Q Exchange
Community Of Practice Portadown
- Idea
- 2018
Meet the team: Community of Practice Portadown #COPPortadown
Also:
- Mrs Anita McCreesh
- Mr Raymond Anderson
- Mrs Helena Buchanan
I hope to build bridges between different professional groups, especially Community Pharmacists (CPs) and General Practitioners (GPs) and create a community of supportive practitioners in Portadown, a town in Northern Ireland. I am keen to work with other interested stakeholders, including our local Southern Health and Social Care Trust and support our Integrated Care Partnership and GP Federation as it continues to grow. I hope to develop an environment that leads to a culture of trust and support of one another where opportunities may develop to find new ways of collaborative working through learning and sharing of ideas and possible resources. This group has the potential to set goals and explore ways to manage chronic disease by affiliating with our local community pharmacy colleagues. This is in keeping with Transforming Your Care (TYC) and more recently Delivering Together.
A colleague and local pharmacist Mr Raymond Anderson already has some experience of working in Integrated Care Partnership and has successfully piloted hypertension clinics in his community pharmacy setting making use of remote access to local GP practice computer system allowing patients to be monitored and treated in community on Saturdays as well as other weekdays. This could be an area to try and build upon having learnt from previous experience already.
Northern Ireland will hopefully introduce E-Prescribing in the next 3 years. In the future with E-Prescribing and better electronic communication between GPs and Community Pharmacy (CP) I expect the relationship between GP and CP to evolve and through the establishment of a community of practitioners now within a locality I hope to get a head start and be ready for early adoption of future ways of delivering healthcare together in community. I would also like to promote Q community within the primary care network in Northern Ireland and build relationships as well between primary and secondary care in the area through the Q network as well.
Below is a letter I have agreed to send out today and begin my journey with Q Exchange as I launch my idea. This will go to my GP peer group in the local town of Portadown as well as my local community pharmacy colleagues:
Dear Colleague
I have worked in Portadown for over 2 years as GP Principal in Riverside and have shared the stress and challenges providing ongoing primary care to the people in this area. For some time, I have been keen on approaching not only my GP colleagues in Portadown, but my community pharmacy (CP) colleagues in the local Portadown area, to gauge interest in the formation of a local community of Health Care Professionals. Such a mutually supportive and collaborative group could provide opportunity for joint learning, shared ideas and thinking and perhaps find new ways of working together both within and outside our own professional grouping for the benefit of our patients and ourselves and perhaps generate space for some creative and innovative thinking and action.
Ideally, I would like to extend this invite to local dentists and optometrists as well but I feel it might be better to start with joining General Practitioners (GP), Practice Based Pharmacists (PBP) and Community Pharmacists (CP) first. Maybe this could be discussed together?
My desire is to build stronger professional relationships, built on trust both within my own professional grouping in the area and extend outside of the group to pharmacists and maybe other professionals with time. I am conscious that with future advances in technology ahead especially with introduction of E-Prescribing, hopefully in 2021 and electronic messaging between GP and CP, the future landscape of how we work together is likely to change significantly. Some of you will know I have been supportive of the work of E-pharmacy through my role on the project board for e-prescribing working alongside GPC, BSO, HSCB, CPNI and other stakeholders. I am keen to get ahead of that curve now by building the kind of supportive professional relationships that will make E-prescribing and electronic communication much more effective and perhaps Portadown can lead the way regionally?
As a new member of Q community from January I have also a chance to compete for up to £30,000 funding for a “Peer Support” Programme. With or without winning this bid it would not alter my desire to push through my overarching goal of building that supportive local professional healthcare network that I have referred to above. It would however help to focus the aims and objectives for the year ahead if we were successful. If you are interested in finding out more about the work of Q or this bid for Q exchange that is open to me as a member of the group please check on the link below.
https://q.health.org.uk/get-involved/q-exchange/
Recently, in my HSCB role and with the connections I have made with the local Integrated Care Partnership (ICP), I have had two conversations with local pharmacist Raymond Anderson. Raymond would share my outlook and would be keen to help me build a network with both GPs and local Community Pharmacists. We have had some conversations in the spirit of Transforming Your Care (TYC) about how we might attempt to move some chronic disease management out to community pharmacy and are keen to explore various ways in which this could be done.
If this Portadown Community of Healthcare Professionals is something that resonates with you, I would be interested to hear from you. Perhaps you have ideas of your own on how this may work and develop?
Below is an attached doodle poll of potential dates where we would hope to try and arrange some food and have a short introductory meeting to see what scope there might be in progressing this potential group. If you want to speak to me please feel free to do so. You can contact me or my business manager in Riverside Mrs Anita McCreesh. As we would like to have a first meeting before the summer please come back to me or Anita before 28th May 2018
I would be delighted to see and/or hear from any GP colleagues, local Community Pharmacists, Practice Based Pharmacists and any practice managers who would have an interest in this proposal.
