Since becoming a provider collaborative in 2015, we have instigated significant transformation, leading to better health and wellbeing for communities. Some of our proudest achievements to date are outlined below. These proven successes demonstrate our ability and commitment to achieving the Greater Manchester health and care ambitions and making a positive difference to people’s lives.
Child friendly dental services
Following a successful pilot, we have seven practices delivering child friendly dental services across Greater Manchester. The service aims for children and young people to be seen and treated in primary care by dental teams with enhanced skills. It also provides recognition for dental practices which strive to improve oral health among children and young people in Greater Manchester by facilitating attendance at dental practices and improving preventive care.
Collaborative networking with PCNs
The Primary Care Provider Board has supported engagement with general practice and other disciplines to enable collaborative working during the Covid-19 pandemic and beyond. This included rapid access to PCR testing, access to PPE and access to vaccinations for staff. In addition, collaborative working with PCNs helped improve uptake of the flu and Covid-19 vaccination programmes.
A total of 74 pharmacy sites were stood up to deliver the 2021/22 Covid-19 vaccination programme. More than 400 pharmacies also delivered the flu vaccination service in Greater Manchester. Community pharmacy teams delivered almost 4.8 million flu vaccinations nationally under the NHS Flu Vaccination Service in 2021/22 – 73 per cent more than the 2.8 million vaccines administered the previous season.
All PCNs and GP practices across Greater Manchester have access to shared live data through Tableau. This enables them to track progress against metrics included in the national Investment and Impact Fund, which supports PCNs to deliver high quality care to their population and to deliver the priority objectives in the NHS Long Term Plan and in Investment and Evolution: A five-year framework for GP contract reform.
In addition, dashboards enable PCNs and practices to understand their populations, including disease prevalence and deprivation; and will also enable identification of patients who may benefit from anticipatory care.
To support tackling health inequalities, we have provided each PCN with health inequality reports for their local populations.
Discharge Medicines Service
To improve medicines safety and reduction of severe avoidable harm after discharge from secondary care, this service began implementation across Greater Manchester in 2020. A total of 15 trusts are now live and sending referrals to community pharmacy in Greater Manchester.
A recent audit of NHS hospital discharges showed that 79 per cent of patients were prescribed at least one new medication after being discharged from hospital. New prescriptions can sometimes cause side effects, interact with existing treatments, potentially leading to readmission. Research by the National Institute for Health Research shows that people over 65 are less likely to be readmitted to hospital if they are given help with their medication after discharge. Research on local schemes implemented around the country has also demonstrated that patients who see their community pharmacist after they have been in hospital are less likely to be readmitted and will experience a shorter stay if they are.
Electronic ophthalmology referrals
Greater Manchester has led the way in implementing direct electronic referrals for ophthalmology from optometry practices. Early iterations of this were embedded during the last few years, with substantial scaling up in January 2021. The project, initiated by the Greater Manchester Local Eye Health Network, in partnership with the Optometry Provider Board and Greater Manchester Confederation of Local Optical Committees, now has more than 80 per cent of practices engaged. In 2021, 48,316 referrals were sent electronically directly to hospitals using the dedicated Opera platform.
Referrals are sent directly to where required, for example hospital eye services, reducing the admin burden on general practice in forwarding referrals, while ensuring notifications are sent to GPs for information. Technology enables optometry practices to share photographs and Optical Coherence Tomography scans with referrals to support triage and diagnosis in secondary care. Technology has also enabled feedback from some hospital eye services using mechanisms integrated into the Opera platform.
Greater Manchester’s development of this innovation alongside Opera developers RMS has supported the use of the platform to support the Electronic Eyecare Referral System (EeRS) programme across the North West and in other areas of England. Data from the IT solution will be used as part of the emerging Optometry Excellence programme to further support quality improvement of referrals and development of education and training requirements for optometry clinicians.
Environmentally friendly inhaler webinars
As part of our ‘delivering excellence’ narrative, we actively encourage general practices across Greater Manchester to attain accreditation and strive to achieve excellence. An aspect of this involves regularly working with colleagues from the Greater Manchester Primary Care Sustainability Group to promote and encourage sustainability in general practice. This multidisciplinary group is working on developing and delivering on primary care sustainability in Greater Manchester.
