GP workload crisis - Digital Primary Care update 3.4.21

Join Andy and Gandhi for our Digital Primary Care update including discussing the dawn of a GP workload crisis, vaccination passports, PCN DES contract, and more....

Is there still a workload crisis?

Welcome

The last few weeks is it busy?

Andy / Gandhi

The theme in the industry media around workload

Year-end for Practices and PCNs, looking forward to 21-22

Changes to workload pressures QOF restart

We’re looking at some stories and tell you about content coming up in next few weeks...

GPs working average 11-hour day, major survey reveals

https://www.pulsetoday.co.uk/news/wor...​

11 Hour WW notes

Results from Pulse workload survey - 1,400 GP respondents

Look at the infographic and discuss

11 hours working day and 37 patient a day (28 thought to be safe)

Longer consultation times

Survey also asked about the impact of the pandemic

See infographic and discuss

Are telephone and online consultations saving time?

More stressful, less information (body language etc.), risk of f2f in a pandemic to manage

What can we do?

Erm….. Difficult

Recognise the impact of technology - pandemic safety and patient convenience yes, helping doctors - no?

Restart some old discussions about funding models, presentation of availability by gov/nhs, managing demand, token charges……?????

BMA says GPs can refrain from non-essential work despite April restart orders

https://www.pulsetoday.co.uk/news/wor...​

Notes

Ready to restart QOF activity in April, CQC resuming some inspection activity

But joint BMA.RCGP guidance - January - 

But ongoing Vaccination clinics, maintaining social distancing… which says ‘most’ GP practices should pause all or a ‘significant proportion of their non-essential work, depending on local Covid rates – ‘remains relevant as we continue in the pandemic situation

Ongoing discussions about pausing QOF again???? - BMA spokesman

? non-story ish?

Workload impact of vaccine passports?

GPs should have no role in administering any vaccine passport scheme, RCGP warns

https://www.pulsetoday.co.uk/news/cli...​

Notes

Government is likely to make some activities dependant on vaccination status - pubs, holidays abroads….

RCGP getting ahead of this and stating scheme should have zero impact on GP workload

Episode coming up about Vaccine passports when we know more in the coming weeks

Just use the NHS App as the basis for “passports”? Tab on their confirming vaccine status with authenticating QRcode?....Just call it allowing people to demonstrate vaccination status… legislate for misuse/discrimination and let industries decide.

What is new?

New DES Guidance published: https://www.england.nhs.uk/gp/investm...​

GP appointment data standardisation work 

Investment and impact fund 

Cancer early diagnosis 

Structured Medication reviews 

Enhanced health in care homes 

New ARRS roles 

- Mental health worker

- Paramedic

- Advanced practitioner

info and Content coming up about this from eGPLearning in the next few weeks to help you digest it

Work as normal?

Exhaustion

Vaccination phase 2

QoF restart

PCN work

ICS work

GPs could be asked to review hospital waiting lists ‘on an ongoing basis’

https://www.pulsetoday.co.uk/news/ref...​

6.6b to NHS for first 6m

https://www.pulsetoday.co.uk/news/cor...​

120m to General practice in first 6m

https://www.pulsetoday.co.uk/news/bre...

Ownership and pay rises in General Practice

Ownership and pay rises in General Practice

Digital Primary Care update 6.3.21

Join Andy and Gandhi as they cover the latest news in primary care including topics such as takeovers and more

Operose “partnership” to operate AT Medics

1% Pay Rise for NHS Staff

Operose - large private company

Now operate 58 practices, nearly 1% GP practices (6,658), >500,000p

Worries that GP is being parceled up and sold off to private business, foreign, American ones at that…

• Why is this controversial?
• Who are the players?
• Do people understand GP ownership structures?
• Does it matter? Should we worry?

AT Medics

• Largest Group of GP practices in London, 37 practices, 49 sites, 120,000p
•  
• Innovative software and programmes - medic assistant

Operose Health

• Owned by Centene
• American
• $111B Revenue 
• NHS Budget £150B
• Centene in Andaluz - Ribera Salud the template for ICS working
• Medicaid and population health in the US, 25m Americans

• My experience
• Good experience of working with PCN practices
• Good people

• Nationally assembling a strong team 
• CMO - Nick Harding OBE / Modality 

Does it Matter?

• Londonwide LMC (Chief Exec Dr Lisa Rothwell) - Strong tradition of GP Practices being led by GPs and teams who live locally and work as part of the frontline workforce.

• On the other hand - Investment - Efficiencies

• increased competition to the market to improve quality for patients and get better deal for tax payer? 

• NHS sets the price and performance expectations in the contract?

Understanding ownership of general practices - PArtnerships - need to change?

NSH 1% payrise 

Is it right or not?

Will you be clapping for carers or not?

Thanks to GP Online for the article

No Pulse article? Why?

Digital Primary Care update 20.2.21

Digital Primary Care update 20.2.21

Join Andy and Gandhi for the latest Digital Primary Care update including QCovid, vaccinations, the NHS white paper and more...

Join the S1 Update: https://youtu.be/HehN5MQhvoA​

What is QCovid episode: https://youtu.be/zhKolDFl5zs​

NHS White paper: https://assets.publishing.service.gov...

WhatsApp? Alternative Messaging Apps for Medical Teams

In the wake of concerns about WhatsApp's terms and conditions, we discuss the leading alternative messaging apps for health care workers to use at work and at home.

Digital Primary Care update 6.2.21

Digital Primary Care update 6.2.21

After a brief respite supporting the vaccination efforts of Nottingham, Andy and Gandhi are back with their Digital Primary care update on GP in the media, telephony, and more. 

The anti-GP agenda....

https://www.pulsetoday.co.uk/analysis...​ 

Gandhi - can I ask you a question… Are you still doing appointments at your surgery?

Is the media accurately portraying whats is happening in General Practice?

A lot has changed, but we’re still open

Some patients still think we are closed and can be frustrated

Telephony costs in practice. 

https://htn.co.uk/2020/11/10/innovate...​

The growing use of the phone in practices

Issues: 

Cost to patients

Cost to practice

Security of remote working

Recording of phone lines

Withheld numbers/non-regional numbers NYE Health

Identification of calls on bills etc. 

GP5T conference launch Apri 24th:

https://hopin.com/events/gp5t​

GP5T: Training Trainers To Train Trainees

RCA and teaching consultation guides

WBPA calibration

How to support IMGs and trainees with dyslexia

Tech tips

General Practice update Jan 2021

Join Andy and Gandhi as they review all the new updates and letters and what this means for you in primary care and social media with fake news..... Links below

Really Difficult New Year Quiz: https://youtu.be/4KlJDfC_TQM

Boardgame Medics: https://www.facebook.com/groups/board...

Freeing up General Practice: https://www.england.nhs.uk/coronaviru...

Operational guidance: vaccination of frontline health and social care workers: https://www.england.nhs.uk/coronaviru...

COVID-19 Vaccine Oxford AstraZeneca – movement of vaccine: https://www.england.nhs.uk/coronaviru...

COVID ES :https://www.england.nhs.uk/coronaviru...

COVID Vaccination Programme Guide

Join Andy and Gandhi as they review the official COVID19 Vaccination Programme DES and their views on how it might be achieved....or not.

COVID 19 DES half-hour guide: https://youtu.be/0ai1H1ThRi0

Watch here for our initial perspective as we were joined by Dr Ishani Patel of Lantum and Jacob Haddad of AccuRx in talking about the speculated COVID19 Vaccination DES and our views: https://youtu.be/lOQjRNSYkdk

NHSE General Practice Webinar: https://future.nhs.uk/connect.ti/P_C_...

Link to slides: https://drive.google.com/file/d/1qq5a... 

The full DES documents are available here: https://www.england.nhs.uk/coronaviru...

BMA guidance on COVID19 Vaccination Programme is here: https://www.bma.org.uk/advice-and-sup...

BMA and RCGP Workload prioritisation guideline: https://www.rcgp.org.uk/covid-19/late...

Link to slides: https://drive.google.com/file/d/1qq5a...

COVID Vaccination DES Set up

Join Andy and Gandhi LIVE as they talk about setting up a COVID flu vaccination clinic with respect to what we know of the DES as the Government announces plans to start vaccinations in the next couple of months.

