In 2018 Dr Pritti Aggarwal, a GP and University of Southampton academic set up the GP Consultant Exchange Model to improve relationships at the interface between primary and secondary care. The scheme was so successful it has been replicated across the Wessex region and nationally.
Dr Aggarwal, who splits her time between the Faculty of Medicine and being a GP, tells Medically Speaking, about the aims of the project and the improvements it’s made to caring for patients.
“As a local General Practitioner there is nothing worse than organising care for your patient and then finding that the ‘system fails’ when they fall through the gaps between primary and secondary care.
“This interface is the most challenging to navigate for all health care professionals and patients alike, leading to feelings of frustration, which in turn increase inefficiency and denigration between professions working within the complex system.
“We all appreciate that collaborative working across the primary and secondary care interface is vital to the quality of care delivered to patients. My own frustrations for delivery of care for my patients care led me to launching the GP Consultant Exchange Model in Southampton in 2017, which aimed to build bridges across the primary secondary care interface. Through this model we wanted to develop:
- Improved mutual professional understanding
- Foster deeper partnership between our clinicians
- Ignite opportunities for innovation and quality improvement
- Find co-owned local solutions for the mutual care of patients
“The idea is simple – clinicians in a secondary care setting are matched with a colleague in primary care. Each ‘pair’ then arranges two half day exchanges in each others place of work at a time that suits them. The last time some of my specialised secondary care counterparts were in Primary Care where when they were at medical school, which could be more than 15-20 years ago and of all specialities Primary Care has had the biggest facelifts, even more so during the pandemic, with huge shifts to technology enhancing virtual models of working. This insight into the workings of the care setting allows to participants to really see what is going on and the challenges their colleagues are facing. There is a great deal to be learnt from both parties.
“At the end of the exchange, the participants complete a short reflection that can be used as Quality Improvement Activity part of their annual appraisal and a meeting is held with all participants to share outcomes, create further ideas and discuss any next steps for future opportunities.
“As time’s gone on, we’ve all got busier and busier and expected to do more with less resource. Some of this can be resolved by understanding the challenges we face and working together to find solutions. We do not talk to one another as much as we used to. There used to be regular meetings between GPs and consultants. This scheme is a way to help put those relationships back into the NHS and patients at the centre. It is important that we try and bring back those one-to-one relationships to support change and move forward.
“This The GP Consultant Exchange model has been replicated across Wessex and developed in Southampton, Portsmouth, Basingstoke and beyond.
“The impact of these schemes has showed significant quality improvements and successfully implementing the measures introduced in the NHS Standard Contract 2017-18. The Primary and Secondary Care Interface Working Group published the Contract Implementation Toolkit which provides practical guidance on implementing the Contract measures and included the model as a case study. Further details can be found on NHS England’s website here.
“The Primary Secondary Care Interface working group had a pause during the pandemic but now has had renewed interest with all Royal Colleges contributing to working across the interface most recently. An analysis of the Wessex Exchange Model has been published in the a BMJ blog post and further reflections on a personal exchange in the BMJ Opinion.
“The exciting aspect about this project is it doesn’t just have to be with GPs and consultants – managers could do it, nurses can do it, in fact any areas could replicate this where individuals want to learn across their interfaces and improve working for the best. The wheel doesn’t need to be re-invented, and we have put all our experience as learning together in a more recent article published in MedEd.
“Through all the reflections we have analysed what was really apparent was how much a boost in morale this exchange offered the participants and the realisation at what an amazing job we really do in medicine. Go on, share some time with a colleague across an interface and help learn what you can do together differently, that will make a difference.”