Prime Ministers Challenge Fund GP Recruitment - Information Pack GDoc Ltd Eastgate House, 121-131 Eastgate Street, Gloucester, GL1 1PX www.gdoc.org.uk Contents The Opportunity and Introduction 1 Background 2 Outcomes and What We Need From You 3 GDoc Contact Details 3 An outline of the Choice+ Service 4 An outline of the proposed Rapid Response+ Service An outline of the proposed Planned Weekend Visiting+ Service Page 6 8 Recruitment Information Pack: Apr 2016 Final v5 GDOC Ltd Registered in England & Wales No. 8230041
Gloucestershire: Joining up your primary care The Opportunity: This is an exciting opportunity to work with GDoc and our NHS partners to pilot new forms of service delivery improving access to primary care services. This opportunity is open to: Practice GPs in salaried / partnership roles and Qualified locum and portfolio GPs We offer competitive rates for weekday, weekend and public holiday cover. Introduction Ltd is a Gloucestershire wide GP owned company that is currently managing a 4million Prime Ministers Challenge Fund Wave 2 programme of innovative service proposals on behalf of the 81 practices. The PMCF programme is overseen by a multi-agency Delivery Board, including GP locality representatives from across the county, Gloucestershire Clinical Commissioning Group (CCG) and Gloucestershire Care Services (GCS). The initiatives include: i) Choice+ (Choice Plus) Clinics: based in central locations (or hub) in each locality each offering extended hours primary care access to patients (triaged in accordance with Choice+ criteria by their own GP Surgeries) up to seven days a week. ii) Enhanced Locality Case Management - Rapid Response+: Support to existing Rapid Response Teams (RRT). The GP will provide telephone advice and guidance to the RRTs across the county from 7pm to 9pm Monday to Friday and 10am to 12noon over the weekend. iii) Enhanced Locality Case Management - Planned Weekend Visiting. Planned weekend GP visits for at risk patients who have been triaged and appointments booked for them by their own GP Surgery. iv) Nursing Support to Practices: Offering nursing support to GP surgeries across the county in the following disciplines: Diabetes, Asthma, COPD, Travel, Family Planning and Sexual Health v) Social Prescribing: targeted, coordinated, managed and measured use of voluntary sector to provide support to those who have been referred by GPs. Recruitment Information Pack: Apr 2016 Final v5 Page 1
vi) E-Consultations: Use of e-consultation systems to facilitate informed online consultation between the patient and their GP. vii) Video Consultations: Piloting video consultations with 10 GP Surgeries across the county to test efficiency and best way of managing the process. viii) Health App: Signposting for the public to relevant services who will be able to help depending on the nature of their query/problem. http://www.asapglos.nhs.uk/ We are at various stages of planning, developing and implementing all the above service proposals (initially as pilot projects). Choice+ is currently being rolled out to all localities with Cheltenham and Gloucester already operational. GP support to Rapid Response Teams (RR+) and Planned Weekend Visits are scheduled for later in the year. We are looking for GPs who would like to work with us on delivering and therefore shaping these exciting new initiatives. If you are interested please read on. Background In June 2015 GDoc Ltd, with support and assistance from the Gloucestershire CCG secured significant funding from NHS England as part of the Prime Minister s Challenge Fund. Building on a successful pilot in Gloucester City to extend access to GP services, the proposed services offer approximately 100,000 new appointments in primary care during the calendar year April 2015 to March 2016. The focus is on the following areas: Improved access to general practice services including some appointments up to 8pm weekdays and access at weekends; offering choice of time and location convenient to the patient. Increased capacity through additional appointments, freeing up time in GP practices to focus on continuity of care and more planned/complex work. Consistent access and patient experience across our 82 practices. Increased integration of primary care with community services, voluntary organisations and other urgent and routine care providers. Use of new technology, e.g. through the use of video consultations, e- consultation and the implementation of a new mobile app. Important steps towards new models of care, as set out in the NHSE Five year Forward View. Recruitment Information Pack: Apr 2016 Final v5 Page 2
