GM Primary Care Blueprint

The Greater Manchester Primary Care Blueprint is the five-year plan for primary care across our city-region and the changes that will be made to keep it sustainable for the future.

Co-authored by Greater Manchester Primary Care Provider Board (PCB) and NHS Greater Manchester (NHS GM), the Blueprint explains how GP practices, dentists, pharmacists and optometrists will work together with partners from across the Greater Manchester Integrated Care Partnership to meet the physical and mental health needs of our citizens and communities.

The Blueprint is the primary care response to the Greater Manchester Integrated Care Partnership Strategy, which was approved in March 2023, and the national Fuller Stocktake Report of May 2022, which sets out the next steps for integrating primary care. 

Infographic describing primary care services in Greater Manchester: 1,800 services, 22,000 workforce, combined budget of £840 million and prescribing costs of £1.7 billion

Blueprint chapters and case studies

The Blueprint document is divided into nine themes, or chapters, describing how the plan will be delivered over the next five years. These include:

  1. Demand, access and capacity
  2. Integrated working in neighbourhoods
  3. Health inequalities
  4. Prevention
  5. Sustainability
  6. Digital
  7. Estates
  8. Quality, improvement and innovation
  9. Workforce

Each chapter includes a number of case studies covering all four primary care disciplines. The case studies reflect the amount of hard work and innovation that is going on across primary care in Greater Manchester. For ease of access, the case studies have been extracted from the Blueprint document and set out below under each chapter heading.

Navigating the Blueprint chapter case studies

To view each individual case study, click on the heading links under each chapter in the menu to the right and you will be taken to the relevant case study.

When you have finished reading a case study use the blue ‘back to top’ button on the bottom right hand side of this page to navigate back to the top of the menu.

Blueprint delivery plan year one

Community pharmacy – year one deliverables

Dentistry – year one deliverables

General practice – year one deliverables

Optometry – year one deliverable

GM Primary Care Summit

The Greater Manchester Primary Care Summit 2024, taking place on 21 March at The Village Hotel Ashton, will provide an opportunity to discuss the GM Primary Care Blueprint in more detail, including year one deliverables and further information and insight about some of the case studies detailed in the Blueprint.

Visit our summit website page for more information.

Blueprint case studies

Demand, access and capacity

Helping people access the right emergency care: new vision for urgent eyecare services

Urgent Eyecare Services (UES) are now available seven days a week for people across Greater Manchester. The scheme runs across all 10 boroughs and treated 49,000 patients between 2022 and 2023.

This service may be carried out via a telephone consultation followed by a face-to-face appointment if required. The UES provides urgent assessment, treatment, or referral for sudden onset eye problems such as flashes, floaters, vision loss or minor eye injuries.

A network of optometrists provides the service so people can get the care and support they need close to home, relieving pressure on general practice and emergency departments. Most patients (81%) who have used the service since May 2020 have not needed further referrals to hospital. The service helps reduce delays in starting any treatment needed.

The UES makes the best use of optometrists in the community who have the expertise and equipment to assess and diagnose eye conditions. It is provided by Primary Eye Services who have partnered with local optometry practices and NHS Greater Manchester Integrated Care to extend the service across the whole of Greater Manchester.

Child-friendly dental practices spreading smiles across Greater Manchester by reducing hospital visits

Following a successful pilot in November 2020, Child Friendly Dental Practices (CFDPs) are now being rolled out across all areas in Greater Manchester.

The CFDP network was created to reduce the number of children being referred into hospital dental services for specialist treatment, including those provided under general anaesthetic. CFDPs provide quick access to additional and complementary services in primary care from dental teams with enhanced skills to minimise the referral of children and young people (aged 0-18 years) with dental decay to specialist services. Where possible, patients are seen, treated, and discharged back to their regular dental practice.

For people who need onward referral, the service can help to manage dental pain while they wait for operating theatre availability.

This approach also recognises the processes CFDPs have in place to improve oral health in children and young people, by improving attendance at dental appointments and supporting preventative care.

To date, 600 patients have been treated across nine practices and it’s the ambition to create a network of 12 CFDPs that will link with other paediatric dental services across Greater Manchester. Greater Manchester was the first area to develop this innovative patient-focused model and to launch this work as a pilot. Other areas have since adopted similar approaches.

