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Why Commissioners Choose Us
 

Medical excellence married with financial rigour and practical sense


Too often in the NHS, clinical, operational and financial aspects of service design and management are organised in a disjointed way. Greenbrook takes a joined up and rigorous medical, operational and financial view of how we run our services, to ensure that the cost and the clinical value of our activities are understood and resources are deployed in a practical, financially efficient and clinically effective manner. This approach allows us to weigh up the medical impact and the cost of different service model options and choose the optimum approach.
We do this in a number of ways:
  • A central management team with the skills and experience to design, evaluate and support each service with a combined clinical and commercial view.
  • An investment in local management resource both clinically and operationally for each service so that continuous service improvements can be implemented locally and autonomously and based on learning of front line staff.
  • A hands on management style that reviews clinical and operational audits, looking to anticipate problems and deliver continuous improvement.
For an example of how we put this approach into action please see our case study on Urgent Care Centres below:


Case Study: Urgent Care Centres


Patient Need: Patients occasionally have a need for medical assistance urgently which can occur at any time of day or night. Over recent years the rise in the number of patients with relatively minor conditions attending A&E departments has been relentless. This has a number of probable causes:
  • A wide range of services and shops are now available 24/7 and expectations have grown that NHS primary care should also be available 24/7.
  • Difficulties in accessing GP advice due to a generally insatiable demand for GP practice appointments outstripping the supply of appointments.
  • Confusion amongst the general public about how to access care when their GP practice is closed. This is coupled with an understandably risk averse / defensive approach to telephone triage of out of hours / 111 services which often direct patients to A&E out of hours.
  • Knowledge that, even if you may have to wait a long time at A&E, that you will always be seen eventually. This fact is coupled with a general reduction in waiting times at A&E since targets around waiting times were introduced.
Greenbrook approach: Develop a new model of care in Urgent Care Centres, based making improvements to the working practices commonly found in A&E minors departments
Results for patients: faster, more effective care when urgent advice is needed, together with encouragement (and help to get an appointment) back to their own GP practice when going to see a patient’s own GP is more appropriate.
Results for commissioners: a lower cost solution to attendances at A&E and more consistent meeting of service performance targets (e.g. >99% of patients treated within four hours).
 
Some examples of the changes Greenbrook has brought in to deliver these results:
  • Reworked minors pathways so that wherever possible a patient can be treated in a single consultation with an appropriately qualified clinician rather than repeated consultations with ever more senior doctors, as happens in many A&E departments.
  • In addition to doctors, nurse practitioners independently see, treat and discharge a large proportion of patients with more minor illness and injuries.
  • Blood tests and other diagnostics are used sparingly, and only where they will make a difference to the patient’s care on that day. E.g. eliminating unnecessary systematic use of blood tests on patients, which is common practice in many A&E departments.
  • Limited use of prescribing to cover only what might be required urgently, and encourage patients to go back to their GP for ongoing care.
  • Review patterns in patient demand to ensure the correct clinical skills required are available at different times of day, and not available when they are not required. Variable shift patterns, varying by day and by time of day.
  • Patient champion working within the Urgent Care Centre to help register patients with GP practices locally and redirect patients to those practices when appropriate, to avoid UCCs replacing General Practice.
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