Becoming an IFHS improves patient care and job satisfaction at Travis Medical Centre
The results achieved by Travis Medical Centre in becoming an Integrated Family Health Service (IFHS) have been so good that IFHS project managers had to check and re-check the data to make absolutely sure it was correct.
“We couldn’t believe it at first but it’s all true,” Canterbury Clinical Network IFHS project manager Jan Edwards says. “They are a star practice with really strong leadership and have achieved their success with a clear vision that’s all about the patient.”
In the four years that Travis Medical Centre has been working towards becoming an Integrated Family Health Service, it has increased its GP capacity by between 9 and 30 per cent (depending on individual GPs), while at the same time increasing its enrolment by 18 per cent. It has also improved patient access to care by lowering the average cost for patients and improving immediate access to the clinical team, when needed.
Despite the rise in enrolled patients, the number of Travis patients using acute hospital services has not increased. And while the Practice’s purchase and expense patterns have changed, there has been no overall reduction in income.
Dr David Pilbrow, one of Travis Medical Centre’s three General Practitioners, says changes at the practice have been made at a slow but steady pace, involving everyone in the team – nurses, doctors, receptionists - at every step along the way.
“Just before the quakes we’d had a meeting with Queenspark and Parklands (General Practices) about working together and rationalising a few things. Then the quakes happened and Jan and Mark Henare (an IFHS project manager) from Pegasus Health came and asked us if we wanted to push things along a bit.”
“We’d got to the point that our way of working wasn’t very satisfying and was potentially unsustainable. Just churning through 15-minute appointments every day didn’t feel like we were doing the best for our patients or anyone working here.”
Changes initiated by the practice have been focused on improving patients’ experience and service; making the GPs’ working life more sustainable; and making better use of the nursing team’s skills and experience. “We also didn’t want to lose our small practice feel and wanted to continue to be a training practice, hopefully encouraging people to work here in the future,” David says.
The first step to becoming an IFHS was for the Travis Medical Team to take part in a series of workshops with teams from two other local General Practices and two local pharmacies. IFHS facilitators at the workshops helped them consider new ways of working, a view of the future for their health community and how they could develop a new model of care.
Jan Edwards says that while there was an initial focus on co-locating and sharing a building, the work that was identified was much more about the ways that General Practice organised themselves, as well as their relationships with partner providers.
One of the most profound discoveries for Travis Medical Centre was that 55 per cent of patients were presenting acutely. As a result, acute slots were introduced before 8.30am for telephone consultations between patients and GPs or practice nurses. “We have found that by talking to people over the phone, rather than immediately booking them, we are often able to give advice that means the person doesn’t need to come in that day or may not need to come in at all. We can also arrange for tests prior to a visit,” David says.
From L-R: Nicky Scott, Jackie Cooper, Sue Peers, Shelley Hall
Another change that the Centre made was to, each morning, preview the records of patients booked for appointments. This might result in a longer appointment with a doctor or nurse or involvement from Care Coordinator Jackie Cooper, who assists the team to identify patients who could benefit from being linked with other health and social services. The local pharmacist, who is now better linked to the Practice through the electronic messaging tool Jitsi, might also be involved in a patient’s preview.
Upskilling nursing staff to work closer to the top of their scope of practice has also paid dividends for Travis Medical Centre. Nurses are now more involved in the management of people with chronic conditions and regularly assess patients, prior to them being seen by a GP. This has been a key factor in enabling GPs to free up time to spend with more complex patients.
David Pilbrow
David says patients have been delighted with the changes at Travis Medical Centre, particularly the increased access they have through telephone appointments. “It has been a great new way of working for this neighbourhood, where we have a higher number of people needing to see their General Practice regularly.”
“I’d never want to go back to the old way of working,” he says. “I don’t have days when I see 35 to 40 patients anymore. I work just as hard but it’s much more enjoyable.
David says Jan Edwards and Mark Henare are to be congratulated for their role in Travis Medical Centre’s success. “They are legends. They really inspired us and kept us motivated with some really good ideas. We wouldn’t have made as many changes without them.”
Pegasus Health hosts the Canterbury Clinical Network IFHS programme, which over time has involved a wide range of Pegasus staff. “When Mark and I eventually move on, we’ll know that the support services for IFHS will be well embedded and sustainable,” Jan says.