Written evidence submitted by OneMedical (FGP0326)

 

 

About One Medical Group

 

Established in Leeds in 2004, OneMedical Group is a leading multi-disciplinary healthcare services provider and our mission is to improve lives by finding better ways to care for our communities.

 

We provide NHS general practice, community and urgent care services in locations across England. We also have a specialism in healthcare property development, working with trusts and providers to transform healthcare estates, improving the environment for clinicians and patients to interact.

 

We have taken action to implement a new, non-traditional model of care, that puts an increased focus on proactive and preventative care – focused on patient education, wellbeing services and using innovative means of interacting with our patients and the community. Our model can improve individual health outcomes and taken more broadly at a neighbourhood and place level; this reduces health inequalities in local communities.

 

We believe in Putting People First, Working Together, and Building Towards a Better Future.

 

Executive Summary

 

OneMedical Group believes that whilst there are considerable challenges ahead for general practice, it is also a service that can facilitate so many of the improvements that government, the NHS and members of the public want to see in the health system.

 

We welcome the opportunity to contribute to and assist with the Health and Social Care Committee’s inquiry on the topic and we set out the following topline insights and recommendations to consider:

 

 

Priority information shared within this submission

 

The Committee’s inquiry into the future of General Practice covers a broad remit. OneMedical Group believe our input is most valuable of the following topics within your terms of reference – which interlink and support your other considerations and overall objectives:

 

 

 

 

 

General Practice and the prevention agenda

 

The Government is rightly putting more of a focus on preventative care in England, and OneMedical Group believes that general practice has a key role to play in ensuring this agenda is progressed. Too often, general practice has been focused on reactive healthcare, and has consistently chosen to treat mind and body separately. OneMedical Group has implemented an operating model which encourages greater emphasis on prevention and patient education across our primary care services, incorporating wellbeing strategies into our care that help patients to get well and stay well. For a patient to receive the full benefit of a service it is important that clinical and social needs are not seen as independent factors and that a holistic approach to care is being considered to all users of the service. The social side of care is more important than ever due to the COVID 19 pandemic, where individuals may be suffering from a decline in their mental health due to lock down, job losses, redundancies and challenges in getting an appointment with a healthcare professional.

 

Understanding and supporting our community with the broader determinants of health is a priority of our organisation. An example of how we do this comes from Corby in Northamptonshire where the general health quality of the local population is below the national average. This includes rates of alcohol and self-harm related hospital stays, rate of STIs, average BMI amongst other indicators. Due to this, we have engaged with community services to ensure we are responding the unique health requirements of our local area.

 

In response to these public health challenges, in 2019 we piloted a dedicated Wellness Hub at our Corby Urgent Care Centre (CUCC), established with the objective of supporting and empowering the community to take greater interest in their own health and wellbeing. We have found that incorporating a wellbeing service into primary care settings enables us to bridge gaps for patient care, enabling a range of different services under one roof that can assist with an individual’s physical health, mental health, and social needs.

 

The positive impact of this service has been particularly evident during the Covid-19 pandemic, as patients who have presented at the CUCC with a separate medical need have been quickly channelled down wellbeing pathways, thereby reducing pressure on crisis services further down the line. We have also established an online platform for patient usage, giving patients more opportunities to participate in their own care, an important factor in prevention.

 

Since April 2020, there has been an increase in the number of patients from the community accessing the Wellness Hub. Our patient feedback surveys have indicated that access to this service accompanied by other primary care services has had a positive impact on the community. This is a model that OneMedical Group is seeking to replicate across England. We have recently established a permanent Wellness Hub in our walk-in centre in Sheffield City Centre which caters for a high number of students - and data shows how well the service is used by this patient group. We are also able to demonstrate how this service to date has eased demand on local mental health services and charities.