New ways of working are boosting patient experience and improving staff wellbeing at Hawkley Brook practice

This practice in Wigan introduced a single point of access – ‘Ask My GP’ – with all patients required to contact the practice this way. For those that are unable to use the online consultation system, patients can ring the practice for support, and a member of the administrative team completes the online form on their behalf.

Appointments are allocated equally to each GP partner who triage the referrals and book an appointment with the relevant practitioner – this could be a GP partner, trainee or with another service such as social prescribing or pharmacy.

The practice guarantees that all patients will have contact from the practice on the same day and/ or see a doctor for all routine and urgent requests, with an average turnaround time of 37 minutes from the point of patient contact to receiving a message from the practice.

Patients with multiple health issues have time to discuss their health needs without being limited to a ten-minute appointment. The new system has allowed for more flexibility, with partners able to stagger start and finish times to suit their needs and spend more time on staff development, with learner tutorials taking place every Friday. They won Employer of the Year at the 2023 Greater Manchester Health and Champions Awards for their commitment to staff wellbeing and career development.

Pharmacies save over 63, 000 GP appointments

The Community Pharmacy Consultation Service (CPCS) connects patients who have a minor illness or need an urgent supply of a medicine with a community pharmacy. It aims to lift some pressure off the wider NHS by delivering a fast, convenient, and effective service.

Initially, this launched taking referrals to community pharmacy from NHS 111, with referrals from General Practice being added in November 2020. The national GP Community Pharmacy Consultation Service allows GPs to refer patients to a same day appointment (face-to-face or remote) with their community pharmacist for help or advice with minor illnesses.

The service is helping to make sure people are provided with the right care, by the right person at a time most convenient to them. This helps increase capacity within general practice for the treatment of patients with more serious health problems.

To date, community pharmacies in Greater Manchester have successfully delivered 63,125 patient appointments helping to remove some pressure from General Practice, with the numbers increasing monthly.

Over 97% of all pharmacies and GPs in Greater Manchester are on board delivering this vital service.

How a new shared urgent appointment system is reducing demand in Salford

Eccles and Irlam PCN in Salford introduced a new referral system to provide urgent same day appointments across the PCN. This has increased the number of routine appointments available, reducing pressure on individual practices and improving staff morale.

Like many practices, demand has increased over the last few years due to a combination of factors including the Covid-19 pandemic, rising mental health issues, waiting times for secondary care, population growth and workforce pressures.

In 2021, the PCN, supported by Salford Primary Care Together CIC, used money from the Winter Access Fund to develop a trial urgent appointment system, run through the patient booking system, ‘EMIS’, which they called Additional Care Today (ACT). The system was used in all seven GP practices across the PCN to provide urgent same day appointments. Due to its success, the system has now been implemented on a permanent basis.

If a patient requiring an urgent appointment is unable to be seen on the same day at their own GP practice, trained reception staff can access the ACT system to book an appointment at another practice within the PCN. Staff run through a few clinical questions generated by the ACT system to check if a same day appointment is necessary.

Depending on demand in the system, the service can offer anywhere between 33 and 99 additional appointments a day. Patients who otherwise may have called 111, or presented at A&E, are now being seen by a GP on the same day.

Integrated working in neighbourhoods

Working in partnership locally to reduce inequalities

The city of Manchester is the most ethnically diverse area of Greater Manchester, so making sure everyone across has equal access to healthcare services and addressing inequalities is a key priority.

The city’s Covid-19 vaccination programme gave an opportunity to work closer than ever before at a neighbourhood level to meet local needs. Engaging partners across voluntary and community organisations helped identify any barriers to delivering care. Working with representatives from specific communities and inclusion health groups as ‘sounding boards’ for direction and advice, and as trusted ‘messengers’ within communities demonstrably closed the gap in vaccination coverage across communities. This approach was evaluated by the University of Manchester.

Manchester has built on this integrated approach, working with local neighbourhood teams, GP practices, community pharmacies, public health, and voluntary organisations to deliver more than more than 2,000 winter vaccines during autumn/ winter 2022/3 in 84 pop-up vaccination clinics. Clinics were based in markets, mosques, community centres, asylum accommodation, sex worker health clinics, supermarket car parks, student centres and warm hubs.

Community volunteers, social media messaging and text messages from GPs brought people through the door with 42% being ‘opportunistic’, and 30% of these saying they would not have had the vaccine had it not been there.

Working together in this way drove forward integration and Manchester is now using this experience to replicate a range of primary care services with a focus on reducing inequalities.