GP Excellence contributed by coordinating webinars on maintenance and reliever therapy (MART) in partnership with the NHS Greater Manchester Integrated Care Clinical Lead for Sustainability in Primary Care and an experienced Greater Manchester Respiratory Pharmacist. The webinars focused on how MART can support the move to more environmentally friendly inhalers, minimising the carbon footprint. A community pharmacy specific webinar was also held around the role of community pharmacy in supporting patients with more environmentally friendly inhaler devices. The webinars attracted more than 250 Greater Manchester GPs, practice nurses and pharmacists and positive feedback was received about how useful the content was.
Eyecare for people with learning disabilities
Greater Manchester established a pathway for patients with learning disability to access Easy Eye Care in 2016. This sees supplementary funding used to enable patients with learning disabilities to access eyecare from optometry practices, using the national pathway developed in partnership with SeeAbility.
Adults and children with learning disabilities are much more likely to have problems with their vision than the general population. However, they are less likely to recognise they have a sight problem and tell others about it. The Learning Disability Eye Test is designed to make it easier for people with additional needs to access the help they need.
This service is commissioned across all 10 Greater Manchester places through the optometry lead provider organisation – Primary Eyecare Services – and is delivered across 54 optometry practices. The service supported more than 400 people in the first five years, a significant proportion of whom had never had an eye examination.
The service recognises that children and adults with learning disabilities may need adjustments to make having an eye test more comfortable and successful. These include:
- The option to visit the optical practice before the test to become familiar with the surroundings and equipment used in the test.
- Longer appointments or a series of shorter appointments so there is no time pressure.
- A trained optometrist who is experienced in testing and talking with people with additional needs.
- Easy-read forms to complete, telling the optician about any eye problems.
- An easy-read report explaining the results of the eye test.
The service is soon to be enhanced with a new single point of access to support people with learning disabilities, and also their carers, to gain easier access to this service.
GP Community Pharmacy Consultation Service enablement
The GP Community Pharmacy Consultation Service (GP CPCS) working group has worked with the Primary Care Provider Board and PCNs to enable implementation of the integrated IT referral pathway for the nationally advanced commissioned service. This service enables general practice to refer minor illness to community pharmacy to increase capacity and improve more effective use of the skills within community pharmacy.
This service is now live in more than 95 per cent of GP practices and community pharmacies across Greater Manchester. The GP CPCS working group has engaged and trained more than 400 practices during 2021/22. To date, more than 15,000 referrals have been successfully completed across Greater Manchester. It is estimated that six per cent of GP appointments could be addressed by community pharmacy through this pathway.
Greater Manchester Access Plus Scheme
In recognition of the ongoing challenges we face across NHS dental services, including increased demand for dental care, we have developed the Greater Manchester Access Plus Scheme. This scheme aims to improve access and continue dental care for those who have received urgent care but who require further care and treatment within an NHS dental practice.
Improved CQC ratings for special measures GP practices
Through our established GP Excellence programme, the Royal College of General Practice has supported more than 30 practices which were placed in special measures after receiving a rating of ‘inadequate’ by the Care Quality Commission.
CCGs have used this service to help practices in the greatest need and it has been a great success, with all the practices supported by the RCGP’s advisors improving their rating upon re-inspection.
This is a peer-to-peer service which sends a team of advisers, drawn from both clinical and practice management backgrounds, to provide hands-on support directly to the practice. The approach is methodical and targeted, focusing on the areas of greatest need first and providing a plan for maintaining and continuing improvements.
In response to practice concerns about CQC inspections post-Covid, GP Excellence facilitated a series of ‘Maintain your Rating’ webinars. They aimed to improve GP practice staff’s understanding of and confidence surrounding CQC inspections and patient access, ensuring they feel as prepared as possible when they receive their inspection notification.
Across the 10 localities, 338 people attended the webinars with 95 per cent of participants reporting they found them very helpful and informative and that their confidence levels had increased regarding the requirements of CQC inspections.
Looked After Children dental pathway
To ensure vulnerable Looked After Children can access NHS dentistry, we have developed the Looked After Children Pathway. This pathway was launched in May 2021 and allows non-dental professionals to refer Looked After Children who are struggling to find an NHS dentist through the normal routes to one of our Looked After Children dental practices using an online referral form. The children are seen, treated and offered a dental home at the Looked After Children practice closest to where they live.
