How this Sussex PCN manages urgent care

Foundry PCN in Lewes, East Sussex, is one of the six networks shortlisted for PCN of the year. It was highlighted in the Fuller Stocktake for its success in managing urgent demand in primary care. Clinical director Dr Philip Wallek explains how his PCN is approaching patient demand

Demand and capacity are huge challenges in primary care. While I would never say we are meeting our patient demand, I can say that our approach allows us to feel in control and plan for it. 

By segmenting our patients into three groups and funnelling them to different types of appointments with the appropriate member of our staff – fully using the additional roles reimbursement scheme (ARRS) – we’ve created a matrix to manage and adapt to our patients’ needs. 

Patients 
PCN patients are coded according to a traffic-light system. 

• Green – generally well patients who access care infrequently and for whom continuity is not a priority, but need ease and speed of access. 
• Amber – patients with ongoing conditions for whom continuity is important. 
• Red – vulnerable patients with complex and ongoing needs for whom continuity is crucial. 

We have created teams to support these patient groups.

• Green team, an evolution of our acute team, works from our urgent treatment centre providing on-the-day and advance-booked appointments. They are paramedics, GPs and first contact physiotherapists.
• Patients in this group are more likely to prioritise speed of access, which can be provided by any competent clinician. They still have a named GP to track any documentation, but they won’t necessarily see that GP. We offer some choice of clinician if they book in advance.
• Amber and red patients are registered with a usual GP and are grouped into micro ‘continuing care teams’ to help maintain continuity. The practice teams are multidisciplinary, including nurses, GPs, care co-cordinators, pharmacists and social prescribers.  

Making the most of our additional roles has required a cultural shift. Receptionists and care co-ordinators have, where appropriate, offered patients alternatives to a GP appointment. Patients have started to realise the benefits in terms of continuity and specialist knowledge. 

Appointments
We provide access via econsult or telephone booking. Receptionists filter queries as appropriate to community pharmacy or to our administration and medicines management team. All urgent on-the-day requests for the acute team are given a telephone appointment and are then seen face to face if needed. Advance-booked appointments are offered within two weeks and also in a month to try to improve continuity and offer patient choice. On-the-day green appointments are 10 minutes, advance-booked green appointments and all amber appointments are 15 minutes. Our red appointments are 15 minutes with GPs and these patients have further time with care co-ordinators, social prescribers and nurse specialists for both reactive and proactive care.

Proactive care is offered by our nursing and pharmacy teams including GPs when needed. We invite patients for long-term condition reviews to manage their needs in as a few appointments as possible.

By looking at patient groups and appointments we can track what’s going on and adjust our focus. Using evidence from data analytics, we are able to intelligently respond to demand and adapt the design of our services, which informs recruitment and deployment of staff. 

Dementia patients were identified as a high-attending group with complex needs. We created a dementia team with a care co-ordinator and nurse specialist who have become the first point of contact for reactive and proactive care. They ask the usual GP for advice or a medical review when needed. This has both improved care, reduced urgent problems and saved GP time.

Urgent treatment centre
We formed a partnership with Sussex Community Foundation Trust to run an urgent treatment centre (UTC) in May 2020. With funding from the Friends of the Lewes Victoria Hospital, we expanded the minor injuries unit. The PCN provides medical supervision from 8am to 8pm seven days a week for an urgent care practitioner-led walk-in service, which also receives telephone triage from 111. We run our green service at the UTC and combine this with our extended hours service and the urgent treatment contract. This benefits both organisations and improves access for patients. The weekend GP shifts are offered to our PCN GPs as extras, which offers them flexibility and improves continuity for patients.

There were challenges in creating this UTC partnership. It has taken time to establish relationships and standard operating procedures but both parties feel it has been a success. 

Outcomes
The South, Central and West Commissioning Support Unit looked at our data and found that our top 5% of frequent attenders only use 30% of GP consultations compared with 40% elsewhere. We have reduced the number of ‘avoidable’ appointments from 9% to 6.5% in late 2021, whereas other primary care services report an average 27% of appointments are ‘avoidable’. We provide around 1,800 GP appointments per week, which suggests we save 370 GP appointments a week. 

We try to ensure that every clinician is working to the top of their capabilities, with the right clinician seeing the right patient at the right time. This improves staff satisfaction and patient care and saves money.

We are currently working with Kent Surrey Sussex Academic Health Science Network to create an independent assessment of our service redesign to help others to understand the benefit of our approach.

Future
We started our journey of merging three practices in five sites in 2015 and hoped to have a new building to be a hub for healthcare in Lewes. Because of planning issues this has been delayed but we hope it may be ready in 2024. The delay has enabled us to look more carefully at how a larger organisation can still offer continuity and the benefits of smaller teams. We have a commitment to always strive to improve. One innovation is a workforce management platform including data analytics that we are using to continually assess and improve our approach that we hope other PCNs may also find useful.

The General Practice Awards are run by Cogora, the publisher of Pulse PCN. These awards highlight innovation in primary care across the UK. This article is part of a series on the shortlisted PCNs.

This article was first published in February 2023.