The importance of community organisations for health: VCSE and PCN partnership improving local links

Since January 2023, the Sale Central Primary Care Network (PCN) has worked with local voluntary, community, and social enterprise (VCSE) organisations to run regular drop-in sessions with a community health advisor.

Some people face specific barriers when accessing traditional services and feel unsure what services are available to them and what time and where.

The drop-in sessions for people living locally help tackle health inequalities by offering an alternative way for people to get help and support on health concerns.

The more informal setting removes some of these barriers and help residents feel more comfortable sharing any health issues they have, as well as specific concerns around smoking, weight management and diabetes. People are also supported to book cancer screening and vaccination appointments.

In one instance, an individual attended an appointment to get a blood pressure check but after speaking with the community health advisor, was given help to book vaccinations, and connected to Age UK Trafford who provided advice and support to help them as a primary carer for their spouse.

Working in partnership helps people get the advice needed to improve their health and wellbeing and be linked to services that can support further including cost-of-living advice, help as a carer, befriending and befriending services to combat loneliness.

Partnering with local VCSE organisations to deliver these sessions has helped community health advisors broaden their knowledge of the community services available in the area and build long-term relationships.

Health inequalities

A new way to deliver trans healthcare

Indigo Gender Service, an NHS adult gender service first launched in 2020, as a partnership between gtd healthcare, a not-for-profit organisation with an established presence of primary care and urgent care services in the north-west and the LGBT Foundation, a national charity delivering services, advice and information for lesbian, gay, bisexual, and trans communities.

Indigo Gender Service is N S England’s adult trans healthcare pilot service for Greater Manchester, helping trans and non-binary people to thrive by moving trans health care into a primary care setting.

A team of care navigators with lived experience works with people who access services to help them to get the most out of the service and enable them to connect with local organisations across Greater Manchester.

The Indigo Gender Service includes an all-round assessment of an individual’s needs. It offers referrals and signposting to other services, as well as access to in-house counselling, and voice and communication therapy. Within its non-clinical team, the service has trans and non-binary staff at every level of the service. In addition, unique to Indigo, all the care navigator team identify as trans or non-binary, meaning they can offer a truly ‘by and for’ service.

The key to the success of the service has been the close partnership formed between gtd healthcare and LGBT Foundation. The service also has an ongoing process of coproduction that combines clinical expertise with community understanding. This includes its service user group who meet regularly to feedback and ensure the service is continuously improving.

Working with Mind to increase uptake of Severe Mental Illness checks

TABA PCN (Tyldesley, Astley, Boothstown and Atherton) which has eleven practices in its network has introduced several initiatives to tackle health inequalities, one of which was with the charity, Mind, to increase uptake of Severe Mental Illness (SMI) health checks. Staff from Mind spent two to three weeks in each practice contacting patients on the SMI health check register to discuss general health concerns, whilst encouraging them to come forward for an SMI health check.

Patients were much more open to discussing their health with volunteers and staff from Manchester Mind who used a more holistic approach to tackle problems affecting people, from housing issues to money worries as well as physical and mental health concerns. This led to further discussions about the benefits of SMI health checks resulting in an increase in the uptake of health checks across the PCN.

The project with Mind also coincided with the purchase of two new point-of-care (POC) blood test machines which rotate around practices in the PCN. The blood test machines provided two types of blood tests – hemoglobin A1c (HbA1c) and lipid testing – both important elements of a health check. Historically, the PCN found it difficult to get patients to have these blood tests as they were only done at Leigh Infirmary which for many patients felt difficult to access, often resulting in no-shows and this part of the SMI health check being incomplete.

Prevention

Community connections: taking health and wellbeing support on the road

The health and wellbeing team for Denton, Audenshaw and Droysden (DAD) Primary Care Network (PCN) is taking their care into the community to encourage people to look after their own health and embrace self-care.

Over the last two years, the team has grown from one to eight care coordinators, first introduced to help run the Covid-19 vaccination programme, but now supporting lots of health promotion activities, including hypertension (high blood pressure) workshops in the community.

The coordinators have a rolling diary of 15+ groups they attend such as coffee mornings, luncheon clubs and playgroups. Through GP records, they identify who’s had a high blood pressure recorded and do a free follow-up check. If it’s still high, people are given advice, a monitor, and a diary, along with a follow-up appointment. Those who are not registered with a local GP practice are offered support and advice on how to lower and prevent heart disease and other related problems.