This episode has guest appearances and more....

Speculated DES guidance: https://www.gponline.com/gps-deliver-two-dose-covid-19-vaccination-1258-per-jab-seven-days-week/article/1699389?fbclid=IwAR0SOUhJNFMwoU4id7bqerefWlNkgn8YL-CGgPq7ekqoAz_rwlScash8WUE

COVID Vaccination DES - Awaited

Due last night….

Approved by GPC Thursday…

Leak leading to info on GPONline & Pulse

Sun - GPs Open at weekends, Xmas day, boxing day

GPs told the have a “Moral Duty” without understanding implications - workforce

https://www.thesun.co.uk/news/13130975/doctors-vaccine-covid-christmas-boxing-day/

So what do we believe is in the DES?????

Use GP surgeries to deliver COVID19 Vaccine, as early as December

975 vaccinations a dose at single sites per network = 81 hrs - 12hrs a day, 7 days a week

PCN sites

PPE and distancing

GP Consent?

Standardized consent package produced centrally

Video?

Group consultations?

Side effects including fever, monitor for, not known

Drive-by not practical

£12.58/dose, 2 doses, paid on second dose (even if the first dose is given?) exemptions process possibly?

Is this enough?

Logistics and storage, “vial of 1000 doses”, 2 people to draw up, -70c until used

Streamline your practice rota and save time with Lantum: https://youtu.be/vFEYOD9XKEg

AccuRx COVID Vaccine delivery plan: https://www.notion.so/COVID-Vaccine-delivery-0b62725ed6c241dcb004875e298d6936

RCGP Mass vaccination guide: https://elearning.rcgp.org.uk/pluginfile.php/149506/mod_page/content/75/Mass%20Vaccination%20at%20a%20time%20of%20COVID%20V2.0.pdf

Apple watch 6 as a Health Device

Dr Andy Foster flies solo in this episode and discusses the newly released Apple Watch 6. He talks through the health monitoring features and discusses what this means for the present and future of consumer health wearables for Primary Care.

NHS Covid App - Digital Primary Care update

Join Andy and Gandhi for their latest Digital Primary Care update on the new COVID app, DigitalPC20 prep, and more...

NHSCovidApp: https://www.nhs.uk/apps-library/nhs-c...

#nhscovidapp #covidapp digitalprimarycare

Twitter response: https://twitter.com/NHSCOVID19app/sta...

Join DigitalPC20: https://bit.ly/DigitalPC20

26 Sept Episode - NHS COVID-19

Welcome

Introductions

Live Saturday Episode

DFPC Conference

Demo…

Video on screen

Postcode - lets you know if area is high risk

Cant change

Info on localised measures and restrictions

Data stays on the app and doesn’t need to go anywhere else

Venue check in - QR code

Check symptoms

Read latest advice

About the app

Enter test result

Switch off contact tracing

How it works diagram and privacy - use FT diagram

https://www.ft.com/content/d2609e26-8... 

No centrally stored data - everything is dispersed across everyone’s phones…

Supposed to address privacy concerns 

No GPS or location data…

All data on phone...

Will people download it?

Use not compulsory

£1-10k fine if you refuse to self isolate… but the government won’t know

Matt Hancock stated was optional….

Will you use it?

Coverage needed?

50% based on comments about German App

In May Iceland had highest uptake with 38% of its 364k population

Singapore has 37% - early leader, bit more authoritarian

Should GPs use the app in surgery?

Can pause contact tracing for periods of time

Not use if wearing PPE??????

Flu clinics?

Should we display a code at the surgery - like bars, hair salons and other venues?

Bars etc. required to display under regulations

No contractual obligation - voluntary

Here is the link to create a code

https://www.gov.uk/create-coronavirus... 

Will your surgery promote it?

Problems!!!

NHS tests do not link to the app - relevant code currently not provided

https://twitter.com/NHSCOVID19app/sta... 

Will it overwhelm testing centres?

Why the delay?

“World beating app” supposed to be released 4 months ago?

UK rejects apple/google solution

https://www.bbc.co.uk/news/technology...

UK Abandons own app

https://healthcareleadernews.com/covi... 

Battery and privacy and technical concerns...

Thoughts?

Missed opportunity?...

Window of opportunity still open?

Work as part of a whole range of measures

But will be so much more ready for the next pandemic?

Opens lots of future possibilities…

New model for handling health data and sharing health data

Gets people used to some health data

Google and Apple as health data partners - kudos and entrance for them to the area

Gets people used to using a smart app to guide health behaviours

Open doors for health apps in the future

So after all that - will you use it? Will you recommend it?

Digital Primary Care Conference: https://bit.ly/DigitalPC20

Digital primary care update - Appointments, flu and video consultations

Join Andy and Gandhi for their latest Digital Primary Care update after a brief break. What is new in general practice and digital health, find out here.

Welcome eGPlearners

Back from our summer break.

Are you refreshed?

Working on DPC conferences - sign up!

Congratulations to fellow eGPlearner and long time Listener - Dr Sonali Kinra on her election to the National RCGP council. 

What are we talking about this morning?

A story about NHSD plans to count GP appointment data and the focus on appointment as the unit of work https://www.england.nhs.uk/wp-content...

A story about how a CCG is partnering with video consult provider LIVI to make video consultations available for all of there 220,000 patients.

Story and discussion about flu immunisation in practices and preparedness

Main discussion point this week.

Mapping time and appointments in GP has been a big issue on discussion forums this week.

New Guidance on accurate monitoring of GP Appointment Data from NHS-D : https://www.england.nhs.uk/gp/gpad/ 

Whats happening?

Data extraction from CRS to NHSD to monitor GP activity

Why causing a buzz?

Provided a definition of of what an appointment is? What will be counted… And what will not be counted as an appointment.

Go through on the PDF….

Talking points

If something isn’t counted then is it not valued? 

Extracting the appointment ledger does not reflect the work taking place

Letters

Bloods

Tasks

Undocumented phone calls

Supervising colleagues

Concern that the real amount of work taking place will be underestimated

What decisions about funding and resource allocation will be base on this data?

Secondary care better at or longer history of strategic data collection - due to historic payment mechanisms?

Leading to a wider discussion in some places about GP workload and the consequences of this being poorly defined and understood. Generally - issues of burnout?

We delude ourselves that we do 9 - 3.5hr sessions - the profession tells itself this lie?

How do you count activity….

Multiple problems in one appointment?

The number doesn’t equate to work and quality?

Everything on the ledger - make everything that can be ana appointment, an appointment

Should we instead focus on truly counting workload/activity?

Should we focus more on outcomes in this population health-driven world?

Why is this happening?

So Governement can say that there are X million more appointments after an initial count and then 

http://www.pulsetoday.co.uk/news/ccg-...

NHS North Tyneside CCG said the 12-month pilot would give free online GP services to 222,000 patients without them having to deregister from the area's 25 GP practices

?extended access funding

Some concerns from local GPS about the limitation of online appointments and whether funding could have been better spent with local practices.

https://www.digitalhealth.net/2019/09... 

Boots/Livi - £25 per appointment

Good for access

But erode / damage relationship and continuity with practices.

http://www.pulsetoday.co.uk/views/how...

More people - shielded, over 50s and existing groups

COVID infection control, social distancing and PPE requirements

The COVID vaccine plans and difference?

Some additional help...

City Care Staff locally able to do flu jabs

Delay 50-65s until November

What are you doing?

Digital Primary Care update - 15.8

Join Andy and Gandhi for the latest Digital Primary care update including what we have planned for the coming months

Join us for Digital Primary Care conference (#DigitalPC20) on 30th Sept right here: https://hopin.to/events/digital-prima...

See the recordings of our previous conference: https:/bit.ly/S1FBUGR

Join in for Recording Consultations - 5-day challenge:

Babylon publishes research report on AI in primary care: https://www.thehtn.co.uk/2020/08/12/b...

Article: https://www.nature.com/articles/s4146...

HIEM 3 Reboot: https://www.eventbrite.co.uk/e/health...

Attending an Online conference

After hosting and attending several online conferences recently, Andy and Gandhi share their tips on how to get the best from attending an online conference and running virtual ones.

