ONE high impact action

“It is not the most intellectual of the species that survives. It is not the strongest that survives but the species that is able to adapt to and to adjust best to the changing environment in which it finds itself”

Charles Darwin, ‘Origin of Species’


Clinical commissioning groups (CCGs) now have significant resources (£3 per patient over two years ) to allow practices to implement some of the 10 High Impact Actions mentioned in the Five Year Forward View.

Both CCGs in Suffolk are taking a different approach. Ipswich and East Suffolk CCG is asking that practices address these actions in groups of above 30,000 patients. In West Suffolk the offer this year is for £1 per patient but with no other restrictions.

Now that the winter period has passed, practices have an opportunity to take advantage. The 10 high impact actions have been developed by general practitioners like ourselves and have been proven to be useful. There are helpful case studies and resources here.

As Lord Carter recently commented in the HSJ it was, “tragic that the NHS in England had done everything right once somewhere!”

Many of these high impact actions can be done at a practice level but others may be more appropriately addressed across a group of practices. I am aware that colleagues in the Deben Health Group are looking at care navigation training, signposting patients to the most appropriate resource which may not be the GP or GP surgery. It has been very effective in other parts of the country but it is important that the resources are available to be diverted to that they can offer same day advice or support. The advantages of a consistent message across primary care cannot be overstated.

On an individual practice basis, in my own practice in Felixstowe we have implemented workflow redirection both for incoming mail and for lab results with significant decrease in the work being flowed through to the doctor. With appropriate protocols this is clinically safe and the coding may be better.  My day certainly is.

In addition to the 10 High Impact Actions, we can also look at improving our work environment. I believe there should be a more more consistent approach to handing back inappropriate work from secondary care and holding the hospital to their new contract, obliging them to ensure they issue the correct amount of medication, issue sick notes, follow up investigations and not redirecting queries to the consultant back to the GP.

A  more proactive approach to this is required from CCGs. It was disappointing that a recent article in Pulse showed that despite thousands of complaints across Britain, no action had been taken to fine hospitals for breach of this contract. It is likely that groups of practices working together will have a much more robust approach to this.

Again, in Felixstowe, our On The Day Team, where patients from three practices are seen in one central location after 3pm, has had a significant impact on our working day and shows what we can achieve as GPs working together. This was achieved just with the energy of local practices, Federation support and some CCG input around the IT problems.

I would encourage colleagues to look down the list of the 10 High Impact Actions. I believe CCGs do need to address how they are going to assist the earlier adopters who have already put some of those in place to ensure they are not disadvantaged, but as my old colleagues up in Sheffield used to say,

“If tha` fancy it, get amongst it.”