The PCB was the first in the country to collaborate in neighbourhood footprints which led to the development of PCN DES contracts in 2016/17. Even before PCNs were established, this methodology for neighbourhood working in small population groups (30-50 thousand population) was being tested and found to reflect real opportunities for local communities, to bring primary care together, working alongside community services and local businesses.
NHS 111 Community Pharmacy Consultation Service
Community pharmacy has been successfully delivering the NHS 111 Community Pharmacy Consultation Service (CPCS) since 2019. The service connects patients who have a minor illness or need an urgent supply of a medicine with a community pharmacy. The CPCS aims to relieve pressure on the wider NHS by connecting patients with community pharmacy, which should be the first port of call and can deliver a swift, convenient and effective service to meet people’s needs.
Since the CPCS was launched, an average of 10,500 patients a week are referred for a consultation with a pharmacist following a call to NHS 111; these are people who might otherwise have gone to see a GP. The CPCS provides the opportunity for community pharmacy to play a bigger role than ever within the urgent care system. The pathway has since been extended to include general practice and urgent care.
Optometry workforce development
Workforce development programmes have supported 116 optometry clinicians to gain additional qualifications, such as independent prescribing and higher glaucoma qualifications.
The project was initiated by the Greater Manchester Local Eye Health Network, in partnership with the Optometry Provider Board and Greater Manchester Confederation of Local Optical Committees. Greater Manchester funding was used to support clinicians to gain qualifications in partnership with the University of Manchester, then use these skills as part of the Greater Manchester Covid-19 Urgent Eyecare Service and glaucoma enhanced case-finding services – since identified as key services to support elective recovery for ophthalmology.
There are many examples of exemplary work which are now established, currently being worked on or in the pipeline where there is ambition to work across providers at neighbourhood, place and Greater Manchester level. The PCB leads some of this work and also works in collaboration as a strategic and operational partner in workstreams such as: community diagnostic hubs; establishing urgent optometry services; recovery of endoscopy services; establishing pathways for urgent care; and multiple elective services, for example, dermatology, gynaecology, post Covid recovery and sustainability, including managing changes in death certification, ensuring primary care colleagues have input in proposed changes to business as usual to ensure rollout and changes are established quickly and with minimum challenge.
PCN cancer leads
PCNs are working alongside the Greater Manchester Cancer Alliance to support the target for 75 per cent of people with cancer to be diagnosed at an early stage by 2028.
This sees PCNs and their practices embedded in design of the Greater Manchester programme of early diagnosis work; shaping and leading local training and improvement work; and accessing standardised referral forms and clinical expertise. They also have access to funding to support PCN-level projects which will contribute to improvements in referral pathways.
To date, this work has delivered improvements in the use of faecal immunochemical tests in primary care; engaged PCNs in clinical cancer webinars; improved practice engagement in cancer screening programmes; provided PCNs with information in a range of formats and languages, enabling patient-facing information to be shared through practice websites. This work also provides a direct line of communication between PCNs and the Greater Manchester Cancer Alliance Early Diagnosis Team.
Primary Care Excellence
GP Excellence and its partnership with the Royal College of GPs has been a shining beacon of success for the PCB during the last five years, being a growing platform supporting practices and individuals, and a conduit for primary care research. This model is now expanding to the other primary care disciplines, and we are currently understanding the needs of optometry, dental and community pharmacy. This work ranges from direct support at practice level, to running training programmes and support networks. An example is the current training programme for practice nurses on personalised care, supporting improved communication with patients accessing structured education for diabetes
Professional development and networking for practice managers
Two GP Excellence facilitated conferences have provided practice managers with valuable opportunities for networking, sharing good practice and collective problem solving. They also supported personal and team resilience and wellbeing. A further conference is being planned for early 2023 in collaboration with workforce and health and wellbeing colleagues.
In partnership with the Institute of General Practice Management (IGPM), GP Excellence is supporting 50 practice managers to go through the first nationally recognised accreditation process in the country. Practice managers working towards accreditation are also being offered the opportunity to attend a series of action learning sets/peer support networking sessions covering the 10 domains within the framework. These are being delivered by IGPM regional leads and members of the GP Excellence Team.