Today… Talk about 

Some stories in the news that caught our attention

Online conferences - Had a great time hosting the first S1 FBUG Online Summit - learnt a lot and will share

Quick Shout out to 

• @JoeTidy - BBC cyber security reports - spoke to about 2017 NHSCyberAttack - Hi Joe
• Bristol medtech society https://www.facebook.com/pg/bristolmedtech
• Jacey Melody and Sonali Kinra - long time listeners and patreons
• Dr Minal Bakhai and providers
• Surina Chibber from MyLocum Manger

Great eGPLearning Content….

• Digital first providers guide
• Top tip for 

Story in the news…

http://www.pulsetoday.co.uk/news/gps-should-do-all-consultations-remotely-going-forward-says-health-secretary/20041246.article

GPs should do 'all' consultations remotely going forward, says health secretary

• Matt Hancock always been a fan of online consultation - vindicates that position
• Good to have air cover for increased appointments
• Can we go too far?
• What is being missed?
• Have we moved too fast? PAtients without access… how do we know it’s safe…

https://www.thehtn.co.uk/2020/07/30/nhsx-launches-clinical-communications-procurement-framework/

NHSX launches clinical communications procurement framework

• Some familiar names on list.
• Discuss opportunities.

Online Conferences

• Big Shout out to Attendees, Sponsors and Speaker at the S1FBUG Online Summit
• We had a great time
• Let’s talk about the Experience of Attending and Running an Online conference.

Getting them right

Different from meetings and webinars

Accommodating

• Multiple speakers
• Multiple simultaneous sessions
• Sponsors and giving them value

Recreating those things that happen at live conferences - networking

Really impressive platform - Hopin

Prepping the guests, speakers, sponsors and helpers… on boarding

Tech support on the day

What sessions did we have?

• Speakers
• Sessions with Sponsors
• Ardens
• Great demonstration on the Eko Stephoscope

Reflect on feedback - delegates and sponsors

What next for online conferences and eGPLearing?

Thanks, subscribe, interact and have a great weekend

Appointments in General Practice

Appointments in General Practice- A digital guide

Welcome

Live episode, please interact

Intoductions

Todays episode inspired by chat on NHS Digital Whats App group about appointments and access

2 themes to cover….

• What is an appointment? And what will count as activity

• Total triage, before and after - what is the best option for the practice and its patients

Up-coming document from NHSE will set out how NHSE will harvest/access data from CRMS (S1/EMIS) to assess activity within general practice to the level of individual surgeries.

• Information such as number and type of appointments.

Led to speculation about how this data will be used in the future…..

• Concerns that used to judge practices and that incorrect or unfair conclusions might be reached?
• Used to allocate resources? Correctly? Similar concerns
• Regulatory attention?
• Use by the media?

What constitutes as an appointment?

• Online / Telephone /video/ F2f / Administrative activity? - would this be covered by online/asynchronous?

• How do we log workload in practice, everything have an appointment slot ie oncall work/ admin etc. 

• Supervision/ second opinion / Administrative tasks (non patient content but often time consuming)

• Dichotomy of primary vs secondary care contracts - PBR vs capitation based contract. 

Thoughts? Gandhi

Needs to be some accountability for spending public money?

But will the right things be counted?

Demand? Or under delivery?

Can this data be helpful? 

If demand/need reliably captured then can build case for redistribution?

Thoughts? Andy

Its coming - similar systems present or developing in other areas of public spending

Embrace - record everything and show our value - build the system to make this automatic

Lots of scope in recording the asynchronous/”online” admin work

Access and appointment options

So many - also discuss in the whatsapp

Lots of ways to structure appointment systems using different models and tools

What will / should the future look like?

Traditional models - return

Blind booking of f2f (or telephone) appointments with clinicians

Patient choice - Allow patient to book type of appointment and choose clinician

Reception guided

Total triage - during the crisis - examples

• All clinicians triage own cases and see for continuity (basic reception/admin triage)
• Single clinician triages incoming work and allocates to appropriate clinician or admin staff 

Triage vs signposting

Tools helpful for these systems available…

Preconsultation information collection - eConsult etc.

Join our Digital First Providers guide on 29.7.20 : https://www.youtube.com/watch?v=ngNhAeMOw_Y

Electronic messaging

Telephone

Video

Photos

Even collection of obs via care home staff or remote devices in the future

Electronic guidance to streamline and improve choices

How do you manage your appointments at your practice? With the new shift to total triage, what now is classified as an appointment?

🔴 Subscribe: https://bit.ly/eGPlearningYTsubscribe 🔴 

Join us as we talk about appointments, total triage, and the journey of a patient. 

Welcome

Live episode, please interact

Intoductions

Todays episode inspired by chat on NHS Digital Whats App group about appointments and access

2 themes to cover….

What is an appointment? And what will count as activity

Total triage, before and after - what is the best option for the practice and its patients

Up-coming document from NHSE will set out how NHSE will harvest/access data from CRMS (S1/EMIS) to assess activity within general practice to the level of individual surgeries.

Information such as number and type of appointments.

Led to speculation about how this data will be used in the future…..

Concerns that used to judge practices and that incorrect or unfair conclusions might be reached?

Used to allocate resources? Correctly? Similar concerns

Regulatory attention?

Use by the media?

What constitutes as an appointment?

Online / Telephone /video/ F2f / Administrative activity? - would this be covered by online/asynchronous?

How do we log workload in practice, everything have an appointment slot ie oncall work/ admin etc. 

Supervision/ second opinion / Administrative tasks (non patient content but often time consuming)

Dichotomy of primary vs secondary care contracts - PBR vs capitation based contract. 

Thoughts? Gandhi

Needs to be some accountability for spending public money?

But will the right things be counted?

Demand? Or under delivery?

Can this data be helpful? 

If demand/need reliably captured then can build case for redistribution?

Thoughts? Andy

Its coming - similar systems present or developing in other areas of public spending

Embrace - record everything and show our value - build the system to make this automatic

Lots of scope in recording the asynchronous/”online” admin work

Access and appointment options

So many - also discuss in the whatsapp

Lots of ways to structure appointment systems using different models and tools

What will / should the future look like?

Traditional models - return

Blind booking of f2f (or telephone) appointments with clinicians

Patient choice - Allow patient to book type of appointment and choose clinician

Reception guided

Total triage - during the crisis - examples

All clinicians triage own cases and see for continuity (basic reception/admin triage)

Single clinician triages incoming work and allocates to appropriate clinician or admin staff 

Triage vs signposting

Tools helpful for these systems available…

Preconsultation information collection - eConsult etc.

Join our Digital First Providers guide on 29.7.20 : https://www.youtube.com/watch?v=ngNhA...

Electronic messaging

Telephone

Video

Photos

Even collection of obs via care home staff or remote devices in the future

Join the S1 FBUG Online Summit : https://bit.ly/S1FBUG2020

⭐Star posts⭐:

Quick video consultation skills for doctors: https://www.youtube.com/watch?v=1UivL...

How to register with the NHS app: https://youtu.be/4nRhmJ_tlI4?t=65

👨🏾‍⚕️Dr Gandalf’s Top medical equipment for General practice 👨🏾‍⚕️ see here: 

YouTube: https://youtu.be/JddoeK5JcRw

Website: https://egplearning.co.uk/ramblings/d...

Subscribe to or follow the eGPlearning platform for more videos, app reviews and content to support technology-enhanced primary care and learning. 

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Conferences and more your Digital Primary Care update 4.7.20

Join Andy and Gandhi as they explore attending online conferences in our post COVID world including a sneak peek at our own:  S1 FBUG SystmOne Online Summit: https://bit.ly/S1FBUG2020

🔴 Subscribe: https://bit.ly/eGPlearningYTsubscribe 🔴 

Welcome

S1 FBUG SystmOne Online Summit: https://bit.ly/S1FBUG2020

Join in before all the early bird tickets go. 

Today...

Exploring an issue from the news this week….

Controversy around RCGP comments that COVID19 is a lifestyle disease…

http://www.pulsetoday.co.uk/views/why...

http://www.pulsetoday.co.uk/news/rcgp...

