Andi Ireson Self Care Facilitator

1. Engaging Health Care Professionalsin North Bradford and Airedale PCT Andi Ireson Self Care Facilitator

2. The start up process within the PCT • Exec sign off • Launch at Practice Managers meeting • Individual practice meetings (by invite) • Attend Forums • HV • District Nurses • School Nurses • Consumer Councils • Clinical Leads • Mixed responses!

3. Incentives for practices • Major driver for achievement of targets ( and therefore rewards) GPs as commissioners seeking efficiencies by: • Demand management • Linking minor ailments schemes • Long term conditions management • Choice – giving patients the skills to choose.

4. Financial incentives • Scheme already in place • No real outcome targets linked to payment • Difficult to change existing arrangements

5. Numbers • 16 groups – 14 practices, 1 Community Intervention Team, 1 PCT Clinical Leads group. • 39 sessions. • 2 non-starters - other time demands. • 1 practice pulled out after session 2. • 1 practice demanded shortened sessions x 2.

6. The broad approach • Three facilitated sessions offered. • Account Manager relationship with each practice. • Identified practice lead. • Facilitation not self care expertise. • Acknowledgement of building on existing…… • Based on gaining ownership, focussing on high demand low complexity top time takers. • Led into mini projects to problem solve areas identified. • ALL practice team involved.

7. What we got! • Mixed responses. • Different paces required. • Often cold start but usually warm finish to sessions! • Reception staff most likely to disengage. • Session feel reflected the culture of the practice overall. ( not surprisingly!)

8. What worked well. • Account Manager relationship. • Flexing pace to suit. • Flexing in sessions. • Mixing staff groups. • Sharing ideas across staff groups. • Helping staff groups understand shared problems from different perspectives. • Using data to inform decisions.

9. What else would have helped? • Learning to share….. but then it was a pilot!!! • Specific ideas for them to try….. earlier. • Possibly using the Circle of Influence during the ‘Sales’ pitch. • More focus on financial incentives for completion. • Clearer links to other practice targets.

10. Tools used • Circle of control, influence, concern. • High demand, low complexity, top time taker matrix. • Care pathways • Basic project management action plan.

11. Circle of Influence Remember: - You need to keep expanding your ‘Circle of Influence’ Circle of Control Circle of Influence Circle of Concern

12. Working up a plan • Now use the template flip chart and decide • What, specifically a good result looks like for this piece of work. • Who needs to be involved to make the work a success – internal and external. • Who should sponsor and who should lead the work. • What you will have achieved in relation to this by the next session. • How you’ll know that you’ve been successful in what you’ve achieved. ( Sponsor = the person in the practice who can unblock any blockages as necessary)

13. Outcomes from the sessions (1) • Mini surveys amongst patients who attended between eight and 11 times a year to get a clearer picture of why they attended. • Exploring whether the practice could provide other services that would help patients and whether they needed to be redirected to more appropriate services. E.g. setting up a support group for patients who shared a common problem e.g. multiple sclerosis.

14. Outcomes from the sessions (2) • Review of the appointments system to highlight inappropriate appointments • Trial telephone consultations with GP's • District Nurses in the process of identifying cases where the DN visit has been inappropriate or not required • Educate patients to understand that test results won't be available until after 4 weeks. • Support and information to people suffering from depression from staff who are based at the practice. • Practice website developed to offer personalised self-help information from GPs on various common conditions.

15. Outcomes from the sessions (3) • Review of repeat prescription process resulting in less wasted time and more responsive service for patients. • Better understanding of presenting conditions of high practice users. • Redesigned reception facility to give greater responsiveness and confidentiality. • Extended receptionist role to include health care advice. • Introduction of group education sessions to educate patients with long term conditions to self care. • Redesigned patient information to support a shift in emphasis towards self-care • Elderly Care Workshop organised for patients 55yrs plus

16. Outcomes from the sessions (4) • Advice from pharmacy to patients via the practice on how best to use pharmacy services • Engagement of the Patient Council in promoting Self Care within the practice • Better understanding of the requirements of care homes of GP’s and alternative ways to manage the same. • Reduction in unnecessary home visits to deliver equipment. • Audit and review of appropriateness of referrals to the Community Intervention Team leading to a re-education exercise on how to make best use of the service. • Introduction into the practice of Citizen’s Advice

17. Where are we now? • Aiming to resource roll out. • Receiving lots of requests for input. • Still learning.