Care in your neighbourhood

Over the next five years, we are investing in our GP practices as the backbone for joined-up health and care. We will recruit more GPs and expand the workforce with a wider range of health and care professionals available at your local surgery, including nurses, therapists, pharmacists, mental health specialists and social care providers.

Our 179 practices are joining together to form 28 primary care networks across mid and south Essex. These local networks will each take responsibility for the health and care of their registered population (around 30,000 – 50,000 people), working together with hospitals, community services, social care and you.

Primary care covers those NHS services which are most likely your first port of call when you are feeling unwell or need medical advice, and this includes your local GP practice, community pharmacy, dentist and optometry (eye health) services.

At the heart of this strategy is our aim to expand our primary care work force to include a much greater range of health and social care professionals including physiotherapists, mental health and social care professionals. This will mean patients can be seen more quickly and by the right professional for their needs. This will reduce pressure on GP appointments ensuring they are able to focus on patients with the greatest need.

We also know we have a large number of older GPs in mid and south Essex and are facing exceptionally high levels of retirement in the years to come. A key part of the strategy is to improve the work/life balance for GPs in mid and south Essex and provide greater opportunities to support their training and development.

This will help us retain vital clinical staff and attract new recruits.

Many who live with long term conditions, such as diabetes and heart disease, or who have mental health issues, need to access local health and care services more often.

GP practices have begun working together and with community, mental health, social care, pharmacy, hospital and voluntary services, in their local areas. They are creating Primary Care Networks (PCNs) to help patients access the support and care they need.

Typically, PCN’s serve communities of around 30,000 to 50,000. They should be small enough to provide the personal care valued by both patients and GPs, but large enough to have impact and economies of scale through better collaboration between practices and others in the local health and social care system

Having PCNs enables health and social care professionals to offer more pro-active, personalised, co-ordinated and joined-up health and social care for patients.

Key benefits include:-

• Primary and community health services will be joined-up; providing a more efficient service to patients with the aim of improving their health and well-being. Having joined-up services will lead to better sharing of information, so people only have to tell their story once to those involved in their care.
• Services can be offered across a network of practices that could not reasonably be offered via an individual practice. Examples of such services include embedding new care models for frailty, long term conditions such as diabetes and access to new healthcare professionals such as clinical pharmacists and social prescribers
• Patients will be able to access a wider variety of health and social care services through PCNs and have options to access these services through more than one GP or health service
• Smaller GP practices will be more sustainable as they can share resources through the wider PCN.

• Mid and south Essex has some of the lowest levels in the country of general practice staff. All five CCG areas have below the average number of GPs per head of population.
• With retirements coming up, we could lose up to 50% of GPs and 25% practice nurses in a worst-case scenario by 2020/21.
• Already, GPs are facing unmanageable workloads. They rely heavily on locums, which is expensive and deprives patients of good service continuity.
• Staff morale is low and the impact on patient care is evident with variable quality in services. General practices in all five CCGs score below average in terms of the number of their patients who would recommend their practice to others.
• We have measured the weekly demand for appointments versus the availability of appointments and found a gap of around 20,000 appointments that are unavailable across mid and south Essex. If we did nothing at all, the gap could rise to 60,000 appointments a week by 2020/21.
• We have reviewed this in detail, looked at what is happening in other parts of the country and developed our strategy from national and international evidence, including NHS England’s General Practice Forward View (2016).
• Our Partnership has secured an increase in the annual allocation of funds for GPs by an extra £29 million by 2020/21.

• Run new recruitment programmes to attract 120 more GPs and other staff.We will work with the new medical school at Anglia Ruskin University. We will improve workplace flexibility, training, development and career progression. We will make mid and south Essex a great place for GPs and others to live and work.
• Develop and change the workforce, so that there is a wider range of health and care professionals who can help you manage your health and wellbeing.Sometimes the best person for your needs is a pharmacist, or a nurse, or a therapist – not always a GP.
• Help practices to develop their local network. Many practices are already working together to share administrative tasks, broaden their range of services and increase the number of appointments on offer to patients. We have earmarked around £9 million to help practices join up along with community nurses, mental health, social care and voluntary sector services. In some areas, this will need better premises; in other areas, several locations connected by IT and shared records.
• Introduce new ways to solve problems and treat people quicker and earlier. We know from studying what happens in general practice that around 25% of patients who go to their doctor would do better with quicker and earlier attention from other health and care professionals. One of the many suggestions from local people in recent discussion groups is to train a range of frontline staff to improve the first point of call for patients. This could lead straight to a physiotherapy service, without having to go through your GP, for example; or you may see a specialist nurse or someone who can help you with a range of problems that may be affecting your health. This allows more GP time for longer consultations to deal with more complex problems.

Examples in practice:

Care Navigators

Care Navigators are members of the surgery reception team who have been trained to help patients get the right care from the right healthcare professional, as soon as possible, by asking for a little more detail from the patient when they book an appointment. Watch the video below to find out more:

Advanced Nurse Practitioner

Nurse Practitioners are highly-trained professionals and can undertake complex reviews of patients, just like GPs. They can assess symptoms and build a picture of a patient’s condition, treat minor health problems, infections, minor injuries and prescribe medication where necessary. Watch the video below to find out more:

Clinical Pharmacist

Clinical Pharmacists are becoming more commonplace in GP practices and are qualified professionals whose skills include reviewing medications for patients who have long term conditions. They can also treat minor illnesses and refer patients onto other services. Watch the video below to find out more:

Healthcare Assistant

Healthcare Assistants can assist with a range of minor clinical duties, like taking blood samples, blood pressure checks etc, under the guidance of the wider healthcare professional team. They work alongside the team and support with observing, monitoring and recording patients’ conditions to provide joined-up care. Watch the video below to find out more:

Paramedic Practitioner

Paramedic Practitioners or Emergency Care Practitioners carry out home visits and give advice over the phone to patients unable to travel to the surgery. Patients normally seen by a Paramedic Practitioner are normally elderly, infirm or nearing end of life.
This means doctors and other healthcare staff are able to see and treat more patients in the surgery. Watch the video below to find out more:

Physiotherapist

Musculoskeletal health issues such as back, muscle and joint pains are the most common cause of repeat GP appointments and account for around 1 in 5 of all GP appointments. Most of them can be dealt with effectively by a physiotherapist without any need to see the GP.
Research shows physiotherapists are the most expert professional group regarding musculoskeletal issues with the exception of orthopaedic consultants. They have the same high safety record as GPs and some are trained to administer steroid injections, order diagnostic tests including scans, and also prescribe medication.
Watch the video below to find out more:

Link Workers

Patients visit their GPs for a range of different reasons and sometimes these issues can be caused by non-medical matters such as loneliness, anxiety, unemployment, illness or debt.

Link Workers also known as a Social Prescribers work in partnership with GP surgeries and can help people to access appropriate support in the community to help them make positive changes to your personal wellbeing.