Plus further details on the exciting up coming S1 FBUG online

The apology…

https://twitter.com/rcgp/status/12768...

The articles…

http://www.pulsetoday.co.uk/news/rcgp...

Event held in coop with sport england

Caused controversy around the term… Lifestyle disease

Promoting the event, the RCGP had said: ‘Covid-19 is a communicable virus but it is also a lifestyle disease. Obesity, diabetes and other lifestyle diseases are associated with poorer outcomes from infection.'

Caused controversy on twitter resulting in apology

 RCGP virtual conference titled ‘Covid-19: A lifestyle disease and the vital role GPs have in beating it’

Most risk factors identified by PHE are NON-MODIFIABLE - BAME increases risk of death by 10-50%, male gender, certain types of employment where homeworking/distancing difficult.

DM & HTN may also be risk factors, and life style is a factor here, but the link to COVID outcomes becomes stretched.

http://www.pulsetoday.co.uk/news/rcgp...

Event held in coop with sport england

Promoting the event, the RCGP had said: ‘Covid-19 is a communicable virus but it is also a lifestyle disease. Obesity, diabetes and other lifestyle diseases are associated with poorer outcomes from infection.'

Comments…

No doubt good intentions

An opportunity to promote impotence of lifestyle and modification of lifestyles for health

Succumbed to the temptation to use COVID19 to draw attention to an event

Diseases where lifestyle is a factor and conditioning in general affects resilience to acute illness - so good point

Benefits of lifestyle medicine - what is it/ how can it be effective?

Wearables as a tool to help?

How much does wealth feed into this?

Publicity and optics, how should this be handled?

Does the RCGP need a PR department?

Running conferences at this time- our experiences

Attending

AiT conference

RCGP council meeting

Key issues:

Engagement

Agenda and running to time

Breaks

Running:

Prep

Screen time before and after

Engagement and games

Feedback

S1 FBUG TPP SystmOne online Summit: https://hopin.to/events/systmone-onli...

S1 FBUG SystmOne Online Summit: https://bit.ly/S1FBUG2020

Join in before all the early bird tickets go. 

⭐Star posts⭐:

Quick video consultation skills for doctors: https://www.youtube.com/watch?v=1UivL...

How to register with the NHS app: https://youtu.be/4nRhmJ_tlI4?t=65

👨🏾‍⚕️Dr Gandalf’s Top medical equipment for General practice 👨🏾‍⚕️ see here: 

YouTube: https://youtu.be/JddoeK5JcRw

Website: https://egplearning.co.uk/ramblings/d...

Subscribe to or follow the eGPlearning platform for more videos, app reviews and content to support technology-enhanced primary care and learning. 

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Other networks:

👍 Facebook - https://www.facebook.com/Egplearning/ 👍🏼

🐦 Twitter - https://twitter.com/egplearning 🐦

🐦 Twitter - https://twitter.com/drgandalf52 🐦

🖥 Website - https://egplearning.co.uk/ 🖥️

💷 Support: https://patreon.com/egplearning 💷

Some links may contain affiliate links to help support eGPlearning see our disclaimer at https://egplearning.co.uk/contact/dis...

Big News Digital Primary Care 20.6.20

Big News Digital Primary Care 20.6.20

Join Andy and Gandhi as they explore new updates to digital primary care with N365, RCGP council and exclusive information about the S1 FBUG SystmOne Online Summit: https://bit.ly/S1FBUG2020

🔴 Subscribe: https://bit.ly/eGPlearningYTsubscribe 🔴 

Welcome

SystmOne User Group Online Conference Announcement!!!!!!

S1 FBUG SystmOne Online Summit: https://bit.ly/S1FBUG2020

Join in before all the early bird tickets go. 

Whilst we waiting for Gandhi let’s look at a story in the news….

“NHS Strikes deal for Microsoft365 digital tools”

http://www.thehtn.co.uk/2020/06/15/nh...

https://digital.nhs.uk/services/micro...

https://news.microsoft.com/en-gb/2020...

NHSX/Digital agreed on a deal to deploy M365 tools across the NHS

Agreement runs 15 June 2020 to April 2023

Includes MS Teams - initially limited to 3m from March

Good news as some organisations and groups were holding off investing time in teams, as access could have been time-limited

Narrative from Matt Hancock and government is that

they are making most up to date digital tools available to NHS

Acknowledging innovation during COVID19

Getting the basics right.

Providing Tools for productivity, COLLABORATION and…

Cyber security right

This news is welcome and a real improvement

After using windows xp (released 2001) and IE7 (released 2006) until about 3 years ago

… and the lapsing of security updates around the time of cyber attack…

Includes...

Office 365 for Word, Excel, Powerpoint, Email and Teams

Windows 10 & security features

“Significant cost savings” - But how much?

Why am I excited by this…

I’m a big fan of office 365 and have a subscription

Previously Google Drive

Office applications are more mature

better compatibility

more storage on 1 drive - 1TB! Vs 15GB with google

Creates a network effect… value of a product or service increases the more people use it - like Facebook / twitter etc.

Great for collaboration - particularly Teams

A chat, projectmanagement, document sharing, video meeting/consultation tool that is suitable for sharing patient identifiable data

THAT ALL OTHER NHS ORGANISATIONS WILL ALSO BE COMFORTABLE USING (and committed to using as it will be staying around) - will be a game-changer for cross-organisation meetings and virtual MDTs.

Bad news for Zoom?

Any downsides?

LOCK-IN… So much value might be created by what the NHS builds on the platform, that it would be difficult for the NHS to function without the platform or to migrate to another that we become LOCKED IN… And Microsoft can up the cost considerably in a few years… as cost of leaving will be too great.

But I’m sure NHSDigital have thought of that right?

Squeeze out, other innovators?

Gandhi ready to Join from RCGP Council virtual meeting?

How is the council working out as a virtual meeting?

Platform?

How many people?

How is it compared to the usual council meeting?

How well do you think RCGP coped and responded to COVID?

RCA?

Support for public and profession in the media?

What role does RCGP have in adoption of technology by the profession?

Does it have a tech strategy?

How well do you think it is doing in this regard?

SystmONe User Group Online Conference Announcement!!!!!!

S1 FBUG SystmOne Online Summit: https://bit.ly/S1FBUG2020

Join in before all the early bird tickets go. 

⭐Star posts⭐:

Quick video consultation skills for doctors: https://www.youtube.com/watch?v=1UivL...

How to register with the NHS app: https://youtu.be/4nRhmJ_tlI4?t=65

👨🏾‍⚕️Dr Gandalf’s Top medical equipment for General practice 👨🏾‍⚕️ see here: 

YouTube: https://youtu.be/JddoeK5JcRw

Website: https://egplearning.co.uk/ramblings/d...

Subscribe to or follow the eGPlearning platform for more videos, app reviews and content to support technology-enhanced primary care and learning. 

🔴 Subscribe: https://egplearning.co.uk/subscribe/ 🔴 

Other networks:

👍 Facebook - https://www.facebook.com/Egplearning/ 👍🏼

🐦 Twitter - https://twitter.com/egplearning 🐦

🐦 Twitter - https://twitter.com/drgandalf52 🐦

🖥 Website - https://egplearning.co.uk/ 🖥️

💷 Support: https://patreon.com/egplearning 💷

Some links may contain affiliate links to help support eGPlearning see our disclaimer at https://egplearning.co.uk/contact/dis...

Digital Primary Care update - RCA, locums and more

Join Andy and Gandhi as they explore digital primary care, social media use by practices and more in your regular update. 

🔴 Subscribe: https://bit.ly/eGPlearningYTsubscribe 🔴 

Welcome

Live update event

Talk about news and topical issues LIVE

Today we have each brought a topic…

RCA, changes to MRCGP/CSA and tips, thought and ideas for trainees and trainers

How the jobs market has been affected by COVID and effects on ST3 and locums - pulse article

Locum GPs forced to claim benefits as work dries up… http://www.pulsetoday.co.uk/news/locu...

INTERACT

How has your week been?

Gandhi…

Andy… Busy!!! Care Home work and ST3 to GP online event - Zoom event - lots of fun and inspired our news item pick today.