With kindest regards to you and look forward to hearing from you.
Philip
How you can contribute
- Local support especially from secondary care colleagues
- Ideas of proven successful initiatives or collaboration between community pharmacists and GPs
- Ideas how to introduce Q to local professional groups
- Ways to influence and encourage collaborative working
- Suggestion of speaker who could be invited to future meeting of a group I get established help motivate
- Welcome Collaboration with HSCB, ICP, GP Federations, RCGP and other professional groups
- Other input from established Communities of Practice.
- Relationship building, developing Trust amongst professional groups
Comments
Matthew Mezey 19 Jun 2018
Hi Philip - if you or anyone in your team is interested in learning about other NHS Communities of Practice (CoPs), please join Q’s CoPs special interest group’s Zoom call on 13 July (1pm) to hear about the evaluation of the Health Innovation Network’s CoPs – their challenges and their journey.
** More info/to register: https://q.health.org.uk/event/the-sustainability-and-impact-of-nhs-communities-of-practice-lessons-from-a-rand-europe-evaluation/ **
The call will be an opportunity to glean advice and insights to help this project too.
Hilda Campbell 12 Jun 2018
Hi Philip
In Scotland, GP's who were working in areas of multiple deprivation began working together with an initiative called the Deep End, part of this looked at social prescribing and the pilot of community links practitioners, this was so successful it is now being rolled out throughout Scotland. Here is a link to the Deep End GP's https://www.gla.ac.uk/researchinstitutes/healthwellbeing/research/generalpractice/deepend/ and also to the Community Links Practitioners https://www.alliance-scotland.org.uk/in-the-community/national-link-programme/
Hope that's helpful
kind regards
Hilda
Hawys Tomos 11 Jun 2018
Hi Philip. I think that initiatives that encourage less siloed or blinkered working within health and care are generally a very good thing. Building trust and support, as you mentioned, as well as understanding and empathy could help “oil the wheels”, so to speak, but also help identify and problem solve interfacing areas that could be improved. I agree that Hilda’s suggestion of involving people from the third-sector, in time, would be worth considering, along with the other roles you mentioned. It also struck me whilst reading your bid that primary care navigators could be good ‘connectors’.
Philip Lusty 11 Jun 2018
Thank you Hawys.
The group is meeting in 2 weeks for the first time and I hope to get thoughts from all present.
The term primary care navigators is relatively new to me and from my limited understanding it is likely to be receptionists who are trained and equipped to take on more lead role, connectors in community?
Wasim Baqir 3 Jun 2018
Great idea Philip. In Northumberland, we have seen the benefits of pharmacists working across primary and secondary care. The key to making that happen was getting the relationships right. Stuff like shadowing, joint educational sessions and co-developing pathways and systems really helps. Good luck.
Laurence Dorman 28 May 2018
Hi Philip,
I am so sorry I am only getting back to you now. I like this project but it will need dedicated professionals like yourself and Raymond Anderson to get off the ground. I am aware of the hypertension project and think it is a good thing. What I would love this to help develop would be pharmacy asthma clinics on a Saturday/Sunday. Asthma clinics throughout the country have a notoriously poor attendance for many reasons so any way we can facilitate patients to see appropriate professionals must be applauded. Keep me posted on how you get on. Laurence
Philip Lusty 3 Jun 2018
Laurence
Thank you for your encouragement and further ideas.
Have to start somewhere!
Philip
Hilda Campbell 25 May 2018
oooopppss when I typed this it was all neatly laid out, now its posted!! Sorry, bit of a word overload! Hilda :-)
Philip Lusty 3 Jun 2018
Thank You so much Hilda
I've printed this all off to take a look at this week.
I might come back to you with some of our thoughts.
At the minute I am trying to put together an agenda for our first meeting. I have at least 5 local pharmacist and another GP Practice who has shown an interest with time still hopefully for others to come on board.
Thanks again for all the info.