The coordinators also attend weekly sessions at the Tameside Wellness Centre and Matlock Sports Centre where they partner with sports coaches who offer patients free gym sessions, whilst the DAD team give health and wellbeing coaching to support individual needs and goals towards a healthier lifestyle.

The next step is to build on this success and introduce a cancer care coordinator to join the health and wellbeing team at their community groups to promote screening awareness, increase attendance and signpost to local cancer support services.

Tackling high blood pressure through community champions

Big Life’s Living Well service designed the ‘Community Champions’ project in Rochdale to deliver blood pressures checks at local events and raise awareness of cardiovascular disease. They wanted more people to be alert to the dangers of high blood pressure and know where they can go to measure it, such as a pharmacy or GP. Heart attacks and strokes can be associated with high blood pressure, with many people not realising their blood pressure is high.

Between February and August 2023, 1480 blood pressure checks have been carried out with over 29% of people (430) found to have a high blood pressure. 418 people received a follow up call, of those who answered (260), 89% of people accessed support from their GP, which for some included home monitors or medication. Others received urgent or hospital care. Following a successful rollout, Living Well have created two new roles for community workers from South Asian communities to increase attendance at GPs for cholesterol checks. On street engagement has taken place to identify any barriers to attendance and improve uptake.

Sustainability

Greater Manchester Dental Quality Scheme improving access to dentistry

A new dental quality scheme was introduced in June 2023 with the aim of improving patients’ experience of access to dentistry. It’s the only quality scheme of its kind run by an integrated care system in the country. It was set up in response to lots of feedback from people that are finding it difficult to see an NHS dentist locally, whether they are in pain or not.

Around 22,000 new patients have been able to access NHS dental practices since the launch of the scheme, with 175 dental practices now signed up.

Practices signed up to the scheme are expected to:

  • Be open to new patients and ensure their details on the NHS website (www.nhs.uk) reflects this, showing that they are accepting new adult and child patients
  • See and treat an agreed number of new patients
  • Be part of the wider urgent dental care system, which provides treatment for dental problems that cannot wait, when dental practices are closed or for those who do not have a regular dentist

Reducing the carbon footprint of inhaler prescribing

Metered dose inhalers (MDIs) are the most common type of inhaler used in the UK, commonly used to treat asthma, COPD, and other respiratory conditions. When patients press the metal canister of the MDI into its plastic case, a gas is released that helps get the medicine to patients’ lungs. When this gas is released, it stays in the atmosphere trapping the sun’s heat, like glass in a greenhouse. This warms the planet which is a problem for the climate. Climate change also increases air pollution which can worsen lung conditions.

There is growing awareness and concern from health care professionals and patients alike about the impact of MDI inhalers on our environment. With over 300, 000 inhalers prescribed each month in Greater Manchester, with the equivalent climate impact of 28,000 cars; GP practices, pharmacies, hospitals, and patients have started making a difference through working together towards greener inhaler choices.

For many people, this can involve a switch to a dry power inhaler, or a combination inhaler. For all patients, it is ensuring they have the most appropriate treatment to get the best control of their illness; and when their inhalers are empty, returning to their pharmacy for proper disposal. So far, this has resulted the equivalent of 3,000 cars being taken off the road in Greater Manchester. People should only make changes once they have spoken to health care professional and should continue to take inhalers as prescribed until then.

Pencycle Recycling Initiative

Greater Manchester local pharmaceutical committee (GMLPC) and Novo Nordisk identified a need for community pharmacies to engage with initiatives to reduce the sector’s carbon footprint, in line with the Greener NHS agenda. Novo Nordisk, who make pens for diabetes and weight management treatments, approached GMLPC to work on and help launch PenCycle, a first-of-its-kind recycling initiative for insulin pens, with the aim of reducing landfill plastic waste. The scheme has led to greater awareness of the environmental impact of disposable pens and provides an easy way for patients to reduce their carbon footprint. PenCycle has enabled partnership working across the healthcare sector and has established community pharmacy as a key partner to contribute to a Greener NHS.

228 community pharmacies in Greater Manchester, almost 40% of all pharmacies have joined the scheme to reduce plastic waste in the healthcare sector. As pens cannot be thrown into the plastic recycling along with common household products, most pens end up in landfill, with a small number burnt in a process called incineration. Landfill uses a lot of space and is unsustainable, while incineration uses a lot of energy and leaves some plastic waste behind.