RCA:

Fourteen Fish provided how to record video and phone consultations:

Video

https://www.youtube.com/watch?v=IOe4E...

Full details:

https://www.fourteenfish.com/recorded...

Easily record

Share with trainer - watch back at faster speed! - excellent

13 consultations, demonstrate competencies across curriculum, video or telephone, explain examination so thinking along the process.

Good video from Amon Arora

https://www.youtube.com/watch?v=Q05ha...

News Item….

http://www.pulsetoday.co.uk/news/locu...

“Locum GPs forced to claim benefits as work dries up”

Dramatic title!!!

GP workload reduced during initial COVID response

Reduced patient demand

People cancelled holidays

Retired GP working for free

Technology enabled sick or isolating staff to continue to consult and work

Locum work cancelled or Not booked

Or shifts that are available in COVID assessment clinics or COVID visiting services

Higher risk an issue for shielding locums

Worries that some of these shifts may be permanent?

Technology and e-consulting may have lasting effect on demand management?

PAtients will continue to be more confident with self care?

What do you think 

Gandhi?

Andy?

Zoom Event with AiTs was interesting

Anxiety about jobs market

Fewer considering locum work and more interest in salaried and partnership

Considering applying and meeting practice during COVID interesting

Tips for ST3s… And Locums?

Andy…

Don’t panic...

“This too will pass”... things will go back to normal… probably

Continue to network, look for jobs, apply

Think about what is best for you… “correction” to locum working risk reward position?

Build financial resilience appropriate to how reliable you stream of work is

Black swan events happen

How to get your CCT: https://youtu.be/wjYvkHOhtC0

How to get a job as a GP locum, salaried or partner: https://youtu.be/rjrNNH5AL_c

Gandhi...

Other interesting points…

Video meetings for practices and MDTs, learning events tips for this and more below

Online meetings in primary care: https://youtu.be/n7XNsEIxF9M

eGPlearning Tech Tuesday : PPG arrangements for practices : https://www.facebook.com/groups/eGPle...

Next time…

Gandhi joining us from RCGP council meeting in 2w

Recorded interview next week

⭐Star posts⭐:

Quick video consultation skills for doctors: https://www.youtube.com/watch?v=1UivL...

How to register with the NHS app: https://youtu.be/4nRhmJ_tlI4?t=65

👨🏾‍⚕️Dr Gandalf’s Top medical equipment for General practice 👨🏾‍⚕️ see here: 

YouTube: https://youtu.be/JddoeK5JcRw

Website: https://egplearning.co.uk/ramblings/d...

Subscribe to or follow the eGPlearning platform for more videos, app reviews and content to support technology-enhanced primary care and learning. 

🔴 Subscribe: https://egplearning.co.uk/subscribe/ 🔴 

Other networks:

👍 Facebook - https://www.facebook.com/Egplearning/ 👍🏼

🐦 Twitter - https://twitter.com/egplearning 🐦

🐦 Twitter - https://twitter.com/drgandalf52 🐦

🖥 Website - https://egplearning.co.uk/ 🖥️

💷 Support: https://patreon.com/egplearning 💷

Some links may contain affiliate links to help support eGPlearning see our disclaimer at https://egplearning.co.uk/contact/dis...

Digital Primary Care update- Care homes, vaccinations and social media.

Digital Primary Care update- Care homes, vaccinations, and social media.

Join Andy and Gandhi as they explore digital primary care and a focus on care home work, social media use by practices, and more. 

🔴 Subscribe: https://bit.ly/eGPlearningYTsubscribe 🔴 

Welcome and Eid Mubarak

Care homes and how to manage them, based on the article: http://www.pulsetoday.co.uk/clinical/...

We talk about:

+ The Care home DES

+ The NHS England funding

+ How to arrange MDT meetings

+ Can economies of scale help?

+ The tech you may want to use

+ Fair share of patients vs geographic spread

+ How will the service be evaluated?

The best social media tool for General Practice: https://www.youtube.com/watch?v=ORkFF...

Free video to support immunisations and vaccinations at your practice: https://youtu.be/AiPI50ASFwY

⭐Star posts⭐:

Quick video consultation skills for doctors: https://www.youtube.com/watch?v=1UivL...

How to register with the NHS app: https://youtu.be/4nRhmJ_tlI4?t=65

👨🏾‍⚕️Dr Gandalf’s Top medical equipment for General practice 👨🏾‍⚕️ see here: 

YouTube: https://youtu.be/JddoeK5JcRw

Website: https://egplearning.co.uk/ramblings/d...

Subscribe to or follow the eGPlearning platform for more videos, app reviews and content to support technology-enhanced primary care and learning. 

🔴 Subscribe: https://egplearning.co.uk/subscribe/ 🔴 

Other networks:

👍 Facebook - https://www.facebook.com/Egplearning/ 👍🏼

🐦 Twitter - https://twitter.com/egplearning 🐦

🐦 Twitter - https://twitter.com/drgandalf52 🐦

🖥 Website - https://egplearning.co.uk/ 🖥️

💷 Support: https://patreon.com/egplearning 💷

Some links may contain affiliate links to help support eGPlearning see our disclaimer at https://egplearning.co.uk/contact/dis...

Post lockdown eGPlearning Podblast update part 2

Post lockdown eGPlearning Podblast update part 2

Join Andy and Gandhi as they explore what primary care might look like after the coronavirus lockdown comes to an end in the UK. 

🔴 Subscribe: https://bit.ly/eGPlearningYTsubscribe 🔴 

Life after Covid Part 2

Welcome

Continuing our conversation about how  COVID has brought a lot of changes and innovations in a short period of time

Check out part 1 where we talked about demand management and total triage, patient behaviour and resilience and video consultations:

https://youtu.be/Z-klLCQ6ATU

Today we are going to talk about how more things might be changed by COVID...

+ Management of long term conditions

+ Working with colleagues in practice

+ Working with the wider MDT

+ And… how can we make changes stick

Live so - Engagement and Chat

+ Managing long term conditions

- 4 waves

- Online management… option

- Suppliers

- Apps from ORCHA etc: https://appfinder.orcha.co.uk/

- Issue of using multiple apps and channels in addition to NHS app?

- Not such an issue if interaction initiated by the practice?

- Single front door

+ Working with Colleagues

- Practice & PCN communications

- Loads of options… WhatsApp, Teams, Zoom

- Apps yes, but also the frequency of meetings - weekly pandemic PCN meetings, cell meetings...

- So many options and some improvisation in crisis - bit fragmented landscape

- What are you planning for practice and PCN for comms?

+ Wider MDT Comms and working

- Remote MDTs in care homes

- Community

- Increasing engage and reducing barriers

- Conversations around care home DES service

+ But will things really sticky

- What will go back to how it was before?

- Patient behavior?

- Inertia to change within NHS return?

- Deliberately and formally taking stock and planning path forward in your practices will help

How Facebook Live can help your medical practice: https://www.youtube.com/watch?v=O43MZZuOlH0

News Article

UKs COVID contact tracing app: 

https://www.ft.com/content/70b86cde-177b-4269-9657-daab6a60a9a5

Pomodoro Technique for Primary Care: https://www.youtube.com/watch?v=qv98Si9I4ZU

Pomodoro Timer for Primary Care: https://www.youtube.com/watch?v=yTDsN_djoQQ

⭐Star posts⭐:

Quick video consultation skills for doctors: https://www.youtube.com/watch?v=1UivLSPDeZo

How to register with the NHS app: https://youtu.be/4nRhmJ_tlI4?t=65

👨🏾‍⚕️Dr Gandalf’s Top medical equipment for General practice 👨🏾‍⚕️ see here: 

YouTube: https://youtu.be/JddoeK5JcRw

Website: https://egplearning.co.uk/ramblings/dr-gandalfs-essential-gp-equipment-list/

Subscribe to or follow the eGPlearning platform for more videos, app reviews and content to support technology-enhanced primary care and learning. 