 

OneMedical Group believes that this is a model that could considerably reduce the current pressure on general practice. We are looking to roll out wellness support to all our centres and future developments. This will allow us to fully embed non-medicinal therapies into local healthcare strategies, allowing us to free up workforce, reduce reactive healthcare, and have a greater emphasis on population health management. Redefining general practice in this manner to follow a similar model would permit patients to be efficiently directed towards the appropriate area for support on-site, freeing up capacity for GPs to focus on preventative care and evaluate the impact that wider determinants can have on population health. This in turn would have an impact on other health services, such as A&E, reducing the number of patients that present at those services in a state of crisis.

 

OneMedical Group would recommend as a means of moving towards this model that the Government undertake a review of the current primary care structure. This would mean a re-evaluation of structure, contracting, and funding. There needs to be an evaluation of general practice and whether what patients need from primary care and community services is different and how the general practitioner role needs to change.

 

This could take the shape of putting general practice at the centre of primary care and introducing ‘same-day hubs’ for more urgent medical needs, essentially creating a ‘one stop shop’ of care. This would include considerations for wellbeing and other wider determinants of health, allowing GPs to focus on preventative, community-focused care. This would necessitate an alteration of the current primary care contracting structure. We would recommend that the Government streamlines the funding for general practice to focus on population health management, allowing same-day access hubs to cater for urgent medical issues.

 

What are the main barriers to accessing General Practice and how can these be tackled?

 

Tackling health inequalities and improving engagement with harder to reach groups is a top priority across our centres. It is important that the Committee supports and advises the Department of Health & Social Care and NHS England on effective means of removing barriers to general practice.

 

OneMedical Group is working on projects – alongside local PCNs and other partners - to understand the challenges faced by local people accessing healthcare and then adapting our offer and service to try and remove these. For example, The Light Surgery (a OneMedical Group centre based in Leeds) is working to make the centre ‘autism-friendly’ to attend and are also working with people with neurodiversity on how to improve their experience at the surgery. OneMedical believes that constructively working with those who have severe mental health issues can ensure that all patients who make use of OneMedical Group general practice services can have a positive experience. The Light Surgery have also employed mental health social prescribers in order to improve timely access to mental health support. This includes people who do not meet the referral criteria for psychological therapies from IAPT nor the criteria for secondary care mental health services. Waiting times are now consistently less than 1 week and the service has now been adopted across the primary care network.

 

We identify healthcare estates as a crucial factor in improving visibility of, and engagement with, our services. Investing in the primary care estate to transform facilities to house a variety of care services on-site e.g., general practice, a community hub and pharmacies alongside some non-care services such as cafes and leisure centres is an effective way of permeating different demographics within the community.

 

This empowers patients to make choices about their own care, engaging them with the healthcare process, and granting healthcare providers greater understanding into why people are making these choices and the social determinants of these choices. OneMedical Group are one of few organisations that can build and renovate healthcare facilities and also deliver clinical care for the NHS. This unique perspective means we are ideally placed to support policymakers and commissioners to develop NHS ‘anchor’ institutions.

 

There needs to not simply be a focus on healthcare, but the wider assets available in a community, such as the voluntary and community sector. Community assets need to be more closely considered, and directly funded by primary care or NHS England, with a closer link between public health and primary care services, with community partners being required as part of PCN delivery.

 

Policymakers should be assessing new integrated models of commissioning that can join up multiple services that people with multiple needs require. For example, a more innovative primary care contract that combines council run services and general practice could be a radical step towards true integration. Furthermore, public health funding directed toward primary care which in turn could commission community services is another option that should be considered. It is encouraging to see parliamentarians debate some of these options as the landmark Health & Care Bill continues its progress through Parliament.

 

OneMedical Group operates working practices which put the community at the heart of our service, and we seek to share our examples with the NHS and other providers to replicate because our approach – designed collaboratively with the service user in mind – delivers high satisfaction results and empowers individuals to take greater interest in their health and wellbeing. This is a crucial aspect of community engagement, as primary care and general practice often remains the entry point into the health system. For example, OneMedical Group has often pushed to perform health checks for the traveller community in Leeds, and also delivered support for homeless people around the city.

