The strategic direction for Health and Social Care in Northern Ireland has been set out in the Bengoa Report ‘Systems Not Structures: Changing Health and Social Care’ and ‘Delivering Together- Health and Social Care 2026’.

The Bengoa Report, published in 2016, recommended that Health and Social Care should formally invest, empower and build capacity in networks of existing health and social care providers, specifically naming GP Federations.

A GP Federation is a group of GP practices, established to address capacity workload issues within general practice.  GP Federations enables practices to retain key aspects of their individuality whilst benefitting from being part of a largescale organisation, in receipt of NHS funding.  We enhance the services offered in primary care, developing primary care to reduce the burden on secondary care, such as our elective care services.

Our clinical and non-clinical networks help us to drive innovation across our practices and we love to share the lessons we have learnt and the quality improvements that may benefit others.

GP Federations provide opportunities to work across practices, which we feel is invaluable in developing staff expertise and skills, and also provides a variety in the work that we do.  As a result, we seek to introduce new roles into practices to provide a greater variety of healthcare services to the population that they care for and support our remaining GPs.

EFSU employs over 30 staff to provide corporate & operational services and professional management at scale to its member GP Federations, on a local and regional basis.

EFSU supports eight GP Federations who cumulatively employ over 200 staff working as General Practice Pharmacists, Senior Mental Health Practitioners and Nurses.

By coming together within a largescale, primary care organisation, it enables economies of scale, not achievable by a single practice, such as:

  • General practice pharmacy scheme
  • Nursing initiatives
  • Multi-disciplinary teams

In addition, EFSU manages a range of local and regional services, which patients benefit from and we employ over 70 staff directly to deliver these including:

  • Elective care services
  • Practice improvement and crisis response
  • Connected community care (social prescribing)
  • Practice based learning
  • Other ad hoc services

Local and regional services delivered by EFSU are detailed below:

GPNI

When it was established

March 2020 

Why it was established

GPNI was set up in response to the emerging Covid-19 pandemic to primarily provide a space for those working in Primary Care to keep up to date virtually with the changing clinical guidelines. It provided the opportunity to network and educate around best practice following the isolation guidelines and the roll out of vaccinations via practices.

How it supports GP Practices

It offers weekly webinars with the most up to date information and a chance for staff to network and highlight any issues. Post covid it has transformed to an established platform for multidisciplinary learning and educational webinars continue to take place, collaborating with stakeholders organisations for a multi-disciplinary, no more silos approach. 

What’s happening now

Weekly webinars continue with the focus remaining on Primary Care education and representing emerging groups from Multi Disciplinary Teams. They have a varied list of upcoming topics and speakers planned and collaborate with stakeholders to disseminate vitel information to Primary Care Staff. Their website is a wealth of resources for staff in General Practice and hosts a back catalogue of all previous webinars.

Website: https://www.gpni.co.uk/

Twitter: https://twitter.com/GPNI_co_uk

General Practice Elective Care Service (GPECS)

When it was established

Nov 2018

Why it was established

Improving waiting times for elective care has been a key priority for several years. To facilitate the     primary care elective transformation agenda, a range of pathways were designed by GP Federations and the SPPGand delivered by federations in a primary care setting, initially focusing on Dermatology, MSK, Gynaecology and Vasectomy. These pathways were to facilitate patients being managed more appropriately in primarycare without the need to refer to  secondary care.

How it supports GP Practices

The service is delivered in local practices at a federation level by GPs with enhanced skills (GPES) in their     chosen area and nursing and HCA support. Beyond primary care capacity they support an improved approach to demandmanagement via peer support, peer review, peer education, self- management and self-directed care at a populationlevel within federations

Where they are now/the future

Since November 2018 over 38,000 patients have been seen in a GP Elective Care Clinic, with over 61 host practices active and over 100 trained GPES.

The latest service to be implemented Eastern GP Federations is the PCSS (Primary Care Surgical Service) which has already been rolled out successfully in Northern and Western areas. It is hoped that it will be fully operational in Eastern areas by September 2022.

Link to website: https://gpecs.easternfsu.com/

Twitter: https://twitter.com/ni_gpecs

General Practice Pharmacy Scheme

When it was established

In 2016 the Department of Health gave approval for £17m to enable pharmacy support to be placed in GP Practices across Northern Ireland.  Recruitment began September 2016 and all Pharmacists were in post, across NI, by April 2020.  

