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Maximise time with poorly controlled asthmatic patients
6Most practices now have access to SMS messaging systems . If yours supports questionnaires , all the better . Send out Asthma Control Test ( ACT ) questionnaires to your asthmatic patients to determine who will benefit most from your precious clinical time . If a patient response suggests excellent control , a further SMS with supporting information and resources for inhaler technique could complete the review without the need for a face-to-face appointment .
Support nurse associates and healthcare assistants to develop their skills
7Nurse associates and HCAs are performing increasingly complex roles within primary care . They can support chronic disease reviews , spirometry and dressings . Nurse associates can train to conduct cervical smears . Maximise their potential and ensure reception and admin teams book patients with them for tasks they can carry out . If your nursing team is thin on numbers and you ’ re the only person who can provide expert diabetes care , you don ’ t want to be booked up with dressings and smears . However , remember to factor in some time for supervision and mentoring . require continuity . For us , cervical screening seemed to be a priority area , and as it involves working age women , evening / weekend appointments are often convenient .
We also use extended access for asthma and hypertension reviews , but prefer to maintain continuity for specific areas such as dementia and learning disability .
Collaborate with your PCN pharmacists
4PCN pharmacists are a valuable resource and can be a lifesaver for overstretched practice teams . It is worth considering that requirements under the PCN Investment and Impact Fund ( IIF ) framework 4 have been significantly scaled back this year , potentially freeing up pharmacists to assist in the more medicationheavy elements of chronic disease management . At my practice , our PCN pharmacist plays a vital role in managing atrial fibrillation and heart failure , for example . Have a chat with your team and your pharmacist to see if they have any areas of interest that they ’ d like to collaborate on .
Care co-ordinators can lighten the admin load
5What if the workforce crisis affects your admin team ? Winter is a huge challenge for administrators , as vaccination campaigns and the looming QOF deadline compete for attention . It can take time for new starters to bed in , and chronic disease management and the QOF may still seem new to staff who started during the pandemic , when these were lower priorities . PCN care co-ordinations may be able to lighten the admin load , although their role differs from network to network , so it will be necessary to seek advice from PCN leads . But if your admin support is nonexistent , co-ordinators could offer a lifeline this winter .
Dr David Coleman is a GP partner and co-clinical director at Doncaster South PCN , South Yorkshire
Use the admin team for obesity casefinding
8Obese patients can be referred to the NHS Digital Weight Management service 5 , a 12-week online behavioural and lifestyle-based programme . While these could be identified in person during chronic disease reviews , a more efficient approach would be to work with the admin team to design a casefinding approach . Patients can be identified using clinical searches and offered support via SMS . Careful wording will be key , but this may be an opportunity to reach more eligible patients and hopefully convert them to the support programme . There ’ s also an active Weight Management DES , so each referral will generate additional funding for your practice too .
Discuss how the doctors can support the nursing team
9If all else fails … no , I ’ m only joking . We ’ re all in this together and doctors can and should support chronic disease management – especially when agendas clearly overlap . I recently did a QOF tutorial for our new GP registrars and I was clear about the importance of chronic disease management , especially for housebound patients . Most housebound elderly patients receive home visits at some point in the year . Conditions like COPD , dementia and diabetes are often integral to the decision making , so my teaching point to the budding GPs was that it makes sense to document the key components of the chronic disease review while on the visit . By helping in this way , doctors can free up nursing capacity without much extra effort on their part .
Support your colleagues – and yourself any workforce crisis , looking after existing employees and colleagues is vital . Regular team
10In
meetings can be a great way of checking in on each other and brainstorming ideas to improve processes and address issues that make working life harder than it needs to be . But remember to take the opportunity to celebrate successes and reflect on good care .