Karen Creffield, PCN manager at Frome PCN, Somerset, one of the 22 PCNs chosen for the capacity and access pilot, talks to senior reporter Beth Gault about how the pilot is increasing capacity in the South West town
Beth Gault: Your PCN is part of the capacity and access pilots that were commissioned last year to understand whether interventions can make a difference to capacity in primary care. How is it going so far?
Karen Creffield: It’s been really good. As part of the pilot, we get an uplift in staffing to try and see if we can measure the gap between demand and capacity, so we’ve done quite a lot of recruitment.
Altogether we’ve recruited 10 new staff members and three of those start in July. These include three GPs, a nurse, an evaluation lead, , a medicines management clinical pharmacist and we’ve increased some hours of our existing staff, for example we’ve got more physio hours and care navigation and care coordination time.
We’ve also employed a health psychologist project worker which is quite a new role in primary care, and she’ll be working with patients and across our teams.
Beth: How much funding do you receive as part of the pilot? And is there any concern about it being non recurrent?
Karen: All PCNs get a 10% uplift in staffing as part of seeing if this addresses the gap between demand and capacity. We are expecting the uplift to become part of the core contract for all practices in the future.
Beth: Each pilot was going to identify particular interventions to improve capacity in their PCN. What are the interventions your PCN has implemented so far?
Karen: There’s extra staffing, and we’ve just agreed the metrics of how we’ll measure the impact of those. For example, one of the objectives is to bring our GPs’ individual list sizes per session down to below 250. There’s research around having a lower list size being better for continuity and reducing the admin burden.
We’ve also recruited an extra 40 hours of care navigation time and our metrics for that is trying to reduce our call waiting time for patients.
For me, the most exciting part of this has been the primary secondary care interface work that we’ve been doing. We’ve been looking at the percentage of work we do that could typically be regarded as secondary care work to look at where that best sits, how we can be more efficient, and how we can collectively plug some of the gaps between primary and secondary care. So far, we’ve been having collaborative meetings with secondary care and auditing some of that work.
Beth: What about digital interventions?
Karen: We’ve set what we want to do for digital interventions, including ambient AI for GPs and across our clinical teams. We’ve just started to work with document workflow automation. And we’re working on a digital assistant for our website, which is not funded by the pilot but instead through our wider PCN funding, but we will look our learning from introducing this as part of the pilot.
Beth: What would the digital assistant do?
Karen: If you went onto the website and you said I’ve got a really bad cough, what should I do? It would give you some options, maybe send you to self-care, or take you to an appointments page. Or it might be that you want to know more about the practice opening times, so it takes you to that page. The digital assistant is linked to our telephone system. We are also quite excited about the potential future application of having a digital assistant and the features it could offer to improve patient communication and ease of access.
We use them all the time in other settings, so it’s just making sure we’ve got it in primary care to improve access to patients who don’t then have to search through the pages for the information.
Beth: And what will the ambient AI do?
Karen: It’s basically a transcription service to help a GP or clinician during a consultation to record it, structure it for you and then put it into your notes.
We’re close to having it linked directly with our clinical system EMIS, we’re just waiting for an extra bit of technology.
What’s interesting about ambient AI is that it’s preconfigured so a patient isn’t informing AI, it’s just a good transcription tool which hopefully means that GPs have more time to spend with the patients talking, rather than trying to write up their notes. It’s about human connection.
Beth: Have you seen any progress from the interventions so far?
Karen: The funding for the extra staff came into place from January, so the past three months has been about recruitment and setting some baseline metrics. We’ll then start measuring against the metrics on staffing in April.
However, we’ve been doing audit weeks, which all the PCN pilots have been doing. We’ve done three so far and we’re getting some good baseline data, measuring demand, capacity and staff surveys.
And in those three months so far, we’ve already seen improvement in our diabetes care by having that extra capacity.
But it is difficult to measure, which is a big challenge. We’ve been working closely with NHS England on getting good metrics and improving how we measure.
We’re now employing someone full time just to look at evaluation, which is quite big for us. There’s so much data collection and evaluation that needs doing. Not just because of the pilot, but also because we want to be as efficient as possible.
Beth: Have you been sharing data across the 22 pilot sites yet?
Karen: We’ve had three different sessions in London where you meet all the other PCNs, so there is a degree of sharing. But once we’re further on the ambition is to share more.
Beth: Have you had any communication with NHS England about how their transition into the Department of Health and Social Care (DHSC) might impact the pilot?
Karen: We were told at our last pilot meeting that it was happening, but a lot of the detail hasn’t come out yet. We’re aware of it but we have not been told if it will have an impact on the pilot.
Beth: Now a few months in, what are your hopes for the pilot?
Karen: I think hopefully we’ll see lots of improvements. We’re already starting to see that increased capacity is helping and we’ve very excited about some of the digital interventions. I’m also excited about some of the improvements we can make with the primary secondary care interface and how the wider system works together. It’s been lots of work to be part of the pilot, but it’s really positive. I’m also really hopeful the work the two Somerset PCNs do will also really benefit the rest of the county.