Direct involvement in delivering the Gloucestershire five year plan working with Gloucestershire CCG and other NHS partners. Key planned outcomes include: Increased patient choice and satisfaction. Improved collaboration and connection between GP surgeries by successfully demonstrating how primary care teams can work together to improve the quality and access of local services. Reduced pressure on A&E by preventing certain attendances through early primary care intervention. Reduced emergency admissions to acute hospitals because GPs have been able to deal with complex cases and offer continuity of care as a result of freed up time from additional appointments through Choice+ Clinics and other Challenge Fund initiatives. Informed input into future initiatives for new ways of working using evidence from Challenge Fund pilots. What we need from you please: We are looking for practice and portfolio GPs who can (ideally) regularly cover shifts for part or whole days at various times through the weekdays, including evenings up to 8pm, and approximately 3/4 hours each Saturday/Sunday morning. These times will vary depending on where you decide to do your shifts and the type of scheme you want to be involved with. You will be informed of the shifts available through our online Rota system (RotaCloud) details of which will be provided when you return your completed application form. If you are interested in joining us on these Challenge Fund initiatives and shaping the future of primary care services please do complete and return the accompanying application form. Recruitment Information Pack: Apr 2016 Final v5 Page 3
In the meantime, if you have any questions please contact the GDoc team: Kevin Fowell Service Lead (Choice+) kevin.fowell@nhs.net Lisa Clack Administrator lisa.clack@nhs.net Trish Boocock Finance Officer patricia.boocock@nhs.net Maria Wear Nurse Team Manager maria.wear@nhs.net An Outline of the Choice+ Service Information on the Choice+ process and criteria based on the successful pilot currently being run by GHAC in Gloucester and Cheltenham. Fees payable are: Weekday: 72 per hr: Weekend: 82 per hr: Bank Holidays: 92 per hr (These figures are inclusive of pension contribution) GPs will invoice GHAC for any work carried out for Choice+ in Gloucester and Cheltenham and GDoc Ltd for Choice+ work done elsewhere in the county. Objective The main objective is to free up on average 6 hrs of time per week in each participating surgery, to focus on continuity of care for patients with chronic conditions. Processes Patients must be clinically triaged by their own Practice using the Practice s triage process. Appropriate patients should be offered the choice of an available appointment at a Choice+ Clinic and will be booked directly by the clinical triage at their practice. These are same day appointments Patients should be offered the next available appointment (leaving time for travel), but can be booked for later the same day if the patient prefers Appointments are booked using SystmOne which will allow those given access to view the appointment book for this service at the relevant Choice+ Clinics. Practice computers will have the relevant system installed prior to the scheme beginning Practices should book double appointments should a translator (e.g. language line) be required. A double appointment reflects 2 from the practice s allocation GDoc will notify the referring practice of urgent cases, for example when a referral is required under the 2 week rule, to enable the patient to be given the appropriate appointment at their usual practice Appointment Criteria Patients suitable to be booked on appointments for the pilot service at the Recruitment Information Pack: Apr 2016 Final v5 Page 4
Choice+ Clinics are: 1. Patients who have contacted their practice for an urgent appointment on the same day AND. 2. Are clinically triaged as per practice policy, meaning that without the pilot would have been offered an appointment at their practice AND. 3. Have not requested an appointment relating to the ongoing care of a previously diagnosed condition/s AND 4. Are not presenting with a Mental Health condition. Choice+ Venue/Hub: Most of the Choice+ Hubs are located within Community Hospitals and supporting reception staff will be on duty at all Hubs whether hospital or practice based. Did Not Attends (DNA) and Cancellations DNAs will be captured by GDoc and rates shared with practices for their reference Patients wishing to cancel their appointment can do so by contacting GDoc directly GDoc will be monitoring appointment utilisation by practice, so cancellations can be fed back to practices to ensure they have an accurate understanding of their allocation utilisation General Practice Responsibilities Each participating general practice has a responsibility for the implementation and utilisation of the service, and its success relies on their support. General practices are responsible for: The appropriate referral of patients to the service according to the agreed appointment criteria Giving appropriate patients the choice of which Choice+ Clinic to visit, checking they have transport to get there in time for their appointment, and are given the relevant address details if required. If the practice uses a text system to confirm appointment times with patients, then this could be used to include the relevant Choice+ Clinic postcode The booking of appointments up to the practice s agreed weekly quota. This will be monitored and use in excess of the agreed number of appointments will be fed back to your practice and the Challenge Fund Delivery Board. This is to ensure all practices are able to benefit from the pilot. The weekly audit of how the time freed up by patients being booked on Choice+ appointments is being utilised for the benefit of your patients with long term conditions. Recruitment Information Pack: Apr 2016 Final v5 Page 5
