Greater Manchester standards are new benchmark for quality in GP care

How Greater Manchester standards are new benchmark for quality in GP care – and part of plan for docs, chemists, dentists and optometrists to work closer together

A bespoke set of standards that recognise the key role that GPs plays in transforming people’s lives in Greater Manchester, have been launched.

The standards, unveiled by the Greater Manchester Health and Strategic Partnership Board – the body overseeing the region’s £6bn devolved health and social care budge – are just one part of a wider strategy for primary care where GPs, dentists, optometrists and pharmacists work closer together as part of integrated care.

The strategy also outlines how a united primary care system can work more proactively within communities – and also as a voice within the Greater Manchester Health and Strategic Partnership (GMHSCP).

The new GP standards, designed to help with consistent high quality care, are to be adopted according to each of the ten borough’s needs across Greater Manchester by 2017. They are:

  •       Improving access to a GP;
  •       Improving outcomes for patients with mental illness;
  •       Improving cancer survival rates and earlier diagnosis;
  •       Ensuring a proactive approach to health improvement and early
  •       detection;
  •       Improving the health and wellbeing of carers;
  •       Improving outcomes for people with long-term conditions;
  •       Promoting medication checks;
  •       Improving outcomes around childhood asthma;
  •       Proactive disease management

They also build on last year’s achievements in Greater Manchester around:

  •       The commitment to seven-day GP access – by December 2015 there were 35 primary care locations offering 7-day access across Greater Manchester;
  •       A six-point plan for more use of community pharmacies, particularly around medicines-related issues;
  •       Preventative dental care – which has cut average waiting times for a child’s first dental assessment to 30 days;
  •       Reducing the risk of sight loss – so that optometrists can manage more minor eye conditions in the community.

Other key shifts announced include new ways of working to put people at the heart of their own care, closer to where they live and out of hospital as much as possible. This will ultimately see more neighbourhood teams made up of a wide range of specialist all based in the community, who will also work with the area’s voluntary and community groups.

Speaking about these ambitions, Lord Peter Smith, chair of the Greater Manchester Partnership Board, said:

“All these ideas work on – and accept – that improvements are most likely to be successful when they are led by the people who live here, because they can see the reasons for change and the benefits. In particular, thousands of people are currently treated in hospital when their needs could be better met in the community; care isn’t always joined up between teams and it is not always of consistent quality. In Greater Manchester people with conditions like diabetes, asthma and hypertension – which can be managed in the community – are more likely to be admitted to hospital as an emergency case, when this could have been avoided.”

Dr Tracey Vell, Associate Lead in Primary and Community care, GMHSCP, said:

“ As GPs we have united with our primary care colleagues, social care colleagues and commissioners to shape the future of care for our population. In itself this collaboration is a huge task which now allows us to deliver better care to our communities without duplication or organisational barriers. We are anticipating being at the forefront of ambitious changes which are set to transform patient are in a unique way across communities.”

Other key areas of the new vision for integrated primary care in Greater Manchester, include:

New models of care

This will see the roll-out of more local care organisations (LCOs) in each part of Greater Manchester. These are organisations that bring health and social care teams together along with other community and voluntary networks. They represent a fundamental change in delivering more services in the community, closer to where people live, and out of hospital.

Stockport and Manchester will be early adopters of these new multi-speciality community provider (MCP) models of care.


Mental illness

Currently people with chronic mental health illnesses in Greater Manchester are likely to die 15 years earlier than people in other areas. It is also understood that patients with mental illness, who have other chronic (long-term) conditions like diabetes and asthma, have better results when the right psychological support is built into physical care plans.

Now, primary care will support people with mental illness in a variety of ways including the introduction of detailed case registers, comprehensive health checks and healthy eating guidance; physical activity and stop smoking programmes. Everyone on mental health and learning disability registers will be offered an annual health check, including appropriate eye examinations.

As part of the strategy, more focus will also be placed on identifying dementia patients earlier, so that they and their carers can be better supported to live well and manage their condition. By 2021 it is estimated that there will be nearly 35,000 people living with dementia.

Other developments will also build on the pilot work of the Greater Manchester Pharmacy Local Professional Network in developing a ‘dementia friendly practice’ checklist – see case study below. This also supports the ambitions of ‘Dementia United’, the Greater Manchester Dementia Programme launched in November last year to make the whole of Greater Manchester more dementia friendly.