Why it was established 

It is proven that Pharmacists in GP practices allow GPs more time to spend with patients thus improving patient outcomes. Due to immense pressures on GPs to cater to an increasing number of patients in a shorter window of time, and a looming workforce crisis, it was deemed essential to implement the GPP scheme throughout NI.

How it supports GP Practices

GPPs work within General Practice as an integral part of the primary care team. Every GP practice in NIavails of the services of a GPP through membership of a GP Federation. Although GPPs have a well-defined and wide-ranging remit, the GPP role within a practice will vary according to practice need and priorities but, in most practices, the GPP will be involved in the following:

  • Clinical Medication Review
  • Medicines reconciliation of hospital letters/discharge information
  • Medicine related queries – from patients and healthcare professionals
  • Prescription requests, queries and re-authorisations
  • Patient facing clinics eg review of long term conditions, complex medicine regimes
  • Managing and monitoring high risk drugs
  • Prescribing system review and improvement
  • Clinical Audits

Each Federation has at least one Lead Pharmacist who acts as a professional pharmacist advisor but is also attached to a practice.   Additional funding was also provided for training so non-prescribing PBPs were offered posts subject to them upskilling to independent prescriber level. 

Connected Community Care Service

The Integrated Care Partnerships launched the Connected Community Care (CCC) service in 2016. It is a partnership with GP Federations, Belfast Health and Social Care Trust and community and voluntary providers. The service was created to support the reduction of health inequalities by empowering people to play an active part in their health and wellbeing outside of the medical setting.

The CCC team works across Belfast to assist GP practices by co- producing a support plan with individuals utilising a holistic needs assessment tool and connecting individuals support services within their local area. The CCC service accepts referrals from anyone aged 18 and over registered with a GP in the Belfast area, regardless of postcode at no cost to the individual.

The types of support offered are indicated below: 

 

CCC Wellbeing Coordinators | CCC Wellbeing Coordinators specialise in supporting those with, or at risk of, developing chronic conditions, isolation, and loneliness. If someone needs help finding support, groups/activities or accessing emotional/practical support they can help.

CCC Wellbeing Coordinators case study example

Social Support | Client was referred to service for social support. Client had mental health problems and as such struggled with the upkeep of their home. This client was aged under 25, which made them eligible for referral to MACS, who provided housing and wellbeing support. To help this client integrate socially they were referred to volunteering opportunities with Volunteer Now. This allowed the client to feel a sense of fulfilment and personal growth. Client was concerned about childcare arrangements when volunteering. A referral to Sure Start addressed this issue and helped them access affordable local childcare.

 

CCC Dementia Navigators | CCC Dementia Navigators provide pre-diagnostic information and supportfor people who have been referred for a memory assessment by their GP and are waiting for an appointment or/and post diagnostic support to people, and their carers, who have already been given a formal diagnosis of Dementia and are living with the condition. For more information click here

CCC Dementia Navigators case study example

Emotional Support | Client referred for emotional and practical support following a diagnosis of dementia. Client was encouraged to engage with local opportunities to improve their confidence and mood, with a focus on their strengths and achievements. To help reintegrate socially client consented to referrals for Dementia Friendly Belfast Activities such as walking groups and local exercise classes, and Alzheimer’s Society’s singing for the Brain. Information and education shared with client and spouse on small ways to makes changes at home. This included signage for rooms and direction and highlighting doorways and steps. Dementia Navigator agreed to refer client to Occupational Therapist in Community Mental Health Team to assess home for equipment and specialist intervention.

Connected Community Care for Cancer Macmillan Community Link Worker | CCCfC Macmillan Community Link Workers specialise in supporting people affected by cancer by connecting them to community, voluntary and cancer specific support services. For more information click here

CCCfC case study example

Self-management Support | Client was referred to CCCfC for self-management support. Client presented with low mood and emotional distress following consequences of undergoing cancer treatment. Upon completion of holistic needs assessment, client was referred to Look Good, Feel Better – a self-management programme designed to improve self-image. To combat cancer related fatigue, client was referred into Macmillan Move More exercise programme. Client found these referrals helpful and felt supported enough to improve their overall health and wellbeing.

How to refer

Please refer via the Clinical Communication Gateway (CCG) system. The service can be found under GP Federations/Integrated Care Partnerships – Connected Community Care.

A patient can also self-refer to the Connected Community Care service by contacting

info@ccchub.co.uk or 028 9590 1407.