🔴 Subscribe: https://egplearning.co.uk/subscribe/ 🔴 

Other networks:

👍 Facebook - https://www.facebook.com/Egplearning/ 👍🏼

🐦 Twitter - https://twitter.com/egplearning 🐦

🐦 Twitter - https://twitter.com/drgandalf52 🐦

🖥 Website - https://egplearning.co.uk/ 🖥️

💷 Support: https://patreon.com/egplearning 💷

Some links may contain affiliate links to help support eGPlearning see our disclaimer at https://egplearning.co.uk/contact/disclaimer/

Post Lockdown Digital Primary Care eGPlearning update 1

Post-Lockdown Digital Primary Care eGPlearning update 1

Join Andy and Gandhi for their fortnightly round-up of digital primary care resources and changes, especially in our COVID way of life as we talk about post-lockdown primary care. 

🔴 Subscribe: https://bit.ly/eGPlearningYTsubscribe 🔴 

Disrupting the disruptor:  https://www.bbc.co.uk/news/technology-52366128

Shiny Minds app guide for NHS: https://www.youtube.com/watch?v=RE3jNNyOfsY

Shiny Minds app guide for Nottinghamshire: https://www.youtube.com/watch?v=GC8ocVleFc4

⭐Star posts⭐:

Quick video consultation skills for doctors: https://www.youtube.com/watch?v=1UivLSPDeZo

How to register with the NHS app: https://youtu.be/4nRhmJ_tlI4?t=65

👨🏾‍⚕️Dr Gandalf’s Top medical equipment for General practice 👨🏾‍⚕️ see here: 

YouTube: https://youtu.be/JddoeK5JcRw

Website: https://egplearning.co.uk/ramblings/dr-gandalfs-essential-gp-equipment-list/

Subscribe to or follow the eGPlearning platform for more videos, app reviews and content to support technology-enhanced primary care and learning. 

🔴 Subscribe: https://egplearning.co.uk/subscribe/ 🔴 

Other networks:

👍 Facebook - https://www.facebook.com/Egplearning/ 👍🏼

🐦 Twitter - https://twitter.com/egplearning 🐦

🐦 Twitter - https://twitter.com/drgandalf52 🐦

🖥 Website - https://egplearning.co.uk/ 🖥️

💷 Support: https://patreon.com/egplearning 💷

Some links may contain affiliate links to help support eGPlearning see our disclaimer at https://egplearning.co.uk/contact/disclaimer/

eGPLearning News and Updates 11 April 2020 CORVID Hubs& Tech

Join Andy and Gandhi as they talk about the rapidly COVID evolving world and digital primary care. Our hubs are up and running and we share our experience and ideas.

Links 🔽

🔴 Subscribe: https://bit.ly/eGPlearningYTsubscribe

🔴 Gandhi's Clinical Management Centre walkthrough: https://youtu.be/HCO0gkZEH3w

News: Babylon and other tech companies ask for bailouts: https://www.bbc.co.uk/news/technology...

Babylon expansion into Canada: https://www.jacobinmag.com/2020/03/co...

COVID Resources: Primary Care Pathways website: http://primarycarepathways.co.uk/covid19

Primary Care knowledge Boosts Podcast: https://primarycareknowledgeboost.pod...

NB Medical COVID podcasts: https://www.nbmedical.com/NBPodcasts

Red Whale GP update Remote consultations: https://www.gp-update.co.uk/webinars

ORCHA COVID app library: https://covid19.orcha.co.uk

Freebies: EE unlimited data for NHS workers: https://ee.co.uk/nhs-unlimited-data-a...

Playlists: Using Zoom: https://www.youtube.com/playlist?list...

Using SystmOne: https://www.youtube.com/playlist?list...

Using AccuRx: https://www.youtube.com/playlist?list...

⭐Star posts⭐: Quick video consultation skills for doctors: https://www.youtube.com/watch?v=1UivL...

How to register with the NHS app: https://youtu.be/4nRhmJ_tlI4?t=65

👨🏾‍⚕️Dr Gandalf’s Top medical equipment for General practice

👨🏾‍⚕️ see here: YouTube: https://youtu.be/JddoeK5JcRw

Website: https://egplearning.co.uk/ramblings/d...

Digital primary care update 14.3.20 - Coronavirus special

Coronavirus tech support, telephone and video consultation tips for your Digital Primary Care update by the eGPlearning Podblast team of Andy and Gandhi.

🔴 Subscribe: https://bit.ly/eGPlearningYTsubscribe 🔴 

Simple  video consultation skills for doctors: Monday 16th March 8pm: https://www.youtube.com/watch?v=F8PccszVoyk

NHS X Information Governance update: https://www.nhsx.nhs.uk/key-information-and-tools/information-governance-guidance

RCGP resources:https://www.rcgp.org.uk/policy/rcgp-policy-areas/covid-19-coronavirus.aspx

Resources to help with telephone and video consultations. 

Quick telephone consultation tips: https://egplearning.co.uk/quick-telephone-consultation-tips-for-primary-care/

Which webcam do you need for video consultations: https://youtu.be/4IyM3e24ffk

Video consultation tips for GPs: https://youtu.be/MxIDHfHwDU0

TPP SystmOne Airmed video consultation demo: https://www.youtube.com/watch?v=Fvnx6tDo1nk&feature=youtu.be

TPP SystmOne Airmed NHS login for patients: https://www.youtube.com/watch?v=3djIAPwmIRk&feature=youtu.be

How to use AccuRx video in under 5 minutes: https://youtu.be/aryAqMqdHg0

Zoom Masterclass for your practice: https://youtu.be/UWPd2Dsr5kI

Sign up to Zoom:  https://bit.ly/eGPlearningZoom (affiliate link)

⭐Star posts⭐:

👨🏾‍⚕️Dr Gandalf’s Top medical equipment for General practice 👨🏾‍⚕️ see here: 

YouTube: https://youtu.be/JddoeK5JcRw

Website: https://egplearning.co.uk/ramblings/dr-gandalfs-essential-gp-equipment-list/

Subscribe to or follow the eGPlearning platform for more videos, app reviews and content to support technology-enhanced primary care and learning. 

🔴 Subscribe: https://egplearning.co.uk/subscribe/ 🔴 

Other networks:

👍 Facebook - https://www.facebook.com/Egplearning/ 👍🏼

🐦 Twitter - https://twitter.com/egplearning 🐦

🐦 Twitter - https://twitter.com/drgandalf52 🐦

🖥 Website - https://egplearning.co.uk/ 🖥️

💷 Support: https://patreon.com/egplearning 💷

Some links may contain affiliate links to help support eGPlearning see our disclaimer at https://egplearning.co.uk/contact/disclaimer/

Digital Primary Care update by eGPlearning Podblast 29th Feb 2020

Improving the Primary Care Network DES service specification

Improving the Primary Care Network DES service specification

How to improve the PCN DES

Welcome, please comment and I will try an answer

SUBSCRIBE AND COMMENT

Check out my original review where I went through the DES: here--https://youtu.be/K1qwyxt63f0

Declaration - I am not involved in the negotiations. I am Nottingham City East PCN Clinical director but these are my own thoughts. For some backstory in 2015 I wrote a further Blueprint for Primary care : https://egplearning.co.uk/a-further-blueprint-for-primary-care/ with a colleague as Jeremy Hunt launched the five year forward view. Some of these aims have been achieved (indemnity) but much can still be done. 

How to improve the DES- I will talk firstly about general changes and the headline points. Then each specification in turn with my more innovative (controversial) ideas at the end.

Ethos

The release time of the specification has caused a lot of frustration. Even more so in the first webinar where little engagement was offered, just reading the spec. This led in part to one CD resigning live. NHSE doing an open consultation on the draft is a good thing. Feigning listening is not. 

At points, the specification makes reference to evidence. In particular vanguard projects. However, it neglects to mention that vanguard projects have had significant higher levels of funding for each aspect and therefore converting this to specifications for networks to follow is a fallacy. 

You cant use a recipe that feeds four people that costs £10 and say provide the same meal for £2 all the time - even with using foodbanks. 

The original outline of the DES was to stabilise primary care. This draft does not do this but further destabilises it by utilising the additional roles above the capacity of work the can create and negates the fact networks will be part funding them. This was a poor way to show that NHSE/I was listening to the needs of general practice. Many comment the draft is intentionally too far to the right to allow any softening to be accepted as better than the original. This is a sceptics dream. 