Best use of professional services

Greater Manchester wants to improve how different health and social care professionals link and work together, so that patients have as much help in the community as possible. This in turn will help to relieve pressure on both GP services and hospitals.

This will include making more use of community pharmacists to help patients look after themselves and also with a wider roll-out of the minor ailments service – where pharmacies with consultation rooms can treat and prescribe for conditions such as hay fever, allergies, headaches, and mild eczema.

Minor conditions currently account for around 57,000,000 GP appointments in England every year, costing the NHS £2bn. No appointment is needed to see the pharmacist and this should contribute to fewer people needing time off work to see their doctor.

Clinical pharmacists in Greater Manchester have already shown how they can reduce the burden on GPs. Pilot sites run through Oldham, Bury and South Manchester Clinical Commissioning Groups have already demonstrated how a pharmacist based in a GP practice can help with day-to-day medicine issues for patients.


Research and Innovation

This will build on the work of Health Innovation Manchester – launched in September last year as a partnership between healthcare research, academia and industry. It will also build on the work Academic Health Science Network so that there is acceleration between a discovery and the implementation of the results for patients.

One of the key areas will also focus on ‘personalised medicine’ – which is targeted medicines for individuals for specific purposes.

More focus on using digital technology means that records can be shared across care providers, with patient consent – reducing the need for patients to re-tell their story or history.

Dr Kiran Patel, Chair of the Greater Manchester Association of Governing Groups (AGG), said:

“Here in Greater Manchester we have the unique opportunity to transform primary care by exploring new models of care that deliver integrated health and social care within neighbourhoods.”

Jon Rouse, chief officer for the Greater Manchester Health and Social Care Partnership, said:

“There are examples of good practice all over Greater Manchester. What we want to do now is learn from that and spread the results across the whole of Greater Manchester so that we can guarantee quality outcomes for patients. That, in tandem, with putting primary care right at the heart of how we get things right for patients near their homes, near their support networks and near the right facilities will help to keep more people well and out of hospital.”

Launched at the Integrated Primary Care conference in Manchester on Weds 5 October, the content of the strategy is also reflected in health and social care plans (locality plans) drawn up by the ten boroughs across Greater Manchester. These borough plans then feed into the overarching strategic view for Greater Manchester called its sustainability and transformation plan.


Pharmacy case study:

Pharmacies across Greater Manchester will become more dementia-friendly thanks to a new scheme developed by the Greater Manchester Pharmacy Local Professional Network and launched by the Greater Manchester Health and Social Care Partnership in July.

Over 850,000 people in the UK have dementia (there are almost 30,000 people living with dementia in Greater Manchester) and this number is rising.

Currently no cure and as dementia is a progressive disease the symptoms will get worse over time. Alzheimer’s Society recently reported that dementia costs the UK over £26 billion a year (just under £968 million for Greater Manchester).

But far more significant than this is the personal cost of the disease.

When a person with dementia finds that their mental abilities are declining, they often feel vulnerable and in need of reassurance and support. The people closest to them – including their carers, friends and family – need to do everything they can to help the person to retain their sense of identity and feelings of self-worth. Local services and organisations also have a part to play and need to be dementia friendly to ensure they meet the needs of people with dementia and their families.

The new framework being launched today clearly sets out the various ways in which local pharmacies and their teams can give greater support to people with dementia. These include:

  • Ensuring that pharmacy staff have undertaken dementia awareness training and that they have signed up to become Dementia Friends
  • Making sure that there is a quiet area available for discussion
  • Helping a person with dementia choose between medicines and/or complete repeat prescription request slips
  • Making sure other systems are in place for checking proof of identify if a person with   dementia cannot remember their address
  • Checking a patient’s change with them
  • Putting specific times for taking medicines on medicines labels (eg. breakfast time, lunchtime) that fit in with how the patient takes their medicine
  • Providing reminder charts to help people with dementia take their medication at the right time
  • Setting calendar reminders to prompt patients to order their prescriptions
  • Thinking about how to speak with patients who make repeated requests for items already purchased
  • Offering a delivery service for prescriptions and encouraging delivery drivers to undertake Dementia Friends information sessions
  • Routinely collecting contact details of relatives/carers, in case of queries
  • Making sure that the pharmacy has leaflets and information about dementia and local support readily available