Written evidence submitted by Ide Lane Surgery (FGP0160)
I am a GP partner jointly managing an 8000 patient practice. We are based on the edge of Exeter and have a relatively static population covering both rural and suburban neighbourhoods. We believe that by focusing on providing continuity of care using named GPs and personal lists throughout the pandemic, we have improved access to our services whilst also reducing waiting times and continuing to offer a highly personal high quality service.
A personal list means that each GP in our practice has a list of patients who are their responsibility. I know these patients and because of this I am highly efficient at providing their care. Whilst other surgeries have moved away from personal lists believing they are unachievable we have made them the bedrock of our system ensuring it our surgery has survived the pandemic with both patients and GPs still satisfied with the service we provide.
Our system is built around the personal list. Our reception team are trained to ensure patients always speak to someone who knows them where possible. This approach works throughout our entire organisation with each patient having a named GP, an allocated nurse and a member of the admin team who works closely with them. All our GPs work part-time but our patients still have good access to their own GP. We use digital triage through econsult to filter the workstreams coming into the surgery. Where it is safe to do so patients are encouraged to wait to see (or speak) to their own GP. Where our triage system identifies risk we have a cover system to ensure ill patients are seen quickly even if their GP isn’t working that day.
This isn’t old fashioned general practice. We have embraced new technologies, using SMS, video consulting, online consultation and digital triage to improve efficiency and allocate the right work to the right professionals in our team. We have First Contact Physios and a dedicated prescribing team led by a clinical pharmacist employed by our PCN. We have done all this without compromising on providing continuity. This is because, while many of the changes forced on general practice in the last few years have had no evidence base behind them we know through years of experience and a wealth of research that continuity works.
Continuity has a strong evidence base behind it now. It provides significantly better patient satisfaction, higher quality of GP care and even a lower mortality rate for patients. Our team experience many of the benefits first hand every day; The understanding of the patients’ history; the familiarity to enter straight into the consultation; knowing the meaning of a blood result or a clinic letter without even needing to open the patient record. These things not only help our patients but they make our days easier and more enjoyable. These relationships keep us engaged and caring about all of our patients. The blood result I am about to file isn’t just a blood result – it has a person behind it and I know that person. This makes our days more rewarding and this in turn helps to avoid burnout and improves our resilience.
In the introduction to the announcement the Chair's comment includes the words: "General practice is in crisis now with an utterly exhausted and demoralised workforce and patients increasingly uncertain what they can expect,"
We believe that general practice has quietly divided into two groups and we hope the Select Committee will recognise that there is another group of general practices valuing and providing continuity of care. Our doctors are certainly not “utterly exhausted” and not “demoralised” as we enjoy our work. We also believe that our patients are reasonably certain of what they can expect since over 90% of them, when surveyed, reported that they have a “regular doctor.”
We know our system is working because we measure it regularly using the St Leonard Index of Continuity of Care (SLICC). Through our participation in the Health Foundations Increasing Continuity of Care in General Practice programme we have been monitoring our continuity for 2 years now. When the pandemic first hit we saw continuity plummet in the first two months while GPs were off sick and our system was turned upside-down. We quickly identified this trend because we were measuring it and immediately looked for ways to reverse it. Within 1 month we had our patients being signposted back to the clinicians they knew and our continuity measures back up to pre-pandemic levels. Learning from this success we continued to tweak our system and watched continuity grow and grow.
We have also been measuring patient satisfaction. When asked - 'How much effort was made to understand your health issues?’ ‘How much effort was made to listen to what matters most to you about your health issues?’ and, ‘How much effort was made to include what matters most to you in choosing what to do next?’ – Our patients scored our GPs between 83-90%.
Is the traditional partnership model in general practice sustainable given recruitment challenges, the prioritisation of integrated care and the shift towards salaried GP posts?’.
We believe that one of the key elements which has enabled us to swiftly adapt during the pandemic is the partnership model we work within. It is because we have a clinicians leading our organisation who truly understand the importance of the style of care they provide that we have survived and excelled during this pandemic. As partners we understand exactly what holds our model together and thus have known which key elements to hang on to so we continue to provide the services our patients need while such huge change is underway. We also believe that it is our smaller size (in comparison with a large federation for example), our openness within our organisation and our shared decision making processes, involving all those who work for us which have allowed us to adapt quickly, effectively and in the right direction. We strongly believe these qualities within of our organisation rest on and are dependent on the fundamental structure of the partnership model. We feel that partnership encourages leadership by clinicians in general practice and that this role should be developed and expanded rather than reduced.
Dec 2021