 

It is crucial that local and national health leaders continue to build links with local communities and demand strategies which identify hard-to-reach communities and demonstrate how to ensure an equality of care, as these will form an integral part of improved patient outcomes on a national scale.

 

Delivery of proactive, personalised, coordinated, and integrated healthcare – how to improve this

 

The thread of personalised care needs to run through all aspects of NHS service transformation and improvement, not simply general practice. Proactive and personalised care is something that we believe should be synonymous with primary care, and we are confident that our innovative models of care deliver this and should be referred to by others looking to replicate good practice. For example, our wellbeing hubs are staffed by wellbeing advisers who are equipped with mental health support training as well and possess other related qualifications such as: domestic abuse, drug and alcohol addictions, safeguarding assessments to list a few.

 

The presence of wellbeing advisers in our primary care centres, ensures that our service is tailored to best support both the physical and mental wellbeing of our patients, and crucially eases pressure on other staff (and other local centres), by allowing them to dedicate more time to more appropriate patients. The successful delivery of this model has indicated that it is of fundamental importance in the local area to managing the capacity of hospitals and ensuring that patients remain close to their communities.

 

OneMedical Group has recognised the impact of the social determinants of health and has employed its own social prescribers for over 10 years, consistently advocating social prescribing as an effective means of improving health outcomes whilst reducing other unwanted affects in the health system. Social prescribing and community-based support is part of the NHS Long Term Plan’s commitment to make personalised care the norm across the health and care system and to bring additional capacity into the multi-disciplinary team within Primary Care Networks. Our dedicated wellbeing advisers who deliver social prescribing within services are part of the MDT.

 

NHS England also estimates that 10% of items dispensed in primary care are overprescribed. This leads to 1-in-5 hospital admissions being caused by the adverse effects of these over-prescriptions, and so ensuring that these patients do not present at hospital in a more serious condition drastically reduces the pressure on the healthcare system. Whilst social prescribing is not the only factor that will reduce overprescribing, it has been identified as something to prioritise by NHS England and we support this.

 

What do effective partnerships in primary care look like?

 

It is crucial for primary care providers to foster strong relationships across the health spectrum. Forming these relationships will mean that primary care providers are able to offer their patients more rounded care. OneMedical Group recommends that this could take shape through an alternative primary care model, which brings together a diverse range of services and permits a variety of choice for patients. We are already working closely with a number of third sector organisations to discuss how community care structures could look in the future. It is our recommendation that this model should bring general practice, wellbeing services, and community care hubs under one roof. We believe that this model will be most effective at identifying health inequalities in a specific population area given that one in five GP appointments focus on wider social needs, rather than acute medical issues - and deliver a sufficiently diverse range of services that will ensure that all patients are supported.

 

OneMedical Group offers wide-ranging support for its practices who work closely with pharmacists, offering guidance on recruitment and training and professional development as part of our Clinical Pharmacist Bridging Programme, which fully integrates a practice’s pharmacy team with GPs.

 

Sustainability of the current GP model

 

OneMedical Group believes that the sustainability of the GP model is dependent on the system evolving to more effectively incentivise and support GPs to deliver preventative and integrated care. The key to this will be recognising and incorporating health inequalities and social needs into funding. Currently some of the poorest areas receive the least funding through general practice, and so it will be crucial for an evolved health system to fully account for these in funding decisions. This in turn should have an impact on the local workforce and its capacity for a diverse range of care.

 

 

I hope this submission is of value to the Committee.

 

Yours sincerely,

 

 

Dr William Dawson

GP and CEO, OneMedical Group

 

Dr Dawson would be pleased to brief the Committee on the learnings and recommendations provided above and provide further written or oral evidence as required. Please contact to get in touch.

 

Dec 2021

 

 

 

 

 

 

 

 

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