Dr Mike Cohen describes how he set up a new clinic in his practice under any qualified provider
In order to expand the services they provide to patients, GPs will increasingly have to register to provide services under any qualified provider (AQP).
By next summer, PCT clusters and clinical commissioning groups (CCGs) will have to choose three community or mental health services to put under AQP, and this is just the beginning.
Diagnostic tests are one of the services that the Department of Health recommends commissioners look at first. Luckily, we have already undergone that process with endoscopy services in Bristol, under any willing provider (as AQP was formerly known).
What we did
We spent a year looking at how we could redesign our gastroenterology diagnostics service with our PCT and an expert patient representative. It became obvious that any community based service would need to offer a clinic/outpatient service as well as diagnostic endoscopy.
As a result of these discussions, we decided to develop a community gastrointestinal service from scratch using GPSIs, under the auspices of the PCT.
The service aimed to complement secondary care and relieve the pressure on hospital day-case lists, increase patient choice and reduce costs.
How we did it
In December 2009, Bristol PCT advertised for a provider to offer the service under an AQP contract. We teamed up with Prime Diagnostics Ltd in Essex – who have experience in developing endoscopy services - to form a joint venture called Prime Endoscopy Bristol.
We had some spare rooms in our practice and an architect was employed to build and design an endoscopy unit in them.
In March 2010, we were told our bid had been successful and were given six months to set up the service. In this time, we built and equipped an endoscopy unit, employed the staff to run the unit, clean the equipment and administer the service.
We arranged to lease the latest instruments (Fujinon) and use transnasal gastroscopes (6mm diameter) and CO2 insufflation for colonoscopy as this is more comfortable for patients.
We marketed the service by contacting local GP's and presenting at GP forums, as without their referrals the service would certainly fail. Unlike the independent treatment centres an AQP contract has no guarantee of activity and all the financial risk lies with the provider of the service – so this was doubly important.
Referral forms and information packages were sent electronically to all Bristol GP's.
Administration was run from within my practice, with a dedicated telephone line installed for this so patients could phone us with queries. A contract was established for a local hospital to process and report our histology
As chance would have it, the senior endoscopy sister from our local hospital announced her retirement from the NHS and agreed to work with us. This was very helpful particularly as things became rather frenetic towards the deadline of the start date.
We also contacted local endoscopy nurses to see who may be interested in doing some bank work. A healthcare assistant was recruited to perform the decontamination of endoscopes.
Finally, we spoke to our colleagues in secondary care to let them know about the service.
It was vital that we had good links here and their agreement to see patients should there be any complications.
We also made contact with personnel involved in the multi-disciplinary team for upper and lower gastrointestinal cancers in all our local hospitals and ensured we had up-to-date contact numbers and emails.
We saw our first patient at the beginning of September and have now scoped over 1,000 patients.
We are on Choose and Book, and patients are referred by fax. The GPSI then triages referrals to either gastroscopy, flexible sigmoidoscopy, colonoscopy or clinic. We contact GP's directly if we require more information or blood test before the procedure. We believe triage is vital and this, in the longer term, may empower GP's to deal more confidently with gastrointestinal problems.
I would stress that we only deal with cases that we feel are suitable for a community service and more complex cases are referred to secondary care. Cancers are referred immediately to hospital.
Our patient satisfaction scores have demonstrated that patient satisfaction is high and GP's who refer to the service have told us they are very pleased with the service offered. The annual patient satisfaction survey found that 86% of patients rated their overall experience of the community endoscopy service as either 8,9 or 10.
We have recently been awarded a prestigious first prize in the annual MAGIC awards, recognising excellence and innovation in patient care within the field of gastroenterology.
The vast majority of patients are discharged back to their GP with a report and management plan and we are currently offering four sessions of endoscopy per week, but this will shortly be increased to five sessions per week.
We have recently expanded our catchment area and are providing the service to patients in South Gloucestershire as well. In recent weeks we have recruited more nurses and the practice has appointed an associate GP who has previous gastroenterology experience as an SPR. It is hoped he will get on board and join the endoscopy team.
Establishing such services in not for the faint hearted-however it is clear that both patients and GP's are delighted with the service we are offering.
Time will tell whether we can live up to our expectations and achieve all our goals.
Dr Mike Cohen is a GPSI in gastroenterology in Bristol
Acknowledgements to Dr Richard Spence, Dr John Entrican, Prime Diagnostics Ltd, Westbury on Trym Primary Care Centre and Bristol PCT.