How can I access Connected Community Care?

You can self-refer to the Connected Community Care Service by contacting referral@ccchub.co.uk or ring 028 9590 1407

Twitter: https://twitter.com/CCC_Hub

Practice Improvement and Crisis Response Team (PICRT)

When was it established

2018

Why it was established

General Practice in Northern Ireland is under pressure for a number of reasons, including an ageing population and increase in chronic diseases, in the context of a limited GP workforce. A number of GP Practices raised concerns they may be at risk of Practice closure in the future or unable to deliver their contractual obligations for their registered patients. In recognition of this, the Department of Health agreed that it would be helpful to establish a Federation led General Practice Improvement and Crisis Response Team to circumvent these closures.

How it supports GP Practices

The PICRT is a regional service which supports practices at risk to develop and implement an effective Practice Recovery Plan.

They provide expert General Practice managerial support at short notice for practices at high risk or in a crisis. Practices in crisis can also gain improved access to clinical GP cover at short notice to assist struggling practices who are under intense pressure and at risk of collapse .

When a practice does collapse the GP will hand the contract back to SPPG and it leaves their patients with no GMS cover, thus putting pressure on neighbouring practices as a result. The PICRT can be parachuted into a practice in trouble with 2 weeks’ notice.  Their input is free to the practice.  When the team is not undertaking PICR work they are available using an online booking system for practices in the Eastern area. Referral occurs through the SPPG local offices. Once the practice is referred the PICRT, both the GP and Practice Manager Lead visits the at risk practice and helps formulate a short and medium term plan to keep the practice’s services in place while seeking to design a longer term strategy to stabilise the practice.

Resources that can be used include workload reviews, additional resources from Federation and SPPG, input from members of a list of experienced GPs and Practice Managers that they can arrange to connect with the practices, and sessional GP input. Generally, the PICRT will be involved in supporting practices for up to 3-6 months. There is active review of the support given to practices. 

Where we are now/the future

The service is ongoing and is currently being evaluated to provide further resources for GP Practices in crisis.

Current situation 

74 practices have been visited to date

21 practices still receiving ongoing support

Salaried GPs – 5.3 WTE

Regional PICRT website – coming soon

Federation Education (PBL)

When was it established

The Practice Based Learning (PBL) scheme was introduced in 2015 with the aim of centralising education for the 8 eastern area federations.  In 2017 a central Clinical Education Lead and Educational Co-ordinator were brought on board to oversee the running of the scheme.

Why it was established

It was established to provide high quality educational programmes for federation members, up-skilling GPs, practice nurses, pharmacists, health care assistants and the practice administration team in a constructive environment, in order to facilitate direct improvements in patient care.

Aims of the Federation Education:

  • To support Continuing Professional Development by producing a high quality educational programme for federation members, and relevant others, that facilitates the ongoing personal development of GPs, and other primary care workers
  • To support health care professionals fulfilling the requirements of appraisal and (where relevant) revalidation.
  • To involve the practice team and promote implementation of any learning by delivery of the programme within protected practice time, in an environment where the practice team can get access to high quality education relevant to their role. 
  • To facilitate networking by serving as a forum to allow sharing of examples of good practice. 
  • To facilitate dissemination of local guidelines, clinical pathways or other federation projects.

How it supports GP Practices

Practice based learning events are designed to facilitate better care for patients by providing usable, practical information to practicing staff and team members. A direct consequence of this integrated approach is the creation of a networking forum within each federation for exchange of ideas and for sharing best practice. It also aims to support the Continuing Professional Development of its members by producing a high-quality educational programme for federation members and supports healthcare professionals in fulfilling the requirements of appraisal and revalidation where relevant.

It gives protected learning time out of practice to facilitate dissemination of local guidelines, clinical pathways or other federation projects which are available to GP practices.

Where we are now/the future

PBLs are being arranged for the forthcoming academic year with the aim that they will return to face to face post covid. They have consulted with Federations leads and listened to feedback to begin designing an informative programme for each Federation

For further information please contact: Ruth.Fitzsimons@easternfsu.co.uk or Rachel.Hawkins@easternfsu.co.uk

Nursing Initiatives

Nursing in Primary Care

Nurses have been long established members of Primary Care Teams, increasingly taking on new roles and responsibilities within Practice settings.

