In the concluding part of our interview, Hope Farm Medical Centre PM Tim Goldsbrough discusses the practice’s approach to social prescribing and supporting carers, as well as reflecting on the many recent changes in primary care and considering what the future holds for general practice.
Social prescribing has become more and more popular over the past few years, and aims to address the wider social and lifestyle aspects of patients’ health. Tim and his team have placed a focus on helping to support and care for patients by working collaboratively with them to identify activities that will benefit them and then directing them to an appropriate service.
I understand that you've done quite a bit of work to support carers at the practice - tell us more about that?
When I started back in 2014, one of the areas identified was the huge number of carers in our practice population. I started to engage with the Cheshire & Warrington Carers Trust to look at how we could start to identify and increase the number of carers we had on our register.
We had quite a long discussion and what we decided to do was rather than just hit the number of carers (which we probably could have quite easily done), was concentrate on the ones we do identify and really make those referrals into quality referrals.
Carol from the Carers Trust came in and worked with the Patient Services team and the clinicians, just so they were aware of the carers, the new Care Act that came in, and the benefits to patients, practice and carers. It was very much a holistic approach.
Then it was a case of working with the population - engaging with the PPG, looking at ways they felt we could start to engage with carers… We had carer links within the Patient Services team and developed links with dementia groups as well, so patients could actually speak to a named member of staff if they wanted further support or advice.
We then started to look at more innovative approaches, so we have a carers’ drop-in clinic on the last Thursday of every month, which is publicised in the practice. Carol from the Carers Trust comes in for two hours every Thursday afternoon and patients can just drop in and see her.
And what's been the response to that?
We were quite surprised at how many carers use that drop-in clinic. Initially we planned on running it for three to four months to see if there was a need, but it was quite clear from month one that there was. We started to offer the service to other practices in the locality, just to let them know that if they’ve got carers or people that want to know more about the Carers Trust they can come to our practice on that Thursday as well.
We also developed a “patient buddy system”. Initially it was very much looking at the carer’s side, but since we’ve started to develop this role, I think the role of the patient buddy has expanded as well. For three mornings a week, a member of the Patient Services team spends time on the other side of the reception desk in the waiting room - they’ll sit and talk to patients, ask them to confirm things like their contact details are up to date as a way of getting into a conversation, but then they can start to ask if they are caring for someone, if someone cares for them, ways we can improve the service and access...What was initially just an idea to possibly identify carers has identified other improvements we can make to the practice. From a patient’s perspective they feel more valued because they can see the practice investing that time to engage with the team and the patients.
Since you started here, you don’t seem to have been standing still, with lots of new and innovative ways of dealing with the demands, so what’s next for you and Hope Farm?
One of the key things is looking at ways we can possibly expand the practice and offer other services. Another aim is to start to engage with the ‘Third Sector’, and bring in services such as Citizens’ Advice and Debt Advice and have them situated in the practice.
We’ve done a lot of training on social prescribing to help patients with their social needs, so hopefully that will improve their health – it should have the knock-on effect that they don’t need to come and see the GPs as much, so we want to start developing that. We also want to link in with the Five Year Forward View – utilise practice pharmacists, possibly the practice physician associates as well.
You seem to have quite a holistic approach to the way that you want to deal with patients and respond to their needs?
I went on a site visit to Bromley by Bow Health Centre in London, and saw first-hand how social prescribing in general practice can really change and empower patients. That’s what we want to try to do here, look at the holistic approach – we could tread water for ever and a day trying to just meet patients’ health needs, but if we don’t tackle some of their social problems and issues, we’re never going to be able to solve their health and clinical needs.
We’ve got a Wellbeing Co-ordinator in the practice who’s been here for just over 12 months, and what we can do is refer patients directly to her and she can give them one-to-one support, look at their social and welfare needs and refer them on to other services.
These last few years have seen a lot of changes in primary care, and a lot of focus on general practice. What’s been your biggest challenge so far?
I think, for me, because I’ve only been in general practice for the last two years, I suppose I’ve been shadowed by some of the previous change. Since I’ve come in, some of the bigger changes have already happened and I’ve just implemented them. There are constant changes in legislation, even recruitment of salaried GPs – we’ve always been really lucky here that every time we’ve recruited we’ve always had some good candidates, and we’ve got a really good stable workforce.
I know that is certainly an issue in this locality (West Cheshire) that recruitment of salaried GPs has started to become an issue – we’re also a training practice, so we want to make sure that the next generation of GPs are available. I think that is one of the key areas I’ve had to deal with is getting up to speed with the new sector that I’ve come into, but also the smaller changes within the contracts.
What would you say are your top priorities or “Must Do’s” for practices?
I think networking is extremely important, and possibly underestimated at times. I certainly spend a lot of time networking with the LMC and the CCG – I want to know about new initiatives that are coming out, any new services that are on offer, because if I know about them I know whether I want to push for us to either pilot them or be involved with them. Even just networking with other Practice Managers – that was really invaluable for me when I first came into general practice, so I would say networking is really key to finding out what’s happened, what’s likely to happen and any changes on the horizon.
You’ve obviously got a very successful, very busy and very popular practice here, and it’s a credit to you and the team for all the recognition you’ve achieved - what keeps you motivated? More importantly, how do you keep the team motivated as well?
One of the key things is the fact that it is a ‘whole team’ approach – any recognition that we get we make sure we share that as a team. For myself, I suppose I like a challenge, the fast-paced environment… I don’t like things to stand still.
The fact that we can provide high quality patient-centred care to our population is really important to the whole team as well as me, and I suppose that’s one of the most motivating factors for me – getting the satisfaction back from the patients that the service delivering is meeting their needs, they are happy with the service and are supportive of any new initiatives or change that we are looking at introducing.
For the full transcript of the second half of the interview, you can download it as a Word document here. If you missed the first part of our interview with Tim you can find it here, where we discuss strategies in patient care and his unique approach to building a strong team.