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Provision of care for people who work
The CQC now inspects and rates practices against six population groups – older people, long term conditions, mother’s babies and children, working age, people living in vulnerable circumstances including people with a learning disability , and people experiencing poor mental health , including dementia. This article, the fourth in a series of six, will address the ‘people who work’ population group and how we could improve the service we give to them.
This particular patient group includes all people in the practice population who are of working age and those recently retired (up to the age of 75). Working age includes adults up to the age of 75, whether or not they are in employment. For example, it includes students aged 18 and over. The CQC will assess how people in this group are able to access appointments and services at the practice.
How will the CQC assess services provided?
The CQC will look at intelligent monitoring data and patient feedback reports, such as NHS Choices. They will be assessing how patients can book appointments with the practice at times and in ways that are convenient to them. The CQC will also consider the type and availability of services provided to people who are of working age as well as those recently retired.
The CQC inspection team will review the information provided prior to the visit, the practice presentation given on the day of the inspection visit, and evidence collated throughout the inspection. Recent CQC reports rating practices as Good or Outstanding indicate that they are providing a wide range of services which meet the convenience of patients.
How to achieve a Good or Outstanding rating
Many practices now offer patients the choice of booking appointments by telephone, in person or online via a practice website. This enables patients to book appointments whenever is convenient for them. Online booking of appointments will of course be a GP contractual requirement from April 2015. Many practices also offer extended surgery appointments in the morning before 8.00am, in the evening after 6.30pm and at weekends. Occasional evening and weekend clinics to provide specific services, such as flu clinics, may also be offered. Regardless of specific requirements, it is important to endeavour to meet patient needs wherever possible so that they may be able to see their GP of choice and can request to see a GP of the same gender. The ability to book routine and follow-up appointments weeks in advance is also popular with working patients so that they can make necessary arrangements.
People who work, particularly full-time workers and commuters, often can’t attend the surgery to order or collect their repeat prescriptions during surgery opening times. Patients often give positive feedback when they have been able to use an online repeat prescription service. Online repeat prescription ordering will, of course, also be a GP contractual requirement from April 2015.
The CQC will be looking for practices to provide relevant health and screening clinics to detect and prevent illness and promote general health and wellbeing, as well as offering other clinics. In some cases, cardiovascular risk assessment clinics are run by the practice nurses with the aim of advising patients on a healthy lifestyle and disease prevention. At these clinics blood pressure checks, weight advice and cervical smear testing can also be offered. A family planning clinic could be offered, including coil fitting, emergency contraception and advice about the menopause, including hormone replacement therapy. Health checks for newly registered patients should be promoted for people aged 40-75, in line with NHS initiatives.
These clinics are often provided during core working hours, but provision of a service to people who can’t access these clinics between 9.00am and 5.00pm because of work commitments may be considered Outstanding. It is essential that practices consider the needs of this particular patient group and adjust the services provided to ensure they are accessible, flexible and offer continuity of care.
The levels of incapacity due to chronic ill health in the working age population will very often play through into later life. Therefore, patients need to be equipped with the information and confidence to self-manage their health conditions. Even though working patients may not be able to attend the surgery in person very often it is important that they have access to information about a wide range of health promotion and screening services available. The use of practice websites is becoming more widespread, and information provided on them should be relevant, accurate and kept-up to-date.
For those who can attend the practice, they may not have time to search through the mass of patient information leaflets often kept in the waiting room. For this reason many practices now have a visual information system (TV screen) if the waiting room that combines health awareness and practice information messaging, and sometimes with a patient call facility. Enhancing the patient experience is essential so finding a way to deliver educational information to patients whilst they wait to be called for their appointment would be useful. Waiting times may feel shorter and communication is improved as patients receive targeted health related messages and important practice information.
Many practices now offer telephone consultations to help provide access to patients from this population group. Even after patients have been seen in the practice, if they require referral to specialist services they should be offered a choice of services, locations and dates.
The CQC reports highlighted one particular practice that rated as Outstanding because they used the Human and Environmental Risk Assessment (HERA) risk stratification tool, which assisted doctors in detecting and preventing unwanted outcomes for patients. This helped to profile patients by allocating a risk score dependent on the complexity of their disease type or multiple comorbidities.
The practice also had a Primary Care Plus nurse who worked as the interface between primary and secondary care and other agencies such as social care. The nurse provided a communication link for patients being admitted and discharged from hospital. This helped ensure a safe admission and discharge for the patient. Whilst these services are applicable to any patient, the understanding of individual patient needs and circumstances, such as working people, would assist with the management of these services.
Key areas for action
These are actions which practices should consider to evidence they are meeting the needs of working people and what outstanding provisions may also be offered.
- Publicise services, screening and clinics on the website and waiting room screen
- Provide online repeat prescription ordering
- Provide online appointment booking
- Offer clinics outside of core opening hours
- Offer telephone consultations
- Working with other healthcare professionals to highlight individual patient circumstances