The nurse-led triage call centre, which is run out of and delivered by Trinity Medical Centre (TMC), has expanded from a service started more than 10 years ago by just two surgeries. The system later rolled out to cover five practices, and in 2017 it became a city-wide initiative for part of the week, part-funded by the CCG and covering 38 practices and a patient population of 370,000.
The service, called GP Care Wakefield, has dramatically reduced demand on GP appointments and improved patient access to service.
How the service works
The triage centre runs seven days a week, dealing with in-hours calls, Monday to Friday from 8am and 6pm for five practices (covering 55,000 patients) this part of the triage is funded by the practices. It switches to an out-of-hours service for all the city’s practices between 6pm to 10pm in the week and from 9am to 3pm at weekends and bank holidays. The centre deals with same day care, but also offers some routine care delivered by practices nurses and HCAs.
Dr Omar Alisha, GP clinical lead, explains that a team of nurses answer calls to assess patients and then decide on the best course of action. During in-hours this could include booking a same day appointment with a GP at the patient’s own practice, a routine appointment for another day, a telephone consultation or advising on self-care.
'Around 30% of these calls end with self-care in the in-hours part of the service and 15% during the out-of-hours, which is where we really see the benefit,' Dr Alisha says.
'Where needed our team can also link up with other health teams such as district nurses, social service, physiotherapists, CPNs and so forth, again saving on GP appointments and helping patients get quicker access to the care they need.'
From 6pm-10pm and at the weekend the service switches to a different system to cover 38 practices. Patients making calls to their own surgery are automatically put through to the triage call centre, where nurses have full access to medical records so they can make a proper assessment.
The service is linked to all of the practices so nurses are able book a patient in for an appointment at a later date with their own GP if urgent care is not required.
The centre is also able to deliver routine care during some of its out-of-hours opening times. Practice nurses are available to see patients for asthma reviews, repeat contraception prescriptions, dressings, blood pressure, blood tests and so forth. Practices can book these slots in advance.
Four GPs and advanced nurse practitioners are also on hand, based in different parts of the city, to see patients between 6pm and 10pm. Practices that have a ‘spillover’ of appointments at the end of the day can also book them into GP Care Wakefield, which enables them to better manage demand.
GP Care Wakefield is also linked into the local NHS 111 service so any calls are routed to the triage service when its open and the service works closely with the area’s GP-out-hours provider, Local Care Direct, to ensure a smooth hand over takes place when it closes.
Setting up the scheme
Initially, the triage service was delivered as a practice-led initiative under a PMS contract. In 2014, five practices working in a GP federation secured funding from the CCG to expand the service to a seven-day operation covering their patient population.
It proved so successful that within two years the CCG asked Trinity Medical Centre to develop the centre so it could offer an out-of-hours service to cover the entire CCG. The CCG provided funding to cover set-up costs and extra support to help the practice meet the challenges of scaling up.
The new arrangement now includes involvement from the local GP confederation, Conexus Healthcare, which was formally commissioned by the CCG to provide the city-wide service.
Key challenges that needed to be overcome in setting up the service on such a large scale included sharing of records, issues around consent, IT, and recruitment. 'We had to work together to sort out these issues and create buy-in,' explains Dr Alisha.
He says it was important that all practices and staff felt they 'owned' the service so co-operation, partnership and building trust was vital in getting the scheme off the ground.
Communication was also key. 'We had regular consultation with patients,' Dr Alisha says. 'And we updated practices about developments though regular newsletters.'
The scheme is now paid for through two funding streams – costs for the out-of-hours element are met by funding from the GP Access Fund, while the in-hours activity is paid for by the core five practices.
As the provider, TMC generates income from the scheme. 'TMC is on the frontline and as a business the scheme generate income for us. But there is full transparency around this. All the practices involved understand this,' Dr Alisha says.
What difference has it made?
Data collected over seven months from September 2017 when the city-wide service was launched, shows that during a typical week nurses deal with 326 calls. Of those, only 172 have resulted in a GP appointment being made. Other callers have been advised on self-care or supported in accessing a more appropriate service.
In addition, the figures showed that 53%of patients accessing this service via NHS 111 did not in the end to need to see a GP. Without the clinical advice and booking service, current GP capacity would need to be doubled to cope with demand, the data also found.
Dr Alisha says that despite the centre being expensive to run 'it’s cost effective because we have seen such a massive reduction in the requirement for GP appointments.
'It has boosted efficiency and given our city population improved access to seamless care,' he adds.