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GP example: Providing emotional support
Key question: caring?
C3: Do people who use services and those close to them receive the support they need to cope emotionally with their care and treatment?
Helping people get back to work
An urban practice with 7,700 registered patients.
The practice worked as part of a local initiative to encourage people back to work. The practice hosted an employment support advisor from the Job Centre one day a week to provide advice on a full range of work related issues to interested patients. The practice booked patients into the service and they demonstrated that it was having a positive impact. For example, 30 patients had started full time work, 19 had started voluntary work and 31 had participated in work based training.
Empowering patients to be experts in their care
A suburban practice with 14,000 registered patients.
This example of outstanding practice shows an innovative service that promotes patient self-management. The service is popular with patients and demonstrates improved outcomes for patients.
The advanced nurse practitioner at the practice ran a six-week structured group-based education programme for patients with diabetes. At the time of our inspection, this was the only practice in the area Redditch and Bromsgrove that offered this in-house programme. The aim of this programme was to give patients the knowledge, skills and confidence necessary to self-manage their diabetes. The GP partners supported the programme as they placed a high value on patient education and self-management of long-term conditions. Ten to 18 patients attended each week for two and a half hours.
The national database figures for 2014 showed improved outcomes for patients such as weight loss, reduction in HbA1c (blood sugar levels) and reduced cholesterol. We saw that patients who had attended one of these courses gave very positive comments to the practice.
Supporting patients, carers and families with high quality services
A suburban practice with 9,100 patients.
The practice employed a community and care co-ordinator (C&CC) who provided services to support vulnerable people. The C&CC ran and co-ordinated a support group for carers of people with dementia, a support group for patients with chronic fatigue and a bereavement support group.
The bereavement support group was held twice a month. It was facilitated by two counsellors and also provided one-to-one support. The group linked in with a follow-on group which met fortnightly. A practice GP saw that a patient was still struggling with their loss several years after suffering a bereavement, and so had invited them the group.
The C&CC had also established a voluntary service that worked to reduce loneliness and social isolation. A team of volunteers offered one-to-one support for patients in their own homes, providing practical help or a befriending service. We saw application forms in the waiting area encouraging patients to either volunteer or to use the service.
Supporting people in difficult circumstances
A rural practice with 14,000 registered patients.
The practice actively supported patients and their carers to cope emotionally with care and treatment by inviting patients to attend a free, confidential service held and facilitated by a volunteer chaplain listener every week. Appointments lasted up to 50 minutes and were available for patients who felt they would benefit from an opportunity to discuss any concerns for example, illness, the prospect of surgery, a difficult diagnosis or bereavement.
Practice staff, such as a GP, nurse or team member, could suggest making an appointment, or patients could ask for an appointment for themselves. There was information to promote the service in reception.
Patient liaison role
A practice in a deprived urban area with 8,300 patients.
The practice had a dedicated member of staff in a patient liaison role. Their role included working with the patient participation group and local initiatives to improve services for patients. They also contacted all bereaved patients and new mothers to offer support and advice.
We received a number of very positive comments from patients who told us about this member of staff and their work, particularly their ability to support patients and assist them with their health and social care needs. This staff member visited people at home to ensure they were receiving adequate support and had sourced equipment to enable one patient to be supported at home at the end of their life.
Improving mental wellbeing
A practice in a rural area serving 11,000 patients.
A patient singing group was held on a monthly basis and had been running since August 2013. The group comprised of patients over 60 years (and their carers) who had a chronic illnesses such as Alzheimer’s disease and memory problems. This activity was aimed at improving the mental wellbeing of older patients.
Innovative approaches to fighting social isolation
An inner city practice with 7,400 registered patients.
The practice was outstanding in its compassionate approach to offering services for a range of registered patients.
For example, the practice was the first in the area to address the risk of social isolation by organising a reading group and starting a gardening co-operative where patients could grow vegetables in the garden at the practice, which were then sold to local health and social care providers.
The practice also organised an annual Christmas party for patients aged over 80, which was supported by local charities and provided food and a gift for each person. In addition, the practice had recently engaged with a voluntary organisation that hosted sessions at the practice to promote mental well-being through creativity.
Emergency care services
A practice serving about 5,000 patients in and around a small coastal town.
The practice had instigated a care fund, which was an independent registered charity run by local trustees to provide short-term emergency care, resources and equipment not normally funded by the NHS or social services. The fund provided immediate care and support to those patients with an acute medical or social care need and in many cases was effective in reducing unnecessary hospital admissions by providing short-term care in the home or as near to home as possible.
Self-management programme for long-term conditions
A practice with 9,000 patients in a deprived inner-city area.
The practice had identified that a large number of its patients had long-term conditions. In view of this, it formed a partnership with an evidence-based self-management programme at a local university that supports people with long-term conditions to regain as much control over their physical and emotional well-being. The practice allowed the programme to meet at its premises to give easy access to its patients. As an example of the success of this programme, the practice identified a cost saving in just one patient between 2012 and 2015 of £850,000, while also reducing attendance at the A&E department and GP emergency appointments from 27 to five over 14 weeks.
Patient-support charity and integrated community services
A practice with 7,500 patients in a rural area covering 200 square miles.
The practice was proactive in recognising the pressures on health and care services in the area. It was a founding member of a patient focused charity and continued to promote the services it provided. Patients had immediate and easy access to the many types of support available, including information, transport assistance support and social activities for vulnerable patients living in the community. Over 300 patients are supported each year by this service.
The practice has driven innovation in integrating community services in the area through a long term health conditions project. They developed a specific role of practice community matron providing patients with one point of contact and greater anticipatory care of vulnerable patients. This had reduced the number of unplanned hospital admissions by a third.
- Last updated:
- 10 August 2017