People with diabetes, obesity and other conditions are asked to return their empty pens in a dedicated PenCycle return box to pharmacies so they can be recycled and given new purpose. Pharmacies arrange for these to be collected when they have a full box. Over 20, 000 pens have so far been returned locally with plastic from these pens being reused in furniture and lightbulbs.

New Jackson Medical Centre opens to community with green credentials

New Jackson Medical Centre, located across the ground and first floors at Elizabeth Tower on Chester Road, houses new additional practice sites for Cornbrook Medical Centre, Vallance Centre in Ardwick and the Docs, in Bloom Street. It is the first GP medical centre to open in Manchester city centre since the City Health Centre in the Arndale shopping centre in 2009.

Funded with the help of a £2.6m grant from Manchester City Council and £1m from NHS England, and having taken four years to complete, it houses 16 clinical rooms and will eventually be able to serve more than 20,000 patients.

With a school and park also being built in the vicinity, the medical centre will be able to cater for an influx of new and existing residents in and around Manchester city. It will also free up capacity in Cornbrook, Vallance and the Docs, and offer more appointments.

A wide range of community health services will also feature, along with ultrasound and dermatology services. Thanks to the NHS Additional Roles Reimbursement Scheme (ARRS), GPs will be able to call on care coordinators, pharmacists, social prescribing link workers and physiotherapists in the new building.

The building’s green credentials are consistent with N S Greater Manchester Integrated Care’s commitment to achieve a net zero carbon footprint by 2038. It expects to achieve a ‘BREEAM’ environmental rating of ‘excellent’ with its focus on waste management, energy efficiency, transport (proximity to Metrolink stops) and pollution reduction. The creation of the new Jackson Street neighbourhood by Renaker also supports Manchester City Council’s wider ambition of continued population growth within the city and the demand for quality and low-carbon homes, close to transport hubs and new local services.

Digital

Transforming care through digital eye care referrals

A new referral process across eyecare services in Greater Manchester is improving patients’ care experience by making it easier for all referrers to send directly to the right service first time round.

Optometrists can now refer patients directly to hospital for treatment rather than asking the GP to make a referral. This saves time between referral and appointment, reduces the risk of lost referrals and is more efficient.

With over 55, 000 referrals made via the Electronic Eyecare Referral Service (EERS) over 2022 to 2023, and 99% of Greater Manchester practices signed up, the benefits have been felt by patients and professionals alike.

Ophthalmologists (eye-care consultants) can access the results of eye-care imaging tests, when available, at the point the referral is received. This means patients may not need to visit the hospital for a physical assessment.

Patients receive better care, as the service allows optometrists to share more information and high-quality images with the hospital to inform a patient’s treatment.

GPs are still informed when a referral is made, and their time is better used for more appropriate appointments. The project is continuously evaluated for key learning areas, staff training and potential expansion into other areas.

Beating the 8am rush at Cheadle Medical Practice

Recognising the long call waits on a Monday morning, and patient frustration when appointments quickly ran out due to capacity, one practice has opted for total digital triage and is seeing improvements to satisfaction all round and a drop in phone calls, approx. 10% so far.

Every patient contacting the practice first provides information on their symptoms in a short questionnaire, so care can be provided by the right healthcare professional with the right level of urgency.

No one is excluded as the highly trained reception team support those unable to use the internet to complete the questionnaires, which identify red flags to help the GP make the most appropriate decision.

With over 60 custom questionnaires covering common symptoms, these keep practice productivity high by helping the GP identify any red flags early in the process, empowering them to make better decisions. A service directory embedded into the practice clinical system complements this with receptionists able to suggest appropriate referrals such as a community pharmacist. These referrals have increased from 8 to 19 per week, freeing up appointments for those in need.

One GP each day triages the incoming requests, freeing others to do routine appointments which there is now space for. The practice now sees 96% of patients within two weeks, up from 82% beforehand. Patient feedback has improved with numerous positive reviews and ‘Friends and Family’ responses. The practice is keen to help other practices going through the same journey and involve patients in its next steps through reviewing what’s worked well and room for growth.

Widening access to patient information from the GM Care Record for Community Pharmacists

Health Innovation Manchester is developing a project to provide community pharmacists access to a patient’s full medical record to improve the quality and safety of prescribing in the community.

