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Working at scale to support primary care in North East London

20th November 2018

Jane Lindo, Programme Director of Primary Care Transformation in North East London, shares her experiences of working in partnership to transform primary care services.

To improve primary care services for the local population, the seven boroughs in North East London (NEL) are working together at scale to provide innovative, first class care to its highly mobile, densely populated boroughs – and with great success.

Whilst we have examples of excellent primary care practice, such as the diabetes outcomes achieved in City and Hackney, Newham and Tower Hamlets, we also have the highest percentage of surgeries rated inadequate by the Care Quality Commission (CQC).  NEL also has increased demand on its primary care services as it has the four most deprived boroughs in London (according to indices of multiple deprivation). Population growth is an estimated 5.8% over 5 years, well above the London average, with 6.8% growth in Redbridge. In addition, NEL has a very diverse and highly mobile population and Havering has the highest proportion of population aged over 65 (and associated disease burden) in London.

Strengthening general practice through quality improvement initiatives

Our transforming primary care team is working with the seven borough federations and CCG teams to transform care for the local population. By strengthening general practice through quality improvement (QI) initiatives, we are releasing more time for GPs and their teams to give focused care to those who need it.

For instance, Havering and Redbridge practices focused strengthening patient searches, call and recall systems for their diabetic patients. This resulted in a 5% improvement in their HbA1c and cholesterol achieved through more proactive patient management.

The Tower Hamlets QI initiative to reduce the number of missed appointments or ‘did not attends’ resulted in reductions of 6% in health care assistants (HCA), 2% in nursing and 2% of GPs releasing 39 HCA, 19 nursing and 45 GP sessions per year.  We are also supporting general practice to work together at scale in networks or neighbourhoods. The transformation programme has three key work streams; quality and efficiency, new models of primary care provision and primary care workforce. By working together, we are already seeing positive changes.

Success factors

A few key factors have helped NEL work at scale successfully. We continuously nurture relationships across the system and support our leaders to work across the provider and commissioner landscape. We work in partnership with Health Education England and Healthy London Partnership Transforming primary care programme to deliver our at scale agenda.

We meet regularly too; our provider forum, for example meets monthly and provides the NEL “at scale” primary care provider leads the opportunity to share best practise and discuss their challenges; we use our collective strength to help find solutions. NEL is also taking a systematic and system-wide approach to quality improvement in primary care and sharing learning through at scale working opportunities. IHI Quality Improvement methodology is in use across all NEL boroughs and the learning from different boroughs is being shared via different cross-fertilisation opportunities such as events, meetings and structured visits.

Celebrating success

We put a lot of focus on how we share and celebrate success. We do this in a number of ways, one of which is hosting and attending events. One such event was our GP careers fair where the Royal College of General Practitioners (RCGP), HEE and all NEL federations presented their offers, training opportunities and the vacancies available in their area. Newly qualified GPs had the opportunity to speak to currently employed staff and overall this event led to better awareness of what NEL can offer qualified GPs and awareness of the positive culture that exists within our primary care services.

We also recently hosted the national primary care team who came to visit North East London. Newham and City and Hackney on behalf of NEL hosted the visit. Federation leads and GP clinical leads presented their work, sharing the challenges they face and the initiatives they are putting in place. For instance the establishment of a locally sourced pipeline of physician associates who will work in primary care multidisciplinary teams and clinical supervision for GPs returning to work alongside peer support and mentorship for GPs in their first five years of career. It was a great snapshot of the work across NEL and a time for us to reflect and feel proud of the work and achievements we have made.

NEL nominated Newham Health Collaborative to deliver a national initiative to accelerate change and improvement in GP retention. Newham won this bid and is the only borough to have been awarded the Intensive Site Support funding throughout London. They are currently delivering the programme with support from the Healthy London Partnership Transforming primary care team.

Responding positively to challenges

One of the challenges we have in NEL is the emergence of large new residential areas set to further increase our very densely populated area. To positively respond to this challenge we are using the rare opportunity this presents to trial a new model of fully integrated services on a blank page.  We have designed services around prevention, self-management and health and wellbeing. What we learn from this exciting journey will be shared with our seven boroughs and the wider London system.

We still have a long way to go but working together at scale has provided many benefits and solutions to the challenges we face and in achieving our aim of providing first class primary care to our residents. If you would like any further information please feel free to contact a member of our team newccg.eastlondonprimarycare@nhs.net or visit the Healthy London Partnership Transforming Primary Care  website.

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