Andrew Paterson and Mohsin Patel discuss how general practice can navigate the ‘new normal’ when patient expectations are constantly changing
The COVID-19 pandemic has changed the way in which patients access primary care services in England and revolutionised the definition of access. The NHS saw nearly 40% of GP consultations taking place remotely, primarily by telephone, and this picture continues to change. Face-to-face consultations reduced to only 10% of all consultations at the height of the pandemic, however they are now beginning to rise again, currently at approximately over 60%.
Pre-COVID, the NHS was facing increasing pressures with growth in patient numbers and reducing staff ratios, despite national recruitment drives to increase ‘front-line’ workforce into the NHS. Financial constraints and rising cost pressures have increased this challenge.
Ensuring everyone can access services on an equal footing is a key priority for the NHS, however at present, the gap continues to widen due to health and social care inequalities. Health outcomes are worse for people in deprived areas, those from ethnic minorities such as Asian/African backgrounds, and vulnerable groups like children and young people (CYP), individuals with learning difficulties (LD), autism, dementia, general mental health, and individuals with long-term conditions who account for the majority of health and social care interactions and resources.
It is vital systems have a comprehensive understanding of groups in the community who are experiencing barriers in accessing services and have processes in place to address those barriers and ensure improvements in access to general practice services can be realised.
New normal
The pandemic has changed the concept of access to health care. The post pandemic world has been training populations out of necessity with one of the steepest learning curves since the second world. People are not only aware, but have become more adept with digital technology, using computers, tablets, smart phones etc. With the advent of high internet and broadband speed, there is continued rise and maturation of social media apps, applications, and websites.
The pandemic has also stimulated growth in online shopping, for both groceries and clothes, with some deliveries being offered within 30 minutes. Similarly, online banking and remote working is completely altering the way populations interact and travel, which can often result in more sedentary lifestyles.
Post-pandemic patient behaviour and expectations:
All the examples described above are important to understand what are likely to be the behaviours and expectations of patients and carers in the future. This may manifest itself through the desire to seek out greater information relating to particular conditions, and the medium through which individuals wish to communicate and interact; through remote consultations, group consultations and accessing information online. Moving forward it will become increasingly important to consider flexibility in access times for services, with options for early morning, late evening, and weekends, to accommodate the needs of patients and carers.
Opportunity:
The ‘new normal’ provides a unique and once in a lifetime opportunity for primary care to change their offer of traditional access and provide services in a way that improves outcomes for patients and appropriate utilisation of health and social care resources is achieved. Through our access to numerous practices and primary care networks (PCNs), who have developed and tried different access related local models of care pre and post pandemic, as well as links with academic research we offer several options for individual GP practices and PCNs.
Solutions to consider:
PCC has worked nationally across organisations and delivered several models for improved access, taking into consideration population needs and workforce requirements/access to resources, together with maximising income while maintaining or improving quality. Such models have included:
Scaled up access – working with multi-site super practices or at a PCN / federation level; as well as for out of hours and extended access/weekend cover
Optimisation of appointments; utilisation, reduction in waiting times, and DNA rates
New local place-based pathways with other providers like acute, community, social care and mental health (MH) for frequent attenders and review of A&E, urgent care and MH emergencies (LD, MH, CYP groups)
Sub-contracting to other PCNs, Federations, NHS Trusts or third-party private providers during peaks and troughs (winter pressures, pandemics etc.)
Exploring, developing, and embedding new digital access solutions like e-consult, remote or video consultations with local ICS IT teams. Virtual home visits, virtual wards, NHS @home
Quick wins and tips/tricks to use GP IT systems (EMIS, Vision etc.) – smart use of templates / coding to increase access for vulnerable groups, QOF and LTC as well as be CQC compliant and increase practice access income
Non-clinical workload mapping (via audits for documentation, pathology / blood tasks, secretarial tasks, referrals, sick notes, prescriptions, subject access requests, calls, reception queries etc.) – to optimise and release staff times
Effective and appropriate use of the new ARRS staff to release GP, nurse, pharmacy and other traditional role capacity
Routine GMS/PMS/APMS contract related primary care access including extended access /hours, out of hours models and managing urgent/non-urgent care
What will help your area needs careful consideration. For more information contact [email protected].
Be the first to comment