General Practice Nursing “Now and the Future” A Framework for Northern Ireland (hscni.net)(PHA, 2016) provides a roadmap to develop and standardise the range of General Practice Nursing (GPN) roles. GP Federations were identified as the mechanism through which implementation of the Framework would be taken forward to manage and revitalise a sustainable model of General Practice Nursing in Northern Ireland.

The Framework recommended the development of a career pathway for nurses working in General Practice which was launched in 2018 (View the Career Pathway document.) The Pathway comprises core competencies, education requirements and Job Descriptions to enable a standardised approach to the continued development of five main roles within General Practice Nursing, including Senior Nursing Assistant, Treatment Room Nurse, GPN, Senior GPN and Advanced Nurse Practitioner.

Nursing Initiatives-supporting General Practice

‘General Practice Nursing, Now and the Future’, 2016, and ‘Health and Wellbeing – Delivering Together’ (DoH, 2016), recognised the developing range of Primary services, using an expanded range of professional staff working within Primary Care teams.  Eastern GP FSU worked in partnership with the SPPG and PHA to pilot the introduction of Advanced Nurse Practitioners working in Primary Care. This was successfully tested in Down Federation.  Funding has also supported the successful testing of an initiative in West Belfast Federation (2018/19) to increase numbers of General Practice Nurses working within Primary Care.

Both initiatives are aligned to the GPN Career Pathway (2018) and have now been introduced to several Federation areas. They will be introduced to all Federations when funding becomes available.

Health and Wellbeing – Delivering Together (DoH, 2016) also recognised the need to develop Elective Care and Multidisciplinary Teams (MDTs) within Primary Care. Nurses are included as team members within these initiatives. Within MDTs, nursing roles include Health Visiting, District Nursing, and as members of Mental Health Practitioner teams.

MDTs have provided the opportunity to implement the Delivering Care (2011) policy for health visiting and district nursing which aims to secure safe staffing levels across all practice settings. Since 2017, General Practice Nursing has also been included under the policy which is to be reflected in new legislation through the Nursing and Midwifery Task Group (DoH, 2020). 

The Future

Key initiatives continue to be introduced across Primary Care which will result in an expanded nursing workforce ready to support new and exciting strategic priorities in support of safe and effective person-centred care.

Multi -Disciplinary Teams in Primary Care (MDT’s)

When was it established

In May 2018, the Department of Health announced the Multi -Disciplinary Teams in Primary Care (MDT’s) initiative as part of a £15m transformation fund allocation to primary care.

The Western Health & Social Care Trust, in partnership with the Derry Federation of GP Practices, and the South Eastern Health & Social Care Trust, in partnership with Down GP Federation, were the first to pilot the implementation of MDT’s in Northern Ireland 

Why it was established

The development of MDTs was a central element of the ‘Health and Wellbeing 2026 – Delivering Together’ framework in 2016. They were introduced as part of a regional mechanism for transforming and coordinating health and care services to meet the needs of individuals with complex care needs and focus on person-centred care. 

How it supports GP Practices 

The teams bring together the expertise and skills of different professionals such as First Contact Physiotherapists, Social Workers and Mental Health Practitioners to assess, plan and manage care jointly. Patents registered with an MDT Practice can book an appointment directly with any of the new services, without first having to see their GP. GP practices benefit as they can focus not just on managing ill-health, but also on the physical, mental and social wellbeing of communities. GPs in MDT practices will also see their time utilised more effectively. By ensuring that patients see the most appropriate professional within the primary care setting, GPs can focus on those patients who most urgently require their care.

Where we are now/the future

Multi-Disciplinary Teams continue to be rolled out to GP Practices by GP Federation area

The plan is for each GP Practice to be allocated the following once roll out is complete:

  • 5wte First Contact Physio per 5000 patients
  • 5wte Mental Health Practitioner per 5000 patients
  • 0wte Primary Care Social Worker per 5000 patients
  • 5wte Social Work Assistant per 5000 patients
  • Additionality to increase District Nursing numbers to 10wte per 10,000 patients, district nursing teams to be organized around GP practice list.
  • Additionality in Health Visitor numbers so each HV is only carrying 180 caseloads.

Each Federation’s MDT projects are all currently at different stages of development according to the original timeline. Working groups continue to meet with representatives from all stakeholders to ensure the roll out goes as smoothly as possible. Eastern FSU are also working alongside the HSC Leadership Centre to fund a Leadership Course for Practice Managers initially to equip them with the skills to navigate the arrival of MDTs to their practice. The first cohort began in March 2022 with the hope that further cohorts can be rolled out in the upcoming year.

