South Yorkshire Practice Business Manager Bex Cottey – using the Register with a GP surgery service. Read about the benefits for practices and patients of using NHS England’s online registration service in a Conisbrough, South Yorkshire practice.

We’ve been offering online registration using the Register with a GP surgery service for more than a year.

We find it really useful, especially when people are wanting to register a whole family. They can do it in their own time, they’re not standing at the front desk for hours, filling in everybody’s information.

We would often have people that couldn’t remember the name of the medication their child was using, and they would have to go home, look it up and come back with the paper registration. This is now a thing of the past, though we do have the new look paper form for anyone that needs it.

Sometimes using our previous registration system, we would end up with incorrect information, which we would then have to correct later on. The new service saves us a lot of time, we don’t have to do any detective work to find the patient in the NHS national database or manually input or scan any documents. It’s already in a format which lends itself to copying and pasting into our clinical system, and in the future this information will move across seamlessly.

Patients can get their family or carers to register them with us online too – they don’t need to spend time travelling back and forth on behalf of someone who is housebound or needs things doing for them.  We’ve just had 33 new care home residents registered this way.

My advice around all tech within general practice would be, don’t wait until it’s perfect, because there’s always going to be something new coming down the line. You don’t say, I’m not going to buy a phone because there’s going to be some operating system changes coming up. You just buy it and use it as it is, get familiar with how it works and then you’re ready for the software upgrade which will make the functionality even better.

The practice team at The Roxton practice has found the new Pharmacy First service hugely beneficial, reducing the workload for both the Care Navigation team and clinicians within the practice. Patients are also positive about the new pathway to same-day consultations.

Staff training was key to the successful implementation of the new service. The approach taken by the practice team allowed colleagues adopting the new service to freely ask questions or voice any concerns.

The Service Manager at the practice said:

“The most important components for success are Primary Care and GP training. Once this has been implemented, the service becomes part of the day-to-day process of helping patients receive the right care from the right service, without too much deliberation of what the practice can do that day with our caseloads”

Pharmacy First was implemented through structured training with the Care Navigation team, this included breakdown of the service specs and ‘mock’ conversations where patients would present with qualifying conditions so they could be referred/offered alternate options.

The team were also given individual service binders, laminated crib sheets and a template for Pharmacy First exclusions/inclusions in front of their workstations. These were used as instant query points when they handled a patient with presenting symptoms. This was applied across all sites where Care Navigators would interact with patients.

The practice was already familiar with the predecessor to Pharmacy First, the CPCS service so there were already processes in place that this service be joined onto quite easily. The information provided in the written service specs and resources is a big help delivering the service, as it helped prevent confusion about what is covered.

As is common with new services, the practice worked through a few teething issues including some excluded patients getting referred to the service in error, but this has improved hugely with the Care Navigation team using the training resources successfully.

The positive impact for both practice staff and patients has been obvious. The Service Manager concludes:

Patients are seeing the benefit of the service with quicker treatment options and same day face-to-face consultations to the referred pharmacy. This clearly eases the workload on a practice and allows the patient to get the best possible care at fast pace.

“It has made a huge difference, I don’t believe it can be overstated. Our patients feel there is a legitimate pathway for treatment for issues that occur within 24-72 hours with no wait period for appointments to become available.”

Over 900,000 people are estimated to be living with dementia in the UK and this is set to rise to 1.6m by 2040. An estimated 91.8% of people living with dementia have at least one other health condition.

Liz Tomlinson is one of a number of dementia specialist Admiral Nurses made possible by Additional Roles Reimbursement Scheme (ARRS) funding with the additional support of Dementia UK. Liz was drawn to the role after her grandmother, who brought her up, was diagnosed with the condition and she was able to use her specialist skills (learned as a mental health nurse) to support her family through a difficult time – something she can now offer to others.

The team deal with an average of 57 referrals a month and work closely with GP practice staff colleagues to ensure patients get to see the right person first time – a key principle within the Modern General Practice model, part of the delivery plan for recovering access to primary care.

Liz explained: “We have a nurse in each Primary Care Network, so we cover 28 surgeries across the whole of the locality.

“Our main role is to support families experiencing dementia and help take away some of the pressure the condition creates for them.”

“We get our referrals from GPs, practice nurses, patients and carers, social workers – everywhere. Although I work with a lot of elderly people in the community, the youngest person I have supported with the condition was 32.”

“I couldn’t imagine ever doing anything else. It’s stressful at times, but I just can’t see myself being a nurse in any other field.”

Patients can be triaged to the service where there are ongoing or increasing complexities associated with dementia or suspected dementia; complex family dynamics; complex transitional care; and/or the condition is adversely affecting the wellbeing of the carer of person living with dementia. This can be at any point from time of diagnosis through to end-of-life care and beyond in bereavement.

Liz continued: “Being part of the multi-disciplinary practice team works really well. For example, if I go and see somebody and identify they have an infection from their blood or urine, I can ask for a prescription via our online system – saving GP appointment time for another patient. If a family needs a couple of hours spending with them to assess their complex needs, we can do just that, which would be impossible within a typical GP appointment. Building up that therapeutic relationship with carers is sometimes all that’s needed, and that listening ear.”

As well as working directly with over 500 families each month, nurses have a role in advising, training and being a role model for other professionals to support best practice in dementia care.

Dr Ambreen Qureshi, GP Partner added: “Having an Admiral Nurse working in the PCN has really helped to improve our practice’s service to patients and families dealing with dementia. We continue to receive really positive feedback from the families involved as well as our patient participation groups.”

“You can refer in even before a patient has received a diagnosis – very useful in preventing ‘crisis points’ such as admissions or falls. We have seen far  fewer crisis contacts from families since this service was introduced.”

More information on ARRS and the multidisciplinary team

More information on Admiral nurses