Riverside Medical Practice Dr Richard Fairclough GP Partner

Riverside Medical Practice Dr Richard Fairclough, GP Partner NHS 24 Dr Laura Ryan, Medical Director

Riverside before. . . ØDemand ØSustainability ØDoctor recruitment and retention ØHealthcare for Musselburgh

Co-development of primary care triage with of unscheduled demand with

Collaboration

Benefits triage self-care right person right time

Impacts at Riverside enhanced continuity scheduled service doctor recruitment patients can get appointments longer appointments

Example weekly pattern pre-merger Same day demand

Weekly pattern From NHS 24 call data week 10/9/2018 Data source: NHS 24 CSM Norseman House

Key Message Access enables Continuity

Facts and Figures each week Riverside • Answers 2500 calls (peak volumes up to 14% of list calling in a week) • Provides 800 15 -minute GP consultations, 300 Phlebotomy appointments, 300 nurse-led treatment-room appointments plus an additional 200 -plus for those with chronic or complex needs • Processes over 1000 items of mail • Issues 2000 prescriptions Data source: Riverside data collection & NHSL telecoms dept.

Riverside Call-room

Key Message Governance is necessary to maintain patient safety

Governance

Examples of Clinical Governance • Identified and implementing regular review of certain outcomes: • Complexity suitability • Duty Dr supervision of call room • Virtual clinic case review with CWIC • Self care 7 d and 28 d follow-up • Appointing routine outcomes from NHS 24

Why is NHS 24 doing this • “OOH primary care services are under considerable pressure, as is daytime general practice. They are completely interlinked and mutually supportive. Improvements made to OOH primary care services should be applied from a person-centred, whole systems perspective, in order to avoid any adverse impact on daytime services. The converse is also true”

Evidence Base 1 • This literature describes, as a result of the telephone- first approach, a reduction in face to face appointments, but an overall increased workload due to the increased volume of telephone calls made (Newbould et al. , 2017) • We think we are very different

Evidence Base 2 • Demand for General Practice has been increasing steadily (Baird et al. , 2016). The King’s Fund has described the need for innovative models in General Practice, and a range of endeavors have been implemented to varying degrees of success (Baird et al. , 2018).

Opportunity NHS 24 lens • Pulling Together Report, Professor Sir Lewis Ritchie , 2015 • Transforming Urgent Care • Sustainability in General Practice national work • National Boards Collaborative to support Health and Social Care Integration

LO Riverside - Same Day Appts Weekly W/C 24 th September 2018 100 GP GP NOS 90 ANP Child 80 ANP NP 70 APP MH Referral 60 Spk to Practice 50 HV Other Practice 40 Routine No Reply 30 999 20 A&E Pharmacy 10 Selfcare Other 0 Monday Tuesday Wednesday Thursday Friday

Context 1 Practice in Difficulty

Context 2 Practice Transformation

Thank you