Below is a link to the latest published editorial in Family Practice, including parts of my work on primary care diversity data and its challenges. Many thanks to Carolyn Tarrant and Emma Angell.
On the 5th March I attended the Society for Academics in Primary Care (SAPC) regional conference to present my work on “non-clinical patient needs: mapping diversity in primary care” a parallel session. Dr Alf Collins, Consultant in Pain Medicine at Taunton and Somerset NHS Foundation Trust, and Professor Nigel Mathers were the keynote speakers in attendance. Their talks focused on patient-centred care and, in particular, its influence in the management of long term clinical conditions. Dr Collins talked about the three principles deemed necessary for the personalisation of care: coordination of care, the engagement of patients in decision-making and thirdly, the supported self-management of care for individuals. He described how a fine balance of all three is something that the UK health system is already working towards but that it requires cultural changes within the system for it to work effectively. Following on from this, Prof. Mathers elaborated on the components needed for true patient ‘activation’; the combination of knowledge, skills and confidence which will allow patients to actively and safely manage their health.
Poster viewing sessions were scheduled throughout the day and I found one particular study’s poster quite relevant to the work that I have been doing over the past six months. It was on the feasibility and acceptability of Clinical Commissioning in general practice, drawing on evidence from interviews with GP’s, some of whom were saying that it was not their place to do so and that they had entered into the profession to help to care for people, not to ‘population-manage’ or budget for services. This was of particular interest to me as it provided a possible explanation as to why some of the practitioners I had interviewed responded apathetically to mapping out their population’s needs even though after recognising the benefits of such mapping for their patient population (i.e. informing commissioning decisions with cost implications)
Being the first presentation that I have delivered in front of an audience of health care professionals with academic interests, the planning was slightly more challenging than usual! But having the chance to run-through the presentation beforehand and to receive feedback from the SAPPHIRE group helped me to make the final adjustments. On the day it was well-received and I think it has given me the confidence to do something similar on an even bigger stage!
I presented on the topic of “non-clinical patient needs: mapping diversity in primary care”. Department of Health guidelines continue to emphasise the importance of seeing the patients as customers to a service, listening to them and catering to their requirements. For this to be done effectively within primary care organisations, they will need to have certain knowledge about their patients’ characteristics. There has been on-going interest to reduce health inequalities through using data intelligently, but less focus had been placed on non-clinical data (e.g. age, sex, spoken language, ethnicity, employment status, learning difficulties, visual impairments etc.) and the inequalities to health that arise through patient cohorts with these diversity characteristics. The annual GP surveys have reported a trend in certain patient cohorts who continually report back as being ‘underserved’. Therefore the idea of mapping out a practice’s population based on these needs may help a practice decide how best to allocate their resources (staff time and practice money) to reduce these inequalities. This could reduce inefficiencies in service provision by moving away from a ‘one size fits all’ even spread of services, or allocating services in an ad hoc fashion (as revealed through my interviews with practice staff), to making informed decisions based on real data. It is also key to think about these issues as we move to having Clinical Commissioning Groups or CCG’s nationally. Such data may lead to the smarter commissioning of services.
I have now visited two primary care organisations for interviews with health professionals and practice staff at each site. I would say that the interviewing experience and the data collected have both been interesting in their own way. The interviews have shed light on the practices’ procedures when it comes to recording non-clinical patient information on each patient record and I look forward to analysing the responses. One thing I have noticed is just how immensely busy some health professionals are! Although the meeting times had been scheduled in advance, it was common for the responses to be short and closed (with frequent clock-glancing by the interviewee!). Although I tried to prioritise the key question areas, I can see that some follow-up meetings with a couple of health professionals will be needed to fill in the gaps. Hopefully I can pick up where I left off.
This week I started work on one of the SAPPHIRE Group’s research projects on Responsiveness of Primary Care Services (PCS). Reponsiveness is the ability of the Primary Care provider to adapt to the needs of the patient population they are serving, in order to reduce inequalties to the service delivery. PCSs do make changes but they are often not tailored to the particular needs of their patient groups. As it can be imagined, this is a less effective approach.
Below is an extract from the protocol for the “Responsiveness study” that I’ll be working on:
A key objective of the study is to develop an approach to describing the practice population, which will enable providers to ensure that they have successfully accessed the views of diverse groups and understand how findings apply to their population. We will work with a sub-sample of 3-4 PCOs from the sample of twelve participating in stage 1 of the study, to develop an approach to describing their user population. This will involve identifying pre-existing data at practice and PCT level about the demographic characteristics of their population, as well as identifying how to access internal knowledge about the characteristics of their service users.
^^Looking forward to ‘getting my teeth in’ and meeting the team.