GP Practice Team Roles Project

Just another thought - some Buckinghamshire GP practices have out of area patients whose area community health services depend on the general practice PCN services to deliver specific community heath service functions depending on how their unuty health and social care services for example east Berkshire have occupational therapists as part of their PCN MDTs

I largely share the views already expressed here, so won't repeat them.

The posters / leaflets would be better tailored for each individual practice, since practices are all organised slightly differently. I'm not sure the posters/leaflets all make best use of the space available - I appreciate you have to keep messages concise, but that has to be balanced with getting across enough information to be useful. Even after reading the leaflet, I'm still not sure what the care co-ordinator does (and is that title used for different roles in different places?). If I already know what a dietician does, I'm not sure that "diagnosing and treating nutritional conditions" adds much - perhaps simpler language needed and some examples?
One other thing that was mentioned at the Townlands event was the principle of being able to find the relevant information when you need it. Ensuring it is on surgery websites is the main way to do that, with posters and leaflets in surgeries and on screens to supplement that. There's also a need to think about targeting the audience - get the messages to those who the general public may ask, when they want to know what to do. That doesn't just mean professionals, but also members of the public; the sort of people others go to for advice. I appreciate it's not necessarily simple to operationalise that idea: for instance, for the general public you want very simple language and concise messages, but for the influencers it could be slightly more sophisticated.

I like the video even though it covers roles that are not available at our surgery.

The leaflets are generally ok , however the GP one is too formal. None of our GPs wears a suit and tie or formal attire for women. They look too formal in the poster.

I think it is important to be really clear on what the roles and responsibilities of a GP practice is and what ‘expanded services’ they or the PCN GP alliance they belong to deliver.

It would be great if receptionists and social prescribers & all GP staff were able to direct a person to the other community health or social care services if the GP practice does not deliver the care or support services needed

The descriptions of the additional services will depend on the roles and responsibilities that the ICB funds the GP practices to deliver, same as any local enhanced service. Presumably the descriptions & role/responsibility should follow the national workforce standards of the 17 possible PCN additional roles.

Personally I don’t see the need to explain all the different roles, just the specific GP practice PCN multidiciplinary team set up and the GP Practice process eg
- requests for appointments will be triaged by a senior GP or trained receptionist (seems to vary by practice) to the most appropriate member of the GP practice team.
- Patients can self refer to xyz services

Agree would be good to have photos/names (& job titles) of the GP practice team but not so important to communicate roles as I thought the aim was the PCN MDT working together would deliver the GP NHS standard (DES) contracted services, especially when the PCN additional roles appear open to interpretation.
eg care coordinator is not a care navigator, like the social prescriber is, they are case workers that will work with the person and the various health and social care professionals involved in a persons care to develop a “personalised care and support plan” and they will monitor and oversee the persons care, this is usually a senior nursing role - eg Cancer nurse, Dementia nurse or palliative care nurse and presumably would be the most appropriate clinician considering the persons ‘shared care’ needs and would work closely with district or ASC nurses, social workers, integrated therapies and mental health services as appropriate.

PCN Paramedics or other community Heajth services work in the community to deliver the NHS community services requirements for 2hr urgent community response services but are also used instead of GP home visits (as in the video)

Agree we do not need more ‘working groups’ - GP practices just need ICB support to communicate the services that they do deliver & to communicate where to go for the community health and social care services they don’t. Eg council or NHS trust commissioned services

Thank you for sharing all these documents. My comments are as follows:

1. Why now set up a toolkit development working group? You got lots of ideas and a strong steer from the Townlands meeting: can't you just move forward and implement them, consulting a handful of patient reps on wording and comms channels where appropriate (as you are now doing with the posters)? Action not more meetings...
2. I don't think generic photos and names resonate well. Can't you provide templates for practices/PCNs to insert photos and names of their actual staff and their logo - with the option of a representation of each role, eg 👩‍⚕️, where staff don't want their photos used?
3. I also question whether the best approach is to use separate posters for each role or have a booklet running to several pages which is in effect a collection of the posters. First, you're trying to get over the message that you don't need to have a doctor's appointment in lots of different circumstances. Second, from a patient's point of view I think what's wanted is a one-page (ideally) menu of the different HCPs available to them for different situations and how to book an appointment with them (eg practice online triage, ring receptionist, self-refer.
4. Again, I think the description of the roles needs to be from a patient perspective, ie when might I want to as for the help of a care coordinator, pharmacist, etc or when might my surgery refer me to one. And, in my view, the words used need to be as clear as possible describing what an HCP will do for me eg, for care coordinators, "prepare you for upcoming
conversations about your
health and care" begs various questions: conversations with whom? Why do I need an intermediary? What actually happens when I see/speak to this person? And, crucially for your purposes, what can you say that reassures me as a patient that seeing or speaking to this person is better or as good as having a GP appointment.
5. I don't get the benefits of telling patients that over one third of them aren't aware that receptionists are trained to know who to refer themselves to. Anyone reading this who doesn't know, could feel shamed about their ignorance, while those who do know get no help other than perhaps feeling a little smug! This is not in my view the place for such 'nudge' techniques, but rather: "Did you know that every receptionist at our surgery...". Additionally, the poster doesn't reflect the move to digital triage and the encouragement being give to patients to use this where they can and not phone
6. The following is an article I've included in my contribution to John Hampden's April newsletter which reflect how I think descriptions should be from a patient perspective and related to each particular practice. I believe Healthwatch Bucks may be including it as an example in one of the guides it is producing:-

"The changing face of general practice (multi-disciplinary teams)

There have been lots of changes to how GP surgeries work and there may be more coming.

The two biggest recent changes have been the introduction of digital triage and the development of what are called multi-disciplinary teams (MDTs). Both are said to be in answer to the pressures on surgeries from GP shortages and increasing patient demand.

For the benefit of JHS patients, here is a list of the healthcare staff you might be given an appointment with instead of one of our GPs. You can refer yourself to the staff marked with an asterisk:

Practice nurse: the nurses hold clinics on a number of days each week
Phlebotomist: there are clinics at the surgery to take blood samples two mornings a week. There is also the option of going to Amersham Hospital, which runs a clinic every day [link to BHT website Amersham Phlebotomy]
Social prescriber*: these are staff who support patients who may have difficulties which are not strictly medical issues, such as debt, loneliness, and housing [link to PCN website]
Health and wellbeing coach*: they support patients by empowering them to become more confident at managing their own health [link to PCN website]
Paramedic: this member of the team does a lot of the surgery’s home visits for patients who are housebound and unwell
Pharmacist: you might be contacted by one of the team of pharmacists for example to have a review of your current medications. These pharmacists are separate from Prestwood Pharmacy and Kintons, who process prescriptions and advise on minor ailments [link to minor ailment page of Prestwood Pharmacy website]
Mental health practitioner: this role mainly supports patients with complex mental health needs whose main need is not anxiety or depression
Physiotherapist: their job is to assess, diagnose, treat and manage musculoskeletal (MSK) problems. Self-referral is available only for doing the actual physiotherapy* [link to BOB MSK webpage]
Community midwife: when you’re pregnant you will have a named community midwife who will co-ordinate your antenatal care, guide you through pregnancy, and explain your care and options [link to BHT webpage]
Community nurse: housebound patients may see a community nurse for wound care, general nursing, end-of-life care, etc [link to BHT webpage]"

Mike Etkind