For this process to work- show General Practice that NHSE is truly listening. Much of this has been done amazingly by Dr Nikki Kanani and I do not envy her position. I am mindful of do not shoot the messenger being very apt here. 

Lets move on. The following is a combination of my views and those from the various forums I engage in. 

Trust 

General practice. If I had control I would keep existing structures that could help foster better collaborative working and simply offer the resources to networks to use for their local area. 

General Practice has proved to be the most cost-effective method of delivering healthcare currently doing 90% of the NHS workload for less than 9% of the funding. Trust the networks to deliver primary care with the simple metric of improving the health of the network population. 

Ideally to the global sum but is not then to the networks directly to use as they seem fit to provide roles or services for better patient care along them 5 categories as best for their population. 

However, we do not live in a world of trust despite GPs consistently being the most trusted role in the country. 

So if working towards the confines of adjusting the existing DES and its specification let us have a look. 

Worth looking at the Berkshire, Buckinghamshire and Oxfordshire LMC document link: https://drive.google.com/file/d/1Bj7hkuCQasbXs-Mk7MOKpDq-lfjl3YSK/view?usp=sharing

This outlines workload implications and makes the case for each average practice to lose £100k over the term of the network DES. My thoughts do align with some of this document, however I do not agree with the principle of withdrawing from the DES at this point as this is still a draft version and the final specs may differ. It also does not include AFAIK  the overlap of patients in the DES which would reduce some of the work. 

Other LMCs and organisations have also been verbal on their views including GPSurvival who have started a formal petition about the service specifications.

See this link.: https://docs.google.com/forms/d/1uUa25fyz1Y8vCNTXP17pDvi3G26NQ1q8iOp64P0vfw8/viewform?fbclid=IwAR1w6EGJZ86AtuFWDafMWlXCRPAILHGHHkrs8ElqCQgGSiyodmCajhwfC78&edit_requested=true

DOI I am treasurer of GPSurvival. 

Headline improvements

Time:

• Delay the specifications. The timelines for agreeing the spec, the short consultation time and the level of response has shown the the draft spec is way of the mark. Take a breath and take a while longer to action this. Aim for a July Launch as per the start of the DES with networks able to look at funding from April for the ARRS. 
• Clarify the specification before releasing them. The above will allow time for the spec to be clear, unlike several lines in anticipatory and personalisation which are ‘to be confirmed’. This does not instil confidence that goal posts may change again - do not do this. 
• Stratify the spec for a category a year rather than two in year one with the others to run parallel. Let the network decide which to begin with as they can adapt to what local services can focus on. If one had to be chosen first given the current ARRS and recruitment options looking at the SMRs first may be an option. 
• Solve interoperability and IT. Many of the metrics and outcomes are based on interoperability of IT systems within primary care and between primary care and other sectors. Fix this first then ask for more. At present we can not explore a digital hub as the IT systems do not allow EPS prescriptions from a hub model. Our community teams are on fragmented systems that do not talk with ours complicating care. This duplicates and complicates healthcare and needs resolution to enable effective care.
• Reduce the metrics. With over 30 metrics, keeping track and monitoring them alone will be a challenge. Simplify and reduce these to one or two per spec, or let the networks decide the metrics that are important to their population.

Funding

• Remove the requirement that funding can only be used for additional roles. In many places other ways of funding care may be more useful such as systems to engage with patients, nursing roles, estate management - let the network truly decide how to spend its funds
• If this is not possible, open the funding to all roles and not specified ones so networks can recruit the workforce they need rather than what others think they may need. If the GP role is still not acceptable then roles like nursing, occupational therapists, pharmacy technicians and data analysts. 
• Remove the 70/30 split and fully fund the additional roles from NHSE/I. This will reduce the available workforce but would answer the issue of local practices having to supplement the roles and mean they can do work greater specified by the spec. 
• Remove the necessity for named clinical leads for each spec. If this is a red line then fund them appropriately similar to the clinical director role. Assuming the CD role can do this is false and sharing the funding is not an option to have an effective CD. 
• If a red line then allow the leads to work across networks. In Nottingham city we have a close working of network of networks and the option to share these lead roles across multiple networks is more achievable than each network finding 5 people - however the draft spec prohibits this. 

SMR

Looked at this in my area. Patients on 10+ meds alone was about 5% practice population. 

• Clarify what ‘significantly longer than a routine GP appointment’ is. This line is used to explain how long an SMR would be. Is this 15 mins, 20 mins, 30 mins, and hour? This has clear implications on workload and should be clarified if this area is to be monitored. 
• Do not specify that the review has to be by a prescriber. Many practice and network pharmacists and chronic disease nurses may not have independent prescribing rights yet and this puts a significant burden on training times and availability. This then pushes the work back to GPs adding to the workload. This also would eliminate innovation such as using community pharmacy colleagues from supporting this work and makes a mockery of the MURS programme of recent years. 
• Make SMRs a paid for service. Given this is an extra service above that offered by primary care with no additional funding - allow practices to charge for them commensurate to the workload involved to offer higher quality of care. This can be commissioned by local CCGs or patients. 
• Align SMRs with QoF to prevent duplication of work. This would allow funding for the work to be evident but reduce the burden of work on practices while still offering effective care on a national perspective. 
• Clarify how patients may be contacted for SMRs. Ensure that written communication is clarified to include digital means such as notifications or texts as this in unclear and would further help with reducing climate impact and sensible patient flow. 

EHCH

This specification could have been effective but its prescriptive and ludicrous nature truly raises questions about the aims of the specs. It outlines a staggering increase in workload and specifies being led by roles not funded in the DES ad only on a F2F basis. It also is discriminatory to frail patients who live in their own home. 

To improve it:

• Do not use location or age as the denominator of healthcare need as these may not be good predictors for individual patients. Use validated metrics such on frailty instead to capture patients in and out of nursing homes. 
• Remove the ridiculous premise that a GP/ geriatric consultant must lead the team. Allow the network to source the role best suited based on local recruitment availability in need. 
• Remove pedantic requirements of weekly/ fortnightly visits. Let the network decide the frequency needed to offer appropriate care to its population
• Remove the requirement for care to be only face to face. Allow the increasing use of digital consultations to flourish and be effective. This can be by direct video consultation supported by the home, or with assisted clinicians as a virtual ward round. Additionally allow for funding to be used to facilitate this. Ie a simple webcam like the logitech C920 HD in each nursing home would work effectively on a Zoom system for a basic telemedicine ward round.
  Logitech C920 HD: https://amzn.to/2R7BbTw
  Zoom: https://bit.ly/eGPlearningZoom
• Review the spread of NH in PCNs. The requirement that NHS are aligned to PCNs while seemingly sensible proposes significant challenges. Nursing homes traditionally are denser in areas of low land cost ie more deprived or secluded areas. This can create significant imbalance.  In Nottingham city, Two PCNs have the majority of nursing homes in their network areas. One network has 24 care homes, double that of all the others and is not the largest network. This creates a clear funding deficit to deliver the outlined level of care and WILL DESTABILISE this network (it is not mine - we are next down the list at 12 care homes). 
• Make these reviews paid for service. Several areas of the country already have care homes paying additional to practices to offer an extra level of care above the GMS contract. This aspect of the DES will remove that element. Given an existing precedent, one suggestion is to make this service paid for service to allow the funding to occur. This can be commissioned either by the CCGs or care homes.

Anticipatory Care

Anticipatory care is manageable pending relationships with ICS, CCGs and ICPs, and if appropriate tools exist to support the population based care. I will admit my knowledge gap in this area which leads me to my first improvement. 

• Push back the time frames to allow all networks to develop the local links and priorities. This is a simple fix as with more time much more of this aim is likely to be possible due to its synergy with the EHCH. 
• Be specific over the monitoring aspects at the outset. Several aspects of this spec are ‘to be confirmed’. As mentioned earlier this is not acceptable as it indicates a possibility of shifting goal posts or more work if not in the correct format. Start as you mean to go on. 
• Clarify the responsibility of who is paying for the tools. This spec mentions several tools that could be used, some of which are beyond the scope of a PCN to access individually. A clear direction on the responsibility of costing of these tools needs to be established. In many arenas the PCNs are viewed as the solution to all the problems in primary care. NHS England need to ensure they are not overburdened with destabilising costs and responsibilities due to poorly worded contracts. 
• Clarify the evidence behind using care plans and the need for monitoring delirium assessments etc. This is not provided in the DES specification document and if no evidence that these care plans and assessments lead to impact on reduction of clinician workload and/ or patient demand then they should be removed and replaced with something that does. 

