The full text of the blog is below and you can visit the piece on the NHS Employers website here.
Working at scale across Sheffield to manage the winter challenges
Andy Hilton, the chief executive of Primary Care Sheffield reflects the ways working at scale across Sheffield has helped the organisation respond to the current winter challenges.
I’m a general practitioner (GP) in Sheffield as well as chief executive of Primary Care Sheffield – the city’s general practice-owned not-for-profit primary and community care provider – so I get a fairly unique view of the interplay between general practice and the rest of the health and care system.
What I’ve been struck by this year is that the pressures from last winter never really went away – demand for services remained critically high all through the summer. It’s clear that the ongoing pressures are not driven purely by seasonal changes, but more a chronic mismatch between resource, capacity, and demand.
Given that we are already starting from this high-water mark I think that what general practice in Sheffield is achieving is remarkable. Indeed, the whole system seems to have found an extra gear as we prepare for what undoubtedly will be the most difficult winter we have known.
Delivering additional appointment capacity at-scale
One of the ways in which Primary Care Sheffield has been able to support services has been to deliver additional appointment capacity at-scale. One of the great benefits of this has been the flexibility we are able to offer – ramping up capacity when and where it is needed.
For example, earlier this month our team were able to quickly launch additional GP paediatric streaming appointments for A&E. This in the face of surging demand which was placing unprecedented pressure on primary care as well as the emergency department at Sheffield Children’s NHS Foundation Trust. We also increased advanced nurse practitioners (ANP) and home-visiting capacity at the beginning of November and stand ready to do more when required.
What could that look like? Well, last winter that included a direct access service for domiciliary care providers to garner remote GP advice and a paramedic visit, separate hot-hub capacity for COVID-19 positive patients, providing ‘active-recovery’ support for domiciliary care clients, additional citywide ANP appointments, creating a new citywide paramedic home-visiting service, and a phlebotomy home-visiting service. All of this improved access for patients, reduced pressure on primary care, ambulance service, domiciliary care, and prevented avoidable admissions into secondary care.
We have also worked with the integrated care system to deliver a third-party provider primary care staff bank which helps us attract the staff to deliver additional capacity at pace. This meant that practices in 2021/22 Sheffield were able to create a total of 85,000 additional appointments outside of core general practice.
The domiciliary care visiting service was based upon providing direct primary care access to our most vulnerable patients to avoid 999 calls and admissions. It was funded with a one-off pot of money to run for 12 weeks. We thought we’d need ongoing nurse capacity to keep people at home but found what was required was rapid access to GPs before the carer left the premises, and a follow up visit. It proved difficult to quantify, but best estimates suggest 50% of patients visited avoided at least an ambulance attendance, if not an admission; which is an amazing outcome. However, activity was lower than expected due to the short-term nature of the service, which meant by the time carers were engaged the service was closing.
The citywide hot-hubs, ANP appointments and paramedic and phlebotomy visits were much better utilised, as practices were booking their patients directly using the appointments as same-day over-spill.
Working together on primary and community transformation
Strategically we require underpinning robust contracts with longevity to fund and grow our infrastructure to be able to continue to step up and down services at pace. Our biggest operational challenge remains the difficulties with IT system interoperability.
At the same time as providing that additional capacity we must not take our focus off the longer-term work to innovate and redesign mental health, elective care and urgent care services. In Sheffield we are leading the way nationally in these areas. That’s one of the reasons why Primary Care Sheffield was named as ‘primary and community care provider of the year’ at this year’s HSJ Awards.
Primary Care Sheffield, Sheffield Health and Social Care NHS Trust and voluntary sector organisations continue to work together on primary and community mental health transformation. The aim is to work with people who are falling through the gaps in current mental health care and is designed to prevent people’s mental health from worsening, reduce A&E attendance, and improve their quality of life. The service is currently being trialled in some of the most deprived parts of the city.
At the same time our clinical assessment support and education service (CASES) is an elective care re-design programme that aims to reduce the pressure on elective services and makes sure that patients in Sheffield receive their care in the most appropriate setting from the most appropriate clinician. The last year saw more than 23,000 patient referrals being GP peer reviewed with advice and guidance offered to referring GPs and learning shared through briefing documents and learning events. Overall CASES has resulted in an average 23.7% reduction in referrals across all specialties. The service delivers high quality education and upskilling to Sheffield primary care clinicians based on evidence gained from the screening process.
At the moment we are hanging in there – like the Wile-e-Coyote’s final gravity defying moments after running off the edge of a cliff.
However, without longer-term transformation work alongside proper national strategies for primary care workforce and estates – the eventual plummet onto the rocks below is inevitable.