Dr Chris Potts is a GP at the Moir Medical Centre in Long Eaton, a community GP and a clinical cabinet member (frailty and end of life care) at Erewash Health Partnership.
Please describe your current work?
I started as a salaried GP in one of the larger practices in Erewash. As Team Up was expanding, I was approached to be one of the clinical leads for Erewash. Erewash already had some legacy teams, funding and staff in place before Team Up was launched, so as a clinical leader, I was asked to see how we could match our legacy work with the new plans for Team Up. After a little while as the clinical lead, I thought I should become closer involved and took on a day-a-week as a community GP within Erewash as well. My work pattern is now being a salaried GP in Erewash for two days-a-week, clinical lead for the team one-day-a-week and a member of the team as a community GP for one day-a-week.
How is the philosophy of Team Up influencing your work?
Team Up is a notion and a philosophy that we all have held for a very long time, before it had a name. The direction of travel of Team Up is the direction of travel for primary care and I think it is the right way to go. We need an increased ability to hold risk in the community; to manage complexity at home; to move away from hospitals as the default place of safety; and to be able to build teams, across the disciplines, to manage this within the community, within someone's house or care home.
In one sense it is almost like a return to cottage hospitals at the dawn of the NHS. The teams were small, they all sat in a room next to each other and worked together. But things since just got bigger and bigger, became increasingly more siloed, and people found it harder and harder to access joined up care. The approach of Team Up takes the focus back of everyone onto the individual. It’s very early days in delivering this, it is a big system culture change and we have made small movements in that direction, supporting people with a multi-disciplinary team in care homes and with home visiting. We are seeing the changes and benefits already in Erewash.
How are things working in Erewash?
We have a very well-established team providing enhanced care in care homes and proactive frailty care, with a team of embedded community clinicians, nurses and advanced clinical practitioners who carry out the urgent response element. These are legacy services that existed before Team Up and we are now moving more towards a model of these services working a little bit closer together. So, someone might not be identified as being frail but if you’re visiting them for an emergency situation three or four times a year, then they could probably do with proactive frailty support. We are doing more and more proactive care, with vaccinations being a huge part of that, and there’s a big ask around how we respond to non-injurious falls.
The way that the legacy services are set up is that anybody who is under the care home frailty team will receive planned reviews on a regular basis. But if they have an urgently unexpected need, for example, if a care home member of staff sees that someone is not very well and they are due to be seen at the ward round in another two or three days, then they would call the frailty team and we would arrange an appropriate clinical response, generally a same day acute visiting response. We’re trying to work through some of the logistics of shared working because we acknowledge that there are different skills sets and no single member of staff can have all of the skill sets required, so it is about how best we can work together.
How are your colleagues responding to being asked to work in different ways?
I think there is always anxiety about being asked to work in a new way. That feeling comes from a lot of places but a big part is about recognising that no-one can have every skill required. People think: ‘I’m happy to do what I do now because I know I can do it. But I’m worried that if you’re asking me to do more and more that I’m going to get to a point where I can’t do some of the things that you’re asking me to do.’ There's certainly concerns over expertise and training. They certainly all really see the goal, the need to share skills more effectively, reduce duplication and be more efficient. There is a universal acceptance of the goals but a few differing opinions on how we get to that point and that is an ongoing conversation.
As regards to the local work that falls under the Team Up banner, what are you most proud of?
I think the thing that I’m most proud of, of what we do in Erewash, is around advanced care planning for people who are frail, homebound or living in care homes. It’s very rare for a GP practice to have the capacity to offer bespoke advanced care plans for every resident in a care home. Most of us would agree that people within care homes require a certain level of assistance but when more and more things are unwell with them, it can get really difficult to offer that proactively. Whereas with the frailty team, this gets picked up, they’ll be making an assessment of their current needs, capacities and abilities, both medical and non-medical. We have the staff available and the time to consider issues around their care and work with their families on a care plan. That is shared with all the services who might need to be involved in their care so people are better informed, for example, if a doctor or ambulance was called out-of-hours. I don’t have any grounds to be proud of this work individually as this is being done by everyone else, but it is a credit to Erewash.
How are you finding it in terms of recruiting to posts within Erewash?
In Erewash, like everywhere else in the country, recruitment is the biggest challenge. There are always positions that could do with being filled, something which is true nationwide. I understand that other places across Derbyshire have found it more challenging to recruit, so
we find ourselves in a relatively fortunate position here. However, we’re still struggling to get to the level of recruitment that we would like. Our GP team is growing but we’re not where we’d like it to be. Across the multi-disciplinary team, our nursing team is doing pretty well but that has predominantly been a legacy of having the staff in position and continuing to look after them well. As some of our experienced staff come towards retirement, that’s going to leave some fairly significant voids in the team. It’s something we are very aware of and need to work hard to address. Again, this is by no means unique to Erewash, this is across the NHS.
Read our follow-up blog where Chris discusses the opportunities within Team Up of the community GP role.