Personalised Care

I mentioned in my first video this harkens back to the failed unplanned admissions DES for a few years back. The reliance on care plans and monitoring are lessens still not learned. However this is the first mention of tackling inequality - albeit on a minor scale. 

• If personal health budgets are to be continued and monitored - offer national training to all with a public campaign to education patients rather than passing this cost to networks. I have limited knowledge of patient health budgets. Again no evidence is offered in the document of their impact or effectiveness but this seems more like a public health priority funneled into the DES. Remove or support nationally with education and training. A national website checklist would offer many patients the correct information and evaluate more effectively than spending clinician time doing an administrative task. 
• Remove the target for social prescriber referrals. A target is not necessary for a role billed to have a significant impact on care. 
• Clarify which PAM is to be used - 100 vs 22 vs 13 point version. Clear difference in workload and monitoring outcomes based on these. 
• Clarify the monitoring requirements at the outset as per earlier specifications. 
• Remove the metrics. The metrics for this specification are vague and talk about quality- something that is hard to measure when you do not know what the test is. Given the DES is metric heavy simply remove these and replace with either trust as per earlier or linked population based outcomes like reduction in amputations in diabetic patients, reduced hospital stays in frail patients - essentially let the networks decide their metric for their populations. 

Supporting early cancer diagnosis

Much of this specification I find sensible in its aims. My only question is the time needed to action it given the repeat requirements for a lead and oversight. 

• Provide data analyst support for networks to look at their data. This would help clarify how networks can proceed based on evidence. This could be provided locally by CCGs/ ICS etc, but do not make networks hunt for this. Provide universal validated  metrics so that shared learning can occur.
• Provide social media engagement and community education sessions to networks. Much of the strength of this specification is mobilising the community. This can be achieved with face time with the community outside the confines or practices and via local media and social media. Provide networks with the tools to do this. 
• Provide translation services support. One key challenge is non-english speaking cohorts. Given CQCs hate for Google Translate as a tool, provide support and resources for networks to use to convert resources into other languages to support their networks ie bowel screening videos in Polish or Vietnamese languages. 
• Clarify the safety net metric. This metric is unclear to me no matter how many times I read it. How will this be monitored?

So that is my suggestions for adaptations for the specifications. But what if we were rewriting it? These are suggestions for NHS England which are in their domain to consider, but not covered in the existing DES. 

• Create a national acute visiting service (AVS). Using the funding for ARRS share working on how to deliver a footprint wide AVS using roles such as physician associates and paramedics that can release GPs to offer care to patients while providing equity across the country. Ideas like those of Dr Paul Bennet as shown in the General Practice Podcast could be adapted across the entire country : https://ockham.healthcare/innovation-in-general-practice-time-saving-begins-at-home/
• Create a national formulary. This would help prevent variation and align purchasing to tackle supply issues and allow larger bulk buying for medication supplies. 
• Charge for all prescriptions or charge for none. This would have the plastic bag effect for the need for items on prescription at reduced cost ie £1 per item with pre-payment certificates being an option for all. Bring in equity- charge for all or charge for none. 
• Re-design prescription exemption process. It is ridiculous that a patient with one specific chronic health condition can have all prescriptions free for life, but a patient with a more acute on chronic condition like COPD or asthma is not eligible which will cause greater acute damage to the patient and cost to the system via an admission. At least update the prescriptions to reflect modern times ie universal credit as an exemption so patients are not committing fraud, or adjust the age limits in line with national pension age. 
• National self care for health and finance education programme. Many patients expect the health care system of old -today. A national education programme both in schools and a public campaign identifying the new roles and how to use our NHS effectively would have a greater impact than requiring each area to generate the same resources several times over. Created and delivered centrally offers the uniform message and cheaper costs to deliver public level education about how to use our NHS and how to manage your health responsibility including services. Adding finance at the same time is just further cost saving. 
• National campaign to use NHS app. The NHS app is meant to be the doorway to our NHS and the focus of our digital healthcare revolution. However central support for its use is lacking and limited in information - even for a techy like me. A targeted approach with resources and support (again in multiple languages) could deliver a much-needed kickstart to the digital push we need. 
• Equal funded clinical director (CD) time for all networks. The CD roles are based on network size. While there is some logic to larger networks needing more time, it is evident that one session a week for smaller networks is a drop in the ocean. Offer equal CD funding to all networks ie three-session up to 75k patient population size and 4 session over that. 

What do you think?

Which did you think were sensible and which did you think were lunacy?

eGPlearning Podblast Review 2019

In this episode, we will be looking forward to 2020 and what health technology and eGPlearning PodBlast will be bringing to the world, and our survey: https://bit.ly/podblastsurvey19 ....

eGPlearning Podblast 2019 Review and Looking forward to 2020

HAPPY NEW YEAR!!!!

We looked back and reminisced in our Xmas episode with Ben Gowland of The General Practice Podcast - friend of the podblast: https://egplearning.co.uk/primary-care-networks-in-2019-a-review-with-the-general-practice-podcasts-ben-gowland/

Now looking to the future.

A word about our partners - HTN, The Health Technology Newspaper, your daily dose of news for the health tech community, join us for HTN digital Week on 23.1.20: https://www.youtube.com/watch?v=a62XTayLIX8

Changes over the last year

PCNs

Event Speaking 

Video Conferencing: https://www.youtube.com/watch?v=a62XTayLIX8

Digital GP Fellowship: 

Using the new practice website and video 

Changes and highlights with eGPlearning Podblast in 2019

Great Guests :

Nikki Kanani of NHS England: https://youtu.be/fynHxaebnSo

Liz Ashel-Payne of ORCHA: https://youtu.be/Ou2HKPJ2He4

Changes behind the scenes - Learnt lessons

Tried to improve quality

Found a regular base, experimenting with audio-video capture - new equipment!!!!

Experimenting with episode format - different types of episode

Survey - Help us shape our style, format, and content by completing the listening survey

Survey: https://bit.ly/podblastsurvey19

 🏆 eGPlearning Podblast Awards 2019 🏆

📳 Innovative tech company 📳

🏆 ORCHA sign up: https://youtu.be/K3wjjja8y2g

📈 Disruptor of the year - not bad or good - shakes things up 📈

🏆 NHSE with PCNs - Hello Nikki Kanani

And our honourable mention to Babylon

🚫 Trickiest episode to film - 🚫

🏆 Zoom episode: https://youtu.be/UWPd2Dsr5kI

honourable mention Jeff and Consumer wearables: https://youtu.be/Cmg2ky4XLCw

Future - Hoping to do with podblast and beyond

More interviews

Deep dives

Update episodes

Serving Primary Care Health Tech Community - Aims for 2020

Online courses and toolkits

Health Innovation East Midlands: https://www.eventbrite.co.uk/e/health-innovation-east-midlands-meet-up-registration-85912132501?aff=ebdssbeac

Conference - TEPCAL2020

Productive General Practice - using video more

Social media in primary care

Online consultations

What are we excited about in Primary Care GP Health Tech

Andy - NHSApp - critical mass allowing digital healthcare to go mainstream

Gandhi - Organisations beginning to embrace technology - LMC, NCGPA, RCGP - video, podcast, LMC app

Andy- Consumer health devices becoming mainstream and integrated with primary care

Gandhi - Connectivity - everyone

Predictions for 2020…

But first recap 2019 predictions - true or false.

Andy - Peak AI Hype - we will be talking less about AI…

Gandhi - Rise of personalised medicine

Shout out to Shubz - improving and providing time for communication between primary and secondary care and beyond - How did your prediction come along?

Predictions for 2020...

Andy - Increase in workload resulting from Digital-first agenda and NHS app

Gandhi - Online consultations mainstream

Thanks for listening

Please remember to complete our survey 

https://bit.ly/podblastsurvey19

Looking forward to journeying into the future of primary care with you all in 2020!

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