This week’s leadership message comes from Dr Andrew Sixsmith, a GP from Keighley and member of our primary and community care programme group.

Hello my name is Andy. 

I’m a local GP, proud to be working in Keighley. I’m also working alongside Carol McKenna and other health and social care colleagues on the primary and community care programme for the West Yorkshire and Harrogate Health and Care Partnership. When we talk about primary care, we are talking about GPs, district nurses, health visitors, midwifes, occupational therapists etc.

Changes to primary care are taking place quickly across our area. The new model for how we care for people being implemented aims to improve people’s health across Bradford District and Craven, Calderdale, Harrogate, Kirklees, Leeds and Wakefield. We’re doing this by increasing the skills of our workforce, using technology and more effective and efficient use of buildings.

The changes are also about thinking outside the traditional ways of working. It’s known that things like the quality of a person’s relationships, whether they have a job, their home and the neighbourhood they live in can all have a big impact on both physical and mental health.

Our work is more than just managing a person’s illness, which we know is important. To really transform care we need to look at the reasons why some illnesses happen in the first place and to work with people, their families, and communities to age well.

Sustainable, healthy communities really are the thing of the future which we need to be part of.

One way we’re making that ambition a reality is by using population data - the information, intelligence and insight that we have about people who live in our communities. By working alongside our public health colleagues, who are very good at predicting people’s health, we can understand the communities where we live better and target the care to those most in need.

Looking at performance data will also help us see where there is any variation in people’s experience of care. We want everyone, no matter where they live, to enjoy the same level of high quality care. This is after all only fair and right.

Our new approach is all about working collaboratively with other practices and healthcare providers, sharing learning and working together with people to deliver health and care in manageable chunks.

In West Yorkshire and Harrogate there are 50 neighbourhoods each made up of about 30,000-50,000 people. We’re making changes so that health care teams, community nurses, voluntary organisations, social workers, GPs and occupational therapists work together to wrap round communities in ways that provide better joined up care.

We are also empowering people to have a voice in their own care (often referred to as personalised care and choice). This will help people to look after themselves and receive the support they need to remain healthy and independent. 

One area where we’ve made changes is in training staff. Previously only GPs benefitted from a vocational career scheme. GP practice nurses used to be recruited or ‘poached’ from community care providers or hospitals who had originally trained them.  Now, for all clinical staff there are four primary care training hubs that serve every West Yorkshire and Harrogate practice supporting the training of student nurses, general practice nurses, health care assistants, advanced clinical practitioners and physician associates. The West Yorkshire and Harrogate Excellency Centre is now offering training for non-clinical general practice staff.

In such a short period of time an entirely new system of training staff now exists to ensure that primary care has the potential be self-sufficient in terms of building and expanding our future workforce.

You may have read Carol's blog where she talks about the importance of GP recruitment. We are working to increase training numbers of newly qualified GPs and have an ambitious programme to recruit, retain and return existing GPs.

Previously, GPs did most clinical tasks on their own with little help. Now, they will be assisted by allied health care professionals such as clinical pharmacists, physiotherapists, mental health workers and physician associates – all seeing people in their local surgery or communities.

Other colleagues like paramedics, end of life care nurses and community matrons will also help GPs with home visits to housebound and frail patients. This will help people with chronic diseases and long term conditions stay well and independent for as long as possible.

Previously 40% of GP workload was spent working with people experiencing mental health difficulties mostly related to socially determined problems (such as housing problems, debt worries, air pollution, addiction and unemployment). Now, GPs work with care professionals called ‘social prescribers’ to help solve problems and guide people into meaningful occupation, relationships and environments that lead to better social and emotional health.

Of course, creating new roles in primary care benefits our workforce too and opens up new career avenues for healthcare workers to follow. This should also help us recruit and retain talented staff.

This digital transformation is also about using online consultation systems, improving access for people and making best use of clinicians’ time. We are working together across West Yorkshire and Harrogate on adopting this at scale to ensure effectiveness and efficiency. Plans are progressing for a phased roll out in practices from March 2019 onwards. This work will be supported by a dedicated project team who will oversee the rollout from start to finish.

Alongside this we need to make the most of our assets, i.e. buildings. This work is supported by a multi-million National fund to transform general practice facilities and technology across England. Examples range from internal reconfigurations to multi floor extensions that will make better use of existing space and increase space to enable better patient access and new ways of working. Running in parallel are technology schemes that are increasing provision of mobile devices, wireless access and IT that supports extended hours access hubs and shared telephony. We will keep you posted as the work progresses

Advances in medical care mean people are living longer, but many are living with chronic disease and disability. So we need to do more to improve their quality of life.  Currently, much of the service capacity of primary care is by patients with multiple and complex illnesses and yet less than 0.1% of the time in a patient’s life is actually spent in front of a healthcare professional.

Primary care will be working with patients to use some of the other 99.9% of time to help them more easily manage their own health and illnesses in the comfort of their own homes or community spaces in new ways, such as using health education support, online and video consulting, remote biosensors, artificial intelligence, digital health coaching and other behaviour support technologies.

This is an exciting time for primary care in West Yorkshire and Harrogate. Rather than working in isolation general practices and community services will be working together. The future looks bright - we are truly transforming to meet people’s needs.

You can read more about how primary care fits in with the wider Local Workforce Action Board Workforce Plan

Have a good weekend

Andy