GP Fellowship Programme

When was it established

The SPPG provided funding to the Eastern FSU in 2018/19 to design the Fellowship model for Northern Ireland and we put in place a recruitment exercise for GP Fellows on behalf of Federations regionally to start in August 2019. 

Why it was established

The Fellowship model is designed to enable a group of GPs early in their career to get experience of a leadership and improvement role in General Practice. The posts are based in General Practice within a GP Federation and they will afford an opportunity for participants to develop skills to lead and develop General Practice and specific career pathways in specialties delivered in Primary Care through Elective Care Reform and other strategic regional initiatives. There is a key emphasis on Primary Care with identification of opportunities to work shadow, to be mentored and to be coached by key leaders in Primary Care from General Practice and other disciplines.

How it supports GP Practices

It enables newly qualified GPs to understand the NI Health and Social Care system and produces new GPs with an enhanced knowledge, skills and experience of Leadership and Service Development. The scheme also gives an opportunity to secure potential future leaders of NI General Practice who will help lead and transform Primary Care Services for the better. Clinically they provide support to a practice working at 60% WTE in surgery (at times one in crisis), which reduces pressure on a practice 

Where we are now/the future

There were 3 Fellows recruited throughout 21-22 and we hope to commence recruitment soon for a new cohort of Fellow’s.

Practice Manager Course

When was it established 

In 2019/20, Eastern FSU were successful in applying for funding from SPPG to collaborate with an established Education Provider to develop a Primary Care & Health Management Diploma (ILM Level 5) for selected practice staff in NI, for which at that time there was no existing course available in NI. 

Why it was established

It was designed for existing and aspiring practice managers to focus on dealing with fast moving change, improving practice and staff performance as well as refreshing essential management skills, with the main objective of participation in the course aiming to improve the quality of service to patients in Primary Care. Participants were also encouraged to have a specific project in mind within their practice to highlight how the course has benefited that issue and helped in solving it.

How it supports GP Practices

Practice staff that participate in the course come away with a qualification which equips them to be better skilled at handling busy practice life, be that managing staff, finances, patient queries, high volume workload etc. The value in networking between colleagues is also invaluable to GP Practices as they can learn from each other and adopt best practices to help streamline the services they provide to patients.

Where we are now/the future

There have been 3 successful cohorts to date from 2020 with 38 senior practice staff successfully completing and gaining a Level 5 Diploma as a qualification to date. The current cohort finished in summer 2022 and information on how to apply for the latest cohort for 22-23 will be available in due course via the website.

Stepping Up to Leadership & Management in General Practice

 When was it established 

The programme has just been advertised and is beginning in October 2022 it will be delivered collaboratively by Eastern FSU and Queens University Belfast Graduate School.

Why it was established

We are pleased to offer this personal development programme for experienced General Practitioners in Primary Care, who wish to develop greater leadership responsibilities within their practice. Eligible applicants must be a current GP Partner / Salaried GP within Eastern FSU Area and with management responsibilities in the practice.

Learning Outcomes

  • Understand approaches for personal and professional development
  • Know how to develop as a strategic leader through personal and professional development

How it supports GP Practices

The programme aims to support and encourage GPs who are stepping up to take on leadership and management responsibilities in the practice. It also provides opportunities for GPs to learn from other experienced GP colleagues and network with their peers.

Where we are now/the future

This is the first interaction of the programme and it has been offered to Eastern FSU practices and is part funded by Eastern FSU. An evaluation will take place during and following completion to determine whether this is something which is required and worthwhile offering (or even expanding) on a continual basis.

GP Practice Management Handbook

When was it established 

The Practice Managers Advisory Group within Eastern FSU has been working to develop a GP Practice Management Handbook, the first of its kind in Northern Ireland.

Why it was established 

This project was undertaken after a need was identified to have a comprehensive reference guide, specific to Northern Ireland, primarily for new practice managers. It is hoped this handbook will aid new Practice Managers (and other staff) with induction into the Primary Care setting and be a supportive resource for existing managers in their day-to-day business operations.

Where we are now/the future

The document has been designed to be used as a digital document as it has live links throughout but as things frequently change in general practice this handbook will be updated on a yearly basis. To access the most recent version of the document click the button below:

NI General Practice Management Handbook - 1st Edition - 2023