In addition, 50 practice managers and PCN business managers have completed a Level 7 Diploma in Primary Care Development, offered in collaboration with the National Association of Primary Care. The course aims to develop learners’ skills, knowledge and ability to manage primary care at scale. Modules covered healthcare business and finance, NHS policy, law and governance and personal effectiveness and leadership.
More than 100 practice managers have completed Institute of Leadership and Management Level 3 and 5, offered in collaboration with PMA and Skills for Health. Bespoke offers to individual practices and PCNs following self-referral to the programme have included team building, coaching and mentoring, and quality improvement tools and techniques.
Urgent dental care
In April 2020, all dental practices were told they must close due to the pandemic. To ensure anyone who needed urgent treatment could access the care they needed we set up Urgent Dental Care (UDC) hubs across Greater Manchester. We also invested additional funding to increase telephone capacity and commissioned additional slots from our Greater Manchester Urgent Dental Service clinical providers to help them deal with the increased demand following the pandemic. This service continues beyond the pandemic, with 42 UDC hubs delivering additional appointments for the Greater Manchester Urgent Dental Service.
Urgent dental service for Afghan evacuees and asylum seekers
Launched in October 2021, this service is for Afghan evacuees in bridging hotels and asylum seekers in contingency hotels across Greater Manchester. Non-dental professionals can refer into this service using an online referral form. Patients are then directed to the closest practice providing this service to receive urgent treatment.
Urgent optometry service
The Greater Manchester Urgent Eyecare Service (CUES) launched during Covid-19 introduced an optometry first approach for eyecare problems. This helped keep patients out of general practice, A&E and hospital eye services, where possible, by managing in primary care optometry practices.
In 2021/22, this saw 38,699 patients seen within the service across the 10 Greater Manchester places, with 81 per cent of these wholly managed within the service.
This service is commissioned across all 10 places through the optometry lead provider organisation – Primary Eyecare Services – and is delivered across 211 optometry practices.
Patients access the service by telephone or video call, followed by face-to-face assessment where required. Practices work as a network, using inter-practice referrals to maximise capacity.
Practices use diagnostic testing to support investigation and diagnosis where required, with the ability to share images with hospital eye services where onward referrals are required. In addition, independent prescriber optometrists have been used for the first time in Greater Manchester to support more complex cases, further enabling care close to home where possible.
Evaluation of the Greater Manchester Covid-19 Urgent Eyecare Service (CUES) showed the activity demonstrated sustained reduction in secondary care.
Whole discipline summits
The PCB has hosted multiple summits for providers from across all four primary care disciplines – community pharmacy, dentistry, general practice and optometry. These have created an opportunity to discuss Greater Manchester strategy, and for primary care to be involved and influence across the system and across primary care disciplines. These occasions also enable sharing of good practice and networking.
Workforce health and wellbeing
The PCB secured funding for a health and wellbeing pilot, running from October 2021 to March 2022 and working across the four primary care disciplines – community pharmacy, dentistry, general practice and optometry. The pilot provided an opportunity to test and scope what support is needed to work towards equity in access to workforce wellbeing and develop an infrastructure to underpin ongoing development. That infrastructure includes the creation of an online hub for the whole primary care workforce, signposting to a wide range of support in Greater Manchester and nationally, including crisis support information, as well as access to a digital library of wellbeing apps.
Pilot phase activity was evaluated by the Institute of Economic Studies. The findings showed 45 per cent of staff who responded said the support provided by the programme improved their understanding of mental health. Other findings:
- 39 per cent were more confident in undertaking self-care activities to improve physical wellbeing
- 33 per cent were more confident in their ability to communicate with others about mental health
- 33 per cent improvement in feeling valued by colleagues
The pilot’s success secured an extension of the programme for an additional year, and the PCB continues to work collaboratively across the primary care disciplines to develop the health and wellbeing offer, with a dedicated Health and Wellbeing Programme Manager in place to respond to workforce priorities.
Responding to need, a broader range of workshops and support is now offered, including around wellbeing and resilience skills, supporting managers to manage absence, and improving confidence in dealing with violence and aggression in the workplace. To increase flexibility for a time-challenged workforce, we’re also offering bitesize and lunch and learn sessions.