Philip
Hilda Campbell 25 May 2018
Hi Philip
I think your idea has real merit and fits with work the public would like to see also. Recently we held a discussion with members of the public around the new GP contracts, however, this became more around what people wanted to see in Primary Care. The following is a note of that meeting, if helpful:
What people wanted from the session:
The session started with asking people what they wanted from the discussion
· Learn about new GP contracts
· keep people up to date, out of loop re GP’s and facilities and how to access them
· Work with GP’s around signposting and referring
· Find out about GP’s in general
· How to access services
Everyone present had a GP. No one said that any information on the new contracts had been shared in the surgery, even a poster in waiting room would have been good. In terms of the questions people felt they were pretty straight forward and common sense around, opening times, access if you have additional support needs, whether or not you need to see a GP. People were more interested in how they could influence the new primary care developments, the session then looked at what qualities would an excellent primary care service look like:
What would a primary care service look like
· Don’t need to wait 5-9 weeks for test results
· More time with a community pharmacist to share how to take medication
· Have primary care centres as opposed to individual GP practices
· Show people pathways so people understand why they need to wait
· Manage expectations, if people know why there are delays they can be understanding it’s when you aren’t told what is happening you feel exasperated
· Better inform people on things relating to their health management and what else is there
· Have an online portal to use computers to book appointments, choose doctor, expand on technology so you can see changes to your medication, digital health developments, be able to hit button and print it out, design the system from patient and reception staff up not other way round, recognise issues with personal data, one system which is connected between services, something like my diabetes my way, join the dots initially expensive but in time will bring good stuff
More formal peer support groups being supported, linked to primary care, on common conditions, doesn’t need to be practice which facilitates e.g. have better inks with other bodies who e.g. offer support around arthritis to have peer support groups locally, everyone with that condition on GP list told of the group, ideas people had for peer support groups included:
· Diabetes
· Asthma
· Heart conditions
· Coeliac
· Depression
· Bi polar
· Pregnant parents
· ME
· MS
· Arthritis
· Autistic spectrum disorders
· Dementia and Alzheimer’s
· Diet and activity
Other ideas people had
· Make time so people feel more comfortable to say I don’t know how to do something e.g. use an inhaler, as if don’t use it correctly it won’t work, maybe ask pharmacy to show you, also have an appointment with pharmacist if complicated medication regime so you know how to follow it, don’t waste money having prescription end up not taking
· Better links with local opticians checking for more health conditions so if an issue with your eyes see local optician not always needs to be a hospital, upskill opticians to do this
· Better links with dentists and GP
· Better links with third sector
· Self-management advice what else is there apart from tablets
· GP’s could recommend relaxation exercises, so part of GP training is on self-management
· Some kind of GP wall of advice have a positive side of things to take away, this is what people can look at while waiting for appointment, have it on wall file so neat and with things to take home, download
· Access dietician advice locally, could be workshops run so people get to see someone sooner, if common issues e.g. reduce salt, then everyone on GP list who needs to reduce salt in diet is told about it. Link to third sector cookery classes and other healthy eating initiatives
People wanted to know about what health improvement do and how this links to primary care e.g. smoking cessation
Other resources people shared would be helpful
· Have shop info hub there all the time, wellness shop
· Mobile x ray unit
· Third sector services in primary care like money advice
· Work with patients to find ways to save money on prescriptions
· Find ways for GP’s to become familiar with principles of Co design and co-production, have rules so don’t feel attacked
· House of care model (https://www.alliance-scotland.org.uk/health-and-social-care-support-and-services/house-of-care/) which is conversation based between 2 experts, person with the condition and health professional, way to encourage self-management, based on 20min appointments, speak to primary care about adopting this
· ALISS online database of services in an area, new improved website, going to have local session as info needs to be current
· Raise awareness of other resources e.g. Your support your way Glasgow led by health and social care partnership
· People who use services need more input to set the agenda for what needs discussed
We are also doing work with local GP's around improving supports for people with chronic but mild to moderate mental ill health, this is called Jigsaw, wee bit of an overview:
MANY PEOPLE PRESENT TO SERVICES EXPERIENCING STRESS AND DEPRESSION, OFTEN THIS IS LINKED TO MULTIPLE HEALTH CHALLENGES AS WELL AS INEQUALITIES ISSUES
