referral details. At this point we envisage the service will start offering pre bookable appointments. What do we need to do?• When we give you the nod, start proactive case finding those people who may

benefit from a Community NavigatorEPiC team will provide:• Names of the volunteer Community Navigators who will support your practice• Names and contact details for the Project Manager and Co-ordinator managing

the volunteers and the service• A training package for your practice with information about the service, a

definition of what may constitute a ‘complex’ case and patient pathways.• An approach that will help you with case finding by plugging a query into your

practice system

Redirection of workflow

Routine administrative work will be directed away from the GP and redirected to the admin assistant and clinical PA. The emphasis is on freeing up GP time and at the same time maintaining patient safety.

Pathways and protocols have been developed with the aim of standardising the process and creating a common approach across practices.

The pathways are :• Outpatient letters• DNA letters• Medical Reports

Templates will be created and shared for both SystmOne and Emis.

Redirection of workflow

Due to training capacity the roll out of these protocols and processes will be phased from the 1st September.

This work stream is very much targeted towards your admin teams. It provides a real opportunity to get them involved in pathway redesign and increasing the efficiency and effectiveness of the practice.

The admin teams at Benfield Valley Healthcare Hub have tested these pathways and are very much on board

There is the opportunity for admin teams across practices to learn from each other and share experiences.

Workflow redirection

What do we need to do?• Brief your staff about this work stream and identify those

interested in leading the work on behalf of the practice

The EPiC team will provide:• The final pathways, protocols and system templates• Training package that can be tailored to your individual

practice• Funding for backfill during the training and

implementation period• Advice and support