Community pharmacies currently access patient information through a system called the National Care Record (NCR). The NCR is an electronic record that contains limited information about a patient’s health.

This pro ect aims to provide community pharmacists’ access to a patients’ full health and care record through the GM Care Record. This will provide the following benefits:

  • Improved patient care – community pharmacists can make more informed decisions about the medications they prescribe when they have access to a patient’s full care record.
  • Increased patient satisfaction – most patients expect healthcare professionals to have access to their data and feel more confident in the care they are receiving when they do.
  • Improved medication safety – community pharmacists can use a patient’s care record to identity any potential adverse reactions between existing medication and new medication.
  • Increased efficiency – access to a patient’s care record will help community pharmacists dispense medications more quickly and accurately – in some instances without having to wait for responses from the GP, alleviating the pressures on both pharmacists and practices.
  • Increased communication – community pharmacists can communicate more effectively with other members of the health and care teams when they have access to a patient’s full care record. This helps improve the overall coordination of care a patient receives.

Estates

There are currently no specific estate case studies, although many of the case studies in the other chapters provide some cross-over and examples of innovations around estate issues.

Quality, improvement and innovation

Preparing General Practice for CQC inspection

Between March 2020 and April 2021, the Care Quality Commission (CQC) suspended all routine inspections so healthcare providers could prioritise the increased demand from the pandemic.

When inspections resumed, GP practices having focussed all their resources on managing the impact of the pandemic and stepping up a new vaccination programme, felt vulnerable with regulatory inspection, as their evidence had not been fully maintained. The inspection

process had also changed considerably, including virtual meetings, with evidence shared online. Practices were therefore keen for support to prepare for their next inspection.

The GP Excellence Programme, a partnership between the Royal College of GPs and NHS Greater Manchester to help practices improve and also meet CQC requirements, ran a series of webinars to reach as many practices as possible, with expert advisers covering the main requirements of inspection. The package also included a detailed evidence plan template as a resource for practices to work through, using a traffic light (red-amber-green – RAG) rating against the essential criteria of the CQC’s five key questions. The questions, also known as Key Lines of Enquiry, help inspectors answer if services are safe, effective, caring, responsive and well-led.

More than 330 people joined the webinars. Out of thee 27% who completed an evaluation, 95% stated they found the webinar very useful; and 80 out of 93 respondents reported that their confidence levels had improved.

Since then, the GP Excellence team identified several common themes from CQC inspections where Greater Manchester practices were struggling to demonstrate the required standard. This led to another bespoke webinar series focusing on these themes including medicines management, general policies and procedures, and complaints. The GP Excellence team’s next step is to explore the possibility of providing similar training webinars to dental practices, who are also subject to CQC inspections.

Practice alert system helping manage pressures in primary care

The Primary Care SitRep was first introduced in response to the Covid-19 pandemic for all practices to centrally report their levels of pressure – initially this was on capacity, workforce and PPE supplies – and help identify where support and resources were needed.

As the NHS moved out of pandemic response, back to a changed new normal, the SitRep evolved to produce a Greater Manchester Operational Pressures Escalation Levels (OPEL) score, producing a weekly report to the Primary Care System Board for each of the four primary care disciplines showing where the pressures were and the local area.

In 2022/23, the SitRep process was reviewed, working with primary care colleagues to improve the design and presentation that made it more relevant and meaningful. Significant engagement was undertaken to coordinate a single approach across primary care. A series of workshops were delivered to support those working directly with primary care providers to access and interpret the data; and provide a consistent, supportive response where needed using a clear escalation framework. By taking a collaborative approach, the SitRep is now more user-friendly with a clearer purpose. The data produced by the SitRep allows proactive planning and helps predict where the pressures in the system will be, which leads to a response by the appropriate teams to manage those pressures.

Workforce

More support for international GPs to stay in practice

Attracting and retaining doctors to work in general practice in Greater Manchester is a key priority for the primary care workforce programme.

Under the current system, international doctors are sponsored by NHS England, formerly Health Education England, during their training, and must wait five years to apply for the right to remain in the UK for five years. Once qualified, a doctor needs to find a GP practice who holds the relevant licence. This was previously a challenge with only four practices in Greater Manchester holding a licence and over a third of locally qualifying GPs being international doctors.