Supporting the pilot Practices will be given posters about the new service to display in waiting rooms and staff rooms, and leaflets to share with patients. An electronic copy could also be provided should Practices wish to include this on their website, or share with their Patient Participation Group. IT Crib sheets and training will be offered following installation of the SystmOne appointment booking system on practice computers. Further Information: GPs participating in this scheme will receive further operational details and relevant induction. An outline of the proposed Rapid Response+ Service NHS Gloucestershire Clinical Commissioning Group (GCCG) currently commissions rapid response services from Gloucestershire Care Services (GCS) NHS Trust. This service provides medical support within an hour for a Service User/Patient who is experiencing an unexpected event or crisis in the community where there is a critical risk (non-acute) of them being admitted to Hospital or a Care Home. The primary focus is on the Service User/Patient residing in their own home (including Care Home) but are clinically deteriorating and at immediate risk of losing their independence. A key element of the proposal was to join up care across primary and community health and focus on higher risk patients. However, the service does not currently have routine GP support. The new pilot service will provide GP support and advice to existing Rapid Response Practitioners across 7 days in all Gloucestershire localities. The service will also pilot the use of near patient testing and ECG equipment in the Forest of Dean and Stroud & Berkeley Vale localities. GPs taking part in this scheme will be required to sign an Honorary contract with GCS as part of GCS governance requirements. GP Fee: Weekday - 77 per hour: Weekend and Bank Holiday - 90 per hour (These figures are inclusive of pension contribution). These higher rates (compared to the Choice+ rates) are linked to current LMC rates and reflect the following: Management of high risk, urgent case patients who are otherwise at risk of being admitted (compared with dealing soley with patients previously triaged by their own GP and meeting Choice+ criteria). Management of these cases based on information provided over the phone by RR team - which may or may not be supported with data from diagnostic equipment. Recruitment Information Pack: Apr 2016 Final v5 Page 6
Management of these cases in the evenings 7pm-9pm and at weekends. Recognising that, because of the above points, the RR+ GP support will need to be provided by experienced GPs able to meet the criteria detailed in the Memorandum of Understanding between GCS and GDoc. Operating principles: 1. Telephone based GP support/ advice to Rapid Response (RR) Practitioners will be provided from 7pm to 9pm weekdays and 10am to 12 noon on weekends. The GP will be required to record the advice provided to the RR teams for each case. 2. There will be one GP session per week with the GCS to support further quality improvements, support case reviews and most importantly to act as champion and work with practices that currently do not utilise the RR services. This will normally be carried out by the designated GP lead however other GPs participating in the service may also be required to provide this input and advice as required. 3. Further Information: GPs participating in this scheme will receive further operational details and relevant induction. Recruitment Information Pack: Apr 2016 Final v5 Page 7
An outline of the proposed Planned Weekend Visiting+ Service Description 1. On a weekly basis Practice GPs consider patients who would benefit from a planned visit and/or telephone consultation by Weekend Visit+ GP Service 2. Referrals for planned weekend+ service need to be sent electronically by Friday afternoon to GDoc. 3. GDoc collates Visit+ referrals and puts onto clinical system. Key points Known patients on the 2% risk register exacerbating? Has the person been recently discharged from hospital? Would the Practice decide to visit if it were midweek, i.e. would their concerns prompt them to do a home visit in the next 1-2 days? Requires specific clinical detail Practices can send referrals before Friday if they know planned visit will be required at weekend Referrals booked in for Saturday or Sunday. GDoc confirm appointments with Practices. 4. Host Practice (mainly medical secretaries) calls the patients on the Friday s to advise of weekend + appointment 5. Weekend service available 9am to 5pm Saturday and Sunday Patients told appointment will be Saturday or Sunday and proposed time. Working day is 9am to 5pm Working doctor goes to hub/ base and using laptop screens patients Calls patients for telephone advice Assume ½hr for the above and 1hr per visit, travel and turn-around time Own car used and approx. 6 to 7 visits per day per doctor 6. Links to OOH Where Practice has scheduled a planned weekend visit+ because patient is exacerbating then carry out visit as normal. If exacerbation after planned visit has taken place it is OOH responsibility 7. Post Visit+ Information back to GP Practice in time for Monday Morning 8. Other practice elements Practices review weekend admissions they were not expecting to see if they might have been appropriate for Visit + 9. Supply Assumptions On average each visit with travel time will take 45-60 mins. Each shift will be 8hrs with ½ hr break. Shift start up time of 15 mins as well as approx. 3 x10mins telephone consultations prior to visits commencing. Approx. 7 visits per shift. 1 GP on duty in each locality Sat and Sunday - so weekly capacity is for 28 home Recruitment Information Pack: Apr 2016 Final v5 Page 8
visits and 12 telephone consultations Recruitment Information Pack: Apr 2016 Final v5 Page 9