ANTIDEPRESSANTS, PAINKILLERS AND BETABLOCKERS ALONE ARE NOT THE ANSWER
IN ADDITION, STRESS CAN LEAD TO ADDITIONAL HEALTH PROBLEMS OR EXACERBATE EXISTING ONES INCLUDING EXPERIENCE OF PAIN RELATED TO ILL HEALTH
CHALLENGES PEOPLE CAN FACE WHICH CAN LEAD TO STRESS AND REACTIVE DEPRESSION INCLUDE:
VIOLENCE, HATE CRIME, RACISM
WANTING TO REPORT A CRIME OR ANTISOCIAL
BEHAVIOUR BUT SO NO ONE KNOWS IT WAS YOU
NEIGHBOUR ISSUES OR ANTI SOCIAL BEHAVIOUR
ANOTHER'S OR YOUR OWN ADDICTION PROBLEM
FINANCIAL PROBLEMS
HOMELESSNESS
RELATIONSHIP PROBLEMS
Welfare reform
Work related issues, insecurity of employment
Lack qualifications, experience, not being able to read or write
Loneliness
Losing someone close to you
The physical state of your neighbourhood
Being young and feeling no one listens
CARING FOR SOMEONE
YOUR OWN HEALTH ISSUES
CHRONIC PAIN
CHALLENGES AROUND GROWING OLDER
WORRYING ABOUT CHILDREN AND GRANDCHILDREN
NOT FEELING YOU HAVE ANYONE TO TALK TO WHO WILL LISTEN
How you feel about yourself and your own attitudes
How others have treated you
Seeing what is wrong and feeling powerless to do anything
FEELING LONELY
HAVING NO SENSE OF PURPOSE
And the list goes on……………
THE JIGSAW PARTNERSHIP PROJECT IS AN INITIATIVE AIMED AT EXPLORING NEW CONNECTIONS TO OFFER SUPPORT AND MITIGATE THE IMPACT OF STRESS AND DEPRESSION BY:
LISTENING TO WHAT PEOPLE HAVE TO SAY WHICH CONTRIBUTES TO STRESS AND DEPRESSION
BY PROVIDING INFORMATION ON SOURCES OF SUPPORT AND IDEAS FOR SELF CARE AND SELF MANAGEMENT
BY CREATING NEW CONNECTIONS AND INTERVENTION PATHWAYS IN PRIMARY CARE AND THE COMMUNITY TO ENABLE PEOPLE OVERCOME OR MANAGE CHALLENGES TO HAVE IMPROVED WELLBEING
BY SUPPORTING THE CAPACITY OF PRACTICE LED PATIENT GROUPS TO DEVELOP THEIR IDEAS
TO COMPLIMENT NOT DUPLICATE EXISTING WORK
Not sure if this is helpful as i know initially your focus is with specific partners, however, in time i would suggest bringing the third sector on board, my own service is a charity www.cope-scotland.org for more info on the types of services you may find in your own areas. We only offer direct services in one part of Glasgow but share our learning widely for anyone interested for them to adopt and adapt to meet their needs. An example of bridges we would like to build with primary care: We have 4000 square feet of purpose built premises kitted out to a very high standard and are exploring how it could become a community wellness centre e.g. people who maybe avoid flu jab are offered package of coming to the wellness centre for a day's pampering and lunch and the flu injection is part of that package, my team offer the wellness experience, the practice nurses offer the injections, we have money advisers, relationship counsellors, rooms for perhaps CPN, Community pharmacy, Social work to see clients, as say, early stages of discussion but hopes of some new ways of integrating services
if I can be of any further help please ask
kind regards
Hilda
(My professional background is mental health nursing)
Louise Sands 23 May 2018
Philip, good to hear your idea. About 5 years ago in Lisburn we linked with all the pharmacies in the greater Lisburn area to simplify the process for nominating a pharmacy, re-ordering and collecting scripts. Aside from the patient benefit, it saved time for the pharmacists and practices. It did also help us to understand better the challenges in communication between the two groups. What we implemented was then followed by a number of other practices. Things have moved on a lot since then, and the opportunities with improved technology are great. Happy to help if I can.
Philip Lusty 24 May 2018
Louise
Thanks for taking a look, your experience and your insight. Maybe getting carried away but I would love to see the Community of Practice Portadown #COPPortadown spreading so there is a #COPLisburn #COPBallymena #COPEnniskillen etc.
I've had a lot of positive feedback from community pharmacists in the town since the letter went out last week and encouraging verbal feedback from pharmacists in leadership roles in Northern Ireland about this initiative. I'm hoping to get support from my local GP colleagues and ideally would love all to be present, but understand that probably the biggest barrier to meeting is time and pressure doing our day job that makes our personal time even more precious. This change will be more marathon than sprint!!
I'll keep you posted and please share my idea/concept with any of your colleagues in NIMDTA including trainees and fellow Directors and if anyone including yourself has any thoughts how to use tools QI in this project I would value input. I am considering what measures will I introduce to make sure the change COP makes a difference. I might mention to Steve Harte especially with his Coaching hat on!
Keep in touch and thank you again for your comment.
Jacqueline Morton 16 May 2018
Philip interested to read your idea and would appreciate your comments on our own! Are you hoping to set up a GP/Pharmacy Community of Practice? I have had some experience in doing this over the last 12 months and would be happy to share the learning.
Jacqueline
Philip Lusty 16 May 2018
Jacqueline I was hoping you would get in touch!!
We would welcome you off course and appreciate your experience.
Please get in touch with me or my practice manager to arrange a chance to meet and start with the bridge building!!
My business manager can be reached:
anita.mccreesh@riversidepractice.gp.n-i.nhs.uk
Philip
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