Brighton and Hove’s family doctors take on EPIC challenge to ease pressure in A&E

Posted On 19 Aug 2014 at 10:19 am
The Vote - Frank

Jonathan Serjeant

EPIC initiative by Brighton and Hove’s family doctors could start to heal pain of inspectors’ inadequate A&E rating

Brighton and Hove’s family doctors are recruiting helpers to ease the pressure in their surgeries and keep people out of hospital. They hope more than 60 volunteer care navigators will give patients suitable health guidance in cases where it is more appropriate than a doctor’s appointment.

Two local charities – Age UK and Impetus – are recruiting the care navigators to work with 18 surgeries. The new roles are part of a pilot scheme funded with £1.8 million from the Prime Minister’s GP Challenge Fund. The project – known as EPIC (Extended Primary Integrated Care) – also relies on support from nurses and pharmacists in dealing with more minor ailments and medicine reviews.

The GP surgeries are working in four “primary care modules” under the direction of the Brighton and Hove Integrated Care Service (BICS). They hope the changes will improve access for patients, meaning more same-day appointments between 8am and 8pm seven days a week. The Brighton Station Walk-in Centre is the trailblazer.

They also hope the volunteer care navigators will free up GPs to spend more time on patients with complex needs. In turn it is hoped this will prevent some of those patients from clogging up Accident and Emergency (A&E) at the Royal Sussex County Hospital.

The Royal Sussex needs the help. The hospital requires improvement, according to the Care Quality Commission. The CQC also rated A&E as ‘inadequate’. In response, hospital boss Matthew Kershaw said: “We need to be bold and act quickly to tackle the system-wide issues which have been impacting on so much of what we do for too long.” Those issues included access to GPs.

“There appears to be a real momentum gathering in the GP community to do something different and a recognition of the need to change”

The government has spent billions of pounds on IT for the NHS. Yet the NHS Choices website lists email addresses for just eight GP surgeries in Brighton and Hove and none for individual doctors. Forget 21st-century communication; patients are expected to stick to methods from the 1800s.

Who can bring about change? BICS clinical director Jonathan Serjeant is building a reputation for innovation in the conservative world of general practice. And he seems able to lead change even when he meets resistance.

In the BICS application to the Prime Minister’s GP Challenge Fund, backing came from the chief executive of the Brighton and Hove Clinical Commissioning Group Geraldine Hoban. CCGs were set up to give family doctors more say over local health services. Ms Hoban said: “There appears to be a real momentum gathering in the GP community to do something different and a recognition of the need to change.”

One change could involve tackling public perceptions. At least one critic believes that doing something different means asking volunteer helpers to divert “doctor botherers” to nurses, chemists or charities. If so, GPs will have succeeded only in further insulating themselves from the public. But in Brighton and Hove this is not their aim. The BICS project is more about managing rising demand while funding is relatively static compared with, say, ten years ago.

GPs may be busy but some believe over the past ten years they have become much better paid while taking much less responsibility. It may not be true. But it is rare to hear family doctors publicly defend their position since surgeries have no longer provided 24-hour care. Yet the 2004 GP contract made it unrealistic for surgeries to keep offering out-of-hours care.

It will be interesting to see whether care navigators can find a way to help patients and practices to a better place. Nurses and pharmacists undoubtedly can, even if they take on more work in the process. But unless more family doctors extend their hours – and surgeries communicate more efficiently with patients by phone and email – there is a danger the £1.8 million will be wasted. If anyone can ensure it’s not, surely it is Dr Serjeant.

  1. feline1 Reply

    This definitely sounds like a move in the right direction. I changed my GP to the Brighton Station Health Centre and it’s amazing – I can actually book an appointment to see a GP at evenings or weekends for non-urgent things without having to miss half a day or more at work.

    Previous surgery I was at was a joke – they just ran that bogus “ring up at 8:30am to see if we have any appointments the same day” scheme, so they get to report to the regulator that “no patients had to wait more than 1 day for an appointment” – yes, cos they couldn’t bloody GET an appointment! Facepalmoramic!

  2. Valerie Paynter Reply

    If they do this, they should ensure the Practice records grade patients so that idiots do not try to interfere with long-term, chronic health pictures they have no hope of understanding, but which they could undermine if given any power to prance about playing this game.

    Recently I have noticed that getting repeat prescriptions for my transplant maintenance has meant running the gauntlet with reception trying to determine what I should or should not be getting. When I told my renal consultant it had taken two weeks of wrangling to sort on the occasion just before I saw him, all he did was look fed up and roll his eyes.

    Whilst I am strong enough and compos mentos to police the problem I am safe. But what of those who have to trust they are getting what they are supposed to? Even doctors make mistakes.

    Twenty-four years ago I spent six months repeat visiting the GP I had at the time as my weight ballooned and legs swelled and I got iller and iller. He kept smiling blandly, saying “Change your diet and get more exercise”. I would be dead today had it not been for an out of hours Brightdoc visit one night when I knew I had to break past this somehow. I was literally at death’s door with end-stage renal failure.

    Think these gatekeeper, volunteer care navigator recruits can do better? I don’t think so. I think lives will be lost.

  3. feline1 Reply

    Valerie, under most NHS practice’s zero tolerance policies, the sort of pejorative rant you’ve just posted would get you deregistered.

  4. George Coombs Reply

    I can see a lot of truth in what Valerie is stating, care for vulnerable people in this area does leave a lot to be desired-service users would do much better of they authentically listened to service providers

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