Perform in Primary Care

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Chris Newman, Director of Transformation, Hardwick CCG: Whenwe were looking at primary care, access to primary care for patients, we werereally also thinking about, well, why is there a problem? What’s the demand onthe service? What are the issues underlying that? What can we learn from othersectors, not just in the NHS but in industry generally, about how they managedemand, to give practices a tool they could use not just now but in future.  The Perform system could do that.

Dr Barrett, GP Partner, Shires Health Centre: We were veryinterested in having a go at Perform because we identified two or three mainproblems. First of all, one of the biggest problems is access, it’sunderstanding unmet need. The other problem, which I think is significant, andI think is really important in terms of the outcomes of the Perform model, isthat morale was very low among staff, now we don’t always know that.

Melinda Whiteley, Senior Nurse Practitioner, Shires HealthCentre: I found the coaching and huddle sessions very, very helpful. It enablesyou to put forward ideas.  We also hadstandard setting groups and there was a template to work to which was reallyhelpful. As healthcare professionals we tend to want to rush in and solveeverything when in fact what we need to do is sit back and consider what theissues are.

Karen Bestwick, Practice Manager, Castle Street MedicalCentre: Perform has brought many changes to the practice, many benefits.  It has become embedded into our practicelife.  The huddle happens every day.  And the huddle I think brings enormousbenefits to the whole practice team.

Emma Round, Care Co-ordinator and senior administrator,Castle Street Medical Centre: The clinicians get to see what admin’s concernsare. And obviously, we, the admin team get to know the clinician’s concerns.

The biggest single change is the huddle.  And in a way it is something we have alwaysdreamt of, having 15 minute meetings and looking at data.  I think we never experienced that before andthat’s a big, big change.

Samantha Parker, Receptionist, Shires Health Centre: Thehuddles… the main discussion is really from previous day: what, how manyappointments have been wasted, how the stress levels have been and, basically,how we can make the appointments better utilised. 

Lynne Parsons, Receptionist, Shires Health Centre: Thegeneral atmosphere since Perform has been here, it seems to be happier.

Another thing that was on the huddle board which identifies howwe are actually feeling. Are we, we call it, to the left of the mountain, onthe top of the hill or are we to the right of the mountain? And this isindicating to other members of the team if somebody is particularly stressed.It highlights to the rest of us, is there any help we can give?

Garcia Stoddart: Nurse, Shires Health Centre: The wayPerform has helped up is it has opened up communication channels.  We all feel a lot better. I think it has beenreally positive.

One of the real successes was with appointments.  We realised we had unused appointments, so wewere missing appointments and people weren’t getting booked into them so thenpeople couldn’t get appointments. So we built in changing some face-to-faceappointments which were 10 minutes into five minute telephone appointments sothat we could maybe encompass more people within those.  Having that flexibility enabled us to try andmeet the particular demands of that day.

One of the biggest challenges we are facing is ageing, anageing population, and our patients are getting much more complex. Are elderlypatients are much more frail.  We’retrying to keep them out of hospital because hospitals are costly places.

One of differences is, when there is more appointments,because we’re using them better, there is more appointments to give out.  So we’re not faced with, first thing in themorning, being fully booked and patients getting irate and annoyed because theycan’t get in to see a GP on the day.

Dr Carberry, GP, Castle Street Medical Centre: My personalhope for Perform, using it, would be that it would use my time more efficientlyduring the day with an aim to reduce interruptions and to be able to work moreproductively because there’s more order to the day.

We’ve obviously exploited our capacity in a better way, so Ipersonally feel the days are less stressed. For instance we’ve got moretelephone appointments.  There seems tobe more space in the day somehow, I don’t know, it just seems to have arrived.  It’s improved from that point of view, justmore space to do things, in the gaps.

Perform for me exceeded the expectations of how we couldmanage what we were doing.

We gave the practices the opportunity to choose forthemselves from a number of different models and external consultancies and ofall of those, to date, Perform has been most successful and it has had mostownership from the practices involved in it.

I really feel that Perform has worked for our surgery.  I see no reason why Perform shouldn’t work inany other surgery.

One of the big challenges in primary and community care atthe moment is we need to increase access, because we need to see more people inthe community and reduce their need to go into hospital. Perform could give us theopportunity to allow those teams to become teams.  It could give them the opportunity to startthinking about the problems they face as newly formed, emerging communityteams. So, it could be an approach, a very useful approach, for emerging geographicalcommunities, for emerging integrated care services, and for emerging new teamsin the community.

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