The primary care workforce team introduced a scheme that supports international doctors and GP practices to navigate the application process, access the right legal advice via a helpline, and even cover the cost of the licences. Now, over 90 GP practices hold a licence which has enabled many of our international trainees to stay in Greater Manchester since 2019. Through professional word-of-mouth, it has also helped with attracting other international doctors to work in the area.

How Middleton Primary Care Network increased access by opening a health hub in a shopping centre

The Additional Roles Reimbursement Scheme (ARRS) gives PCNs the ability to create bespoke multi-disciplinary teams through national funding. 17 different roles can be claimed for to meet the needs of local communities making it easier for people to access a wider range of help.

Middleton PCN consists of seven GP practices serving a population of around 46,600. It recently recruited 38 ARRS staff to provide more services across the PCN such as physiotherapy, social prescribing, mental health support, phlebotomy and pharmacy but didn’t have space to house new colleagues.

The idea to rent a space in the local shopping centre was developed by PCN Clinical Director, Dr Mo Jiva. Once approved, monies were pooled together by the PCN, Rochdale Health Alliance, and Public Health to rent a unit based in Middleton shopping centre.

With six consultation rooms, a daily footfall of approximately 50,000, free parking and proximity to the local bus station, the hub is an ideal location to create a centre from which routine appointments can be offered to patients from all seven GP practices. It also provides an opportunity to promote public health campaigns and signpost residents to other services.

Routine appointments for blood tests, physiotherapy and pharmacy are available daily at the hub. This has resulted in reduced waiting times across the PCN and freed up approximately 100 GP appointments per week.

Significantly, the hub provides a space for staff across disciplines to work together to support patients and have important health conversations with people who may have otherwise been missed by their GP.

There are further plans to use the space to promote wider public health initiatives such as HIV testing and stop smoking services. Over 1600 staff have now been recruited into new roles in Greater Manchester as part of the Additional Roles Reimbursement Scheme and they have already made a significant impact in general practice and in the community delivering care to patients.

Budget class cooks recipe to beat loneliness

A slow cooker course in Westhoughton, Bolton has been a huge success after it helped people eat healthily for less and provided much needed social interaction for residents who felt lonely over the winter months.

The course was organised by social prescribing link workers at Bolton GP Federation, in association with Westhoughton Assist, which runs a local community food shop. The sessions were designed to promote health and wellbeing, and a sense of togetherness to combat social isolation and improve people’s mental wellbeing. Cooking simple, tasty meals that can be recreated at home challenged misconceptions that healthy eating had to be expensive.

GPs and other professionals can refer patients to link workers, who in turn can connect people to a variety of community groups and activities for practical, social, and emotional support. This helps to address wider determinants of poor health such as stress and loneliness, something the team at Westhoughton see first-hand.

With an emphasis on healthy eating and cooking on a budget, people felt the course developed their confidence and helped with their mental health. With steep energy costs, a slow cooker is cost effective too as it uses less energy. The course helped with cooking skills and tips. On completion, participants came away with a file of recipes and ideas for easy meals to make at home, plus their own slow cooker. Eating regularly and having at least one hot meal a day can help people to keep warm and stay well during the winter. The group has continued to meet socially even after the course finished, to share new recipes and friendship.

Boost for practice nurses in Oldham

In September 2020, in response to a shortage of practice nurses in Oldham, the then NHS Oldham Clinical Commissioning Group, recruited five nurses to participate in a pilot that saw nurses take up six-month placements at five Oldham practices. The scheme aimed to reduce the barriers for nurses entering general practice and provide a structured education programme to develop the skills needed to work as a practice nurse.

The pilot was successful, and a decision was made to run a second wave in September 2022. Incorporating lessons learned, a further six qualified nurses were recruited, who were placed in Oldham practices that hoped to employ a practice nurse. The programme was based on a simple premise that the nurses would take up a fixed-term placement in GP practices and learn core skills from experienced staff across the borough. The locality funded a proportion of the nurses’ salaries at AfC Band 5, as well as supporting training where required.

The nurses were employed full-time and spent four days per week in practice, with one day of formal training or self-study. At the end of the placement period, the intention was for nurses to complete their existing employment arrangement, and take up permanent roles, preferably at the practice where they were initially based. The second wave of the programme has been very successful, and all nurses are still employed within Oldham practices, with five on permanent contracts and the sixth due to finish an extended placement in the autumn. It is hoped to run a third wave of the programme in late 2023.