“ GP/Consultant Pairings Bridging the gap” Presented by Dr Paul Williams Wyre Forest GP

1. “GP/Consultant Pairings Bridging the gap” Presented by Dr Paul Williams Wyre Forest GP

2. Background • The Gp/Consultant pairing initiative commenced in the spring of 2011 after an idea that was generated by Dr Simon gates, Wyre Forest CCG chair. • The project was developed to promote closer working relationships between primary and secondary care clinicians and enable smoother care pathways to be set up and provide a wider range of integrated health services. • At this time the CCG established an Innovation Fund (£500,000) to provide funding for schemes generated by the GP/Consultant pairings. Proposals requiring funding were encouraged to be submitted to the Clinical Commissioning Group Board.

3. Structure • The pairings consist of a Wyre Forest GP and a consultant with a specialism/interest in a particular area • There are GP/consultant pairing meetings which take place approximately four times a year where new ideas, and projects are shared and discussed. • In-between these meetings the developments are supported by the locality office and the Wyre Forest CCG chair. • Partnerships formed as a result of the parings form a ‘specialism resource’ for developments within the CCG

4. What pairings do we have? • The pairings do change overtime depending on staff availability and the development of new relationships. Pairings include: • Diabetes, Urology, Psychiatry, Gynaecology, Respiratory, palliative care, Pain management, dermatology, paediatrics, trauma and orthopaedics, rheumatology & Gastroenterology.

5. Selection of projects generated from the pairings work • DIABETES • This is a pairing between Dr Dean Evans (GP) and Dr Paul Newrick (consultant) • Funding was provided for diabetes specialist nurses (DSN) to work with our practices (both GPs and practice nurses) on a dedicated cohort of patients • There were 2 phases with different cohorts. • Using a selection criteria patient notes were extracted and their management plans reviewed. • The DSNs provided advice and guidance to the practice staff regarding ongoing management of the patient. Approximately 80% of the cases discussed had recommendations made on changing one element of their management plan, or advice on an ongoing referral. • A collation of the results is being undertaken, but will inform future developments.

6. Pain Management • This is a pairing between Dr David Starkie (GP) and Dr Allen Bennett (consultant) (October 2012) • Funding has been identified to commission the pain management programme’ in the Wyre Forest • Targeting chronic pain, this programme delivers a self management programme and CBT to people who have a diagnosed ‘chronic pain’ • Evidence from elsewhere has shown significant benefits, both in terms of quality and financial outcomes. • Work currently underway to establish delivery mechanism.

7. Dermatology • This is a pairing between Dr Nigel Cockrell (GP) and Dr Phil Preston (consultant) (October 2011) • Funding was provided for a Gp from each practice to sit the Cardiff diploma in dermatology. • Aim - To improve dermatological care in primary care and reduce referrals to secondary care. Furthermore it was felt by up skilling GPs it would help alleviate waiting list pressures and provide patients with a choice to be treated locally. • One GP from each practice was offered the training. The programme is due to finish in June 2013.

8. Learning Disabilities in Children • This is a pairing between Dr Tristan Brodie (GP) and Dr David Lewis (consultant) • Idea generated by the paring to move some non-complex annual reviews back into primary care • The benefits are that the relationship with the child and their families is built up at an early age so when reaching 18, the children fall out of secondary care paediatrics service they have a good relationship with their GP. • Working progress, to launch pilot shortly, with an aim to repatriate approximately 100 children in the first year.

9. Heart Failure • This is a pairing between Dr Helen Routledge (consultant) and Dr John Tudor (GP) (Oct 2011) • WF CCG Board approved funding from the Innovation Fund for a British Heart Foundation Nurse (BHF) heart failure specialist nurse and part time administrative support for three years. This would allow for: • The development and delivery of an educational programme for nursing and medical staff; • Assessment of all levels of heart failure rather than the current situation where those that are most severely affected are seen in primary care.

10. Moving forward • The GP/consultant pairings continue and are seen as a model of excellent practice. • Now authorisation is complete we will have an added focus into this work stream and look at developing more initiatives. • The long term objective for this work stream is to promote and encourage a more cohesive health economy in Wyre Forest. Integrated healthcare services which enable GPs and consultants to co-operate and collaborate in commissioning and provide health services which are sensitive to the needs of the local population. • For more information regarding this work stream please contact the Wyre Forest CCG locality team on 01562 513517 or email executive administrator helen.arnold@worcestershire.nhs.uk