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Practice sees huge benefits from integration

Bringing in nurse, therapy and pharmacy staff improves access and satisfaction

Louise Prime

Tuesday, 17 January 2017

A general practice in Wales has tackled the problems created by the local and national shortage of GPs by integrating highly-skilled nursing, therapy and pharmacy staff into the practice. It said since it made the changes, access and satisfaction have already improved dramatically.

Minafon GP Surgery, a rural practice in Kidwelly, Carmarthenshire, less than a year ago was subject to almost daily complaints about access to care – then the frontline team of practice staff started working with Hywel Dda University Health Board, patient representative body Hywel Dda Community Health Council, the local Patient Participation Group, local councillors, local AM Lee Waters, MP Nia Griffith and the local population to come up with a series of measures to support patient access.

The changes they made include bringing several advanced nurses and allied health professionals such as pharmacists, physiotherapists and paramedics into the heart of the surgery; and some telephone triage for appropriate patients who don’t always need to see a GP. This means that now:

  • Three GPs are providing care in the surgery every day, as well as the satellite surgery, and are meeting all local need with capacity each day for unscheduled appointments.
  • Advanced nursing has provided ‘on the day’ appointments for patients for the past 15 months, and more recently long-term conditions management, which has been positively received by patients.
  • A dedicated Advanced Musculoskeletal Physiotherapist can help patients with management of painful joints, ligaments, tendons and muscle problems. The service is receiving good feedback from patients, with 95% providing positive comments.
  • Practice-based pharmacists are assisting at the surgery with house calls and managing some patients with an urgent need, without the necessity to always see the GP, which is having a positive impact.
  • A review by new Pharmacist Prescribing Advisors of anticoagulant prescribing revealed 25% of patients were not on correct medication; addressing this has reduced risk of stroke and admission.
  • A closer review of medication and appropriateness of prescribing has resulted in the surgery issuing 1,600 fewer items than the previous year.
  • A pilot project between GPs and community pharmacy on sharing information on asthma patients has recruited 20 participants and is also receiving good patient feedback.

Patient representatives have described the outcomes of changes as “really positive at this stage” although practice manager Anne Jenkins, from Hywel Dda University Health Board, said there is more to be done. She said: “We will be considering how we can bring social care and mental health, for example, even closer to the surgery.”

Other practices in the Hywel Dda University Health Board are now monitoring developments at Minafon, and Board chair Bernardine Rees said: “We have asked our teams to look at the art of what is possible with designing new service models and ensuring we use the full range of health care professionals, including health sciences and therapists, to build the strongest teams possible for our patients.”

Vaughan Gething, cabinet secretary for health, well-being and sport praised everyone involved in the project. He said: “The strong partnership working between nursing, therapy and pharmacy staff clearly benefits the patients in your community and ties in with what we are trying to achieve with our Primary Care plan. I am proud to see surgeries using innovative ways of working to achieve the best outcomes for patients.”

Picture: Minafon Surgery. Credit: Hywel Dda University Health Board

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