John Chisholm CBE
BA MB BChir FRCGP DRCOG
Adviser, NHS Working in Partnership Programme
As well as being an adviser to the Working in Partnership Programme, John is also a member of the Councils of the BMA and the RCGP and an adviser to Dr Foster. He chaired the BMA's General Practitioners Committee from 1997 to 2004 and led the negotiation of the new GP contract
The NHS Working in Partnership Programme (WiPP) could have a considerable impact on the future delivery of general practice and primary care. The programme was established as a result of commitments given in Investing in General Practice: The New General Medical Services Contract 2003 – sometimes known as the first "blue book".(1)
The programme's aims are to help clinicians to use their time effectively, build capacity in primary care, improve the availability of services for patients and assist in managing demand and workload. The programme is developing and evaluating evidence-based schemes, and will:
Currently, the programme includes 13 projects. As those projects are evaluated, publicised and mainstreamed, practice managers will have a key role in implementing the lessons that have been learnt by taking forward the programme's exciting opportunities in their own practices.
Because the budget of £10m over three years came from the funding for the new GP contract in England, the projects are confined to England. However, it is hoped that the findings will be adopted by all four countries of the UK. The WiPP website (www.wipp.nhs.uk) will offer easy access to the programme's outputs.
One major project involves using practice data to help practices identify and understand the different high-impact elements of their workload. The Workload Management Tool will enable practices to identify areas for potential change, so as to make the most effective and efficient use of GPs' and other health professionals' time, while improving patient services.
The tool will soon be piloted. It will include three elements:
The Good Practice project is identifying and evaluating effective new ways of working, including skill-mix alterations, which have safely and effectively demonstrated more effective use of clinicians' time, and the implementation of new or improved services or reductions in demand.
The NHS has not always been good or quick at disseminating information about changes that work for service providers and patients, and it is hoped that the project's database (see www.workloadmanagement.nhs.uk /db.php) will help to promulgate information about successful initiatives and inspire others to adapt examples to their own circumstances and give them a try.
Four of the projects aim to reduce the public's need for services through developing and supporting self-care behaviours, promoting healthy living, improving health literacy and signposting sources of help and support. Self-Care for Primary Health Care Professionals is developing a multidisciplinary training package so that clinicians can develop their self-care support skills in such areas as health promotion and long-term conditions management and provide support to those who will benefit most. Self-Care for People is evaluating the role of a self-care support coordinator, operating at PCT level, who will champion the development and implementation of a local strategy for self-care so as to form an integrated self-care support network. The role includes creating a local directory of self-care resources, accessible through NHS Direct Online, training volunteer lay self-care trainers, and developing, coordinating and communicating the self-care activities of healthcare professionals, voluntary and community groups.
Five PCTs are involved in the pilots – three in each project, so that the effect of both projects can be assessed in one of the PCTs. The evaluation is being undertaken by Leeds Metropolitan University.
The Joining Up Self-Care project is examining the effects of an integrated self-care strategy in a single PCT – Erewash PCT in Derbyshire. The components of the strategy include coronary heart disease prevention, asthma management in adults using an approach based on the Expert Patient Programme, and minor illness management by the mothers and carers of young children. The evaluation is being undertaken by PMSI Healthcare.
All three projects are intended to encourage greater confidence in self-care and help with the management of both minor ailments and long-term conditions. The evaluations will look at such issues as consultation rates, prescribing and self-care behaviours, as well as the implications for other PCTs wanting to implement a coordinated strategy.
Making Sense of Health is an exciting and imaginative educational initiative linked into the national curriculum for children aged from five to 16. It aims to:
It is being piloted in 300 schools and evaluated by the Open University. The resources include nine BBC television programmes and a health encyclopaedia for students, focusing on common health problems and worries, which will also be available to teachers and parents.
New ways of working
Most of the programme's projects seek to encourage new ways of working. Some aim to redirect demand away from the practice, others to substitute workload within the practice so work is delegated appropriately, and most projects aim to increase practice efficiency and the effectiveness of consultations.
Two of the projects are particularly relevant to practice managers. The Vocational Training Scheme for General Practice Managers is intended for new managers, who are linked to a trainer – an experienced manager with skills in training and development – for a year. The scheme, led by the Institute of Healthcare Management and evaluated by Nottingham University, is modelled on vocational training for general practice. By offering a structured programme for new managers and recognising and developing the skills of established managers as mentors, it aims to improve recruitment and retention.
The Primary Care Management Development Programme aims to support the strategic and developmental needs of practice managers and provide them with core competencies and skills. It is being led by the NHS Clinical Governance Support Team and the National Primary Care Development Team and is being evaluated by Nottingham University.
Both these projects are informed by the competency framework for practice management that the new GMS contract published and promoted.(1)
The General Practice Nursing project aims to improve the recruitment and retention of nurses working in general practice, develop skills, raise standards and promote good employment practice. The Health Care Assistants project aims to facilitate the employment, training, development and integration of well-trained healthcare assistants. The two projects are closely linked: both aim to support shifts in workload and both are being informed by Staffordshire University and facilitated jointly by the Royal College of Nursing and the Royal College of General Practitioners. Both include PCT and practice pilot sites, will produce web-based support and guidance for practices and PCTs, and will be promoted through national conferences later this year.
Those four projects will help with the employment, training, development and retention of general practice managers, practice nurses and healthcare assistants.
The Collaborative for Demand Management for Common Mental Disorders in Primary Care is aiming to improve services and reduce the number of consultations for depression or anxiety in general practice. It aims to do this through the implementation of a range of demand management strategies. The project is being led by the National Institute for Mental Health in England, the Sainsbury Centre for Mental Health and the National Primary Care Development Team.
Another project, Improving the Management of Repeat Medication in Primary Care, is being evaluated by the National Prescribing Centre. Improved management, including better repeat prescribing and dispensing mechanisms, will ensure effective treatment, minimise therapeutic error, limit waste and save time.
The Sickness Absence Management project is looking at alternatives to the current system of sickness certification and absence management, through the use of occupational health services. The evaluation is being conducted by Warwick University. Not only should there be benefits for employees and employers, including better advice and rehabilitation and improved arrangements for returning to work, but there is potential for GPs' workloads to be significantly reduced.
The Working in Partnership Programme's projects will contribute to the identification, development, signposting and mainstreaming of effective ways to manage demand in general practice and will enable better use of clinicians' time. As a result, new capacity will be created to improve patient services in primary care. Not only are two of the projects focused on practice managers, but managers will have key roles in using the Workload Management Tool and in implementing all the products and lessons of the projects.
The programme is an exciting and valuable initiative that should help to manage demand, encourage self-care, reduce bureaucracy and promote new ways of working and service delivery. Its potential is immense; a relatively small investment should lead to enormous savings for the health service and gains for patients. The challenge is to maintain the investment necessary to encourage the spread of good practice and ensure the effective mainstreaming of the projects.