Harrow East Primary Care Network Initiatives and Challenges
Harrow East Primary Care Network, led by Clinical Director Dr. Meena Thakur, serves a population of over 32,000. The network focuses on improving cervical screening uptake and has faced challenges during the COVID pandemic, including infection control limitations. Initiatives include targeting non-attenders and utilizing text messaging for reminders.
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Harrow East Primary Care Network
Harrow East Primary Care Network Clinical Director Clinical Director - - Dr Meena Thakur Practices in Network Practices in Network - - Honeypot Medical Centre, Bacon Lane Surgery and Mollison Way Surgery Population size: Population size: 28,619 (1st Jan 2019); 29,357 (1st Jan 2020); 32,720 (1st June 2021) Small enough to care and large enough to scale Small enough to care and large enough to scale
HONEYPOT BACON LANE MOLLISON Eligible population for cervical Eligible population for cervical screening every 3 years screening every 3 years Women aged 25 Women aged 25- -49 2172 2172 1447 1447 1619 1619 49 Eligible population for cervical Eligible population for cervical screening every 5 years screening every 5 years Women aged 50 Women aged 50- -64 Cervical screening uptake 25 Cervical screening uptake 25- - 49 year old cohort (Quarter 2 49 year old cohort (Quarter 2 2019) 2019) Cervical screening uptake 50 Cervical screening uptake 50- - 64 year old cohort (Quarter 2 64 year old cohort (Quarter 2 2019) 2019) Quarter 1 2017 Quarter 1 2017 Cervical screening uptake 25 Cervical screening uptake 25- - 49 year old cohort 49 year old cohort Quarter 1 2017 Quarter 1 2017 uptake 50 uptake 50- -64 year old cohort 64 year old cohort 848 654 426 64 66% 63% 56% 92% 82% 81% 53.2% 61.5% 55.2% 71% 76.7% 77.4%
CHALLENGES COVID PANDEMIC COVID PANDEMIC PRIORITISATION OF WORK PRIORITISATION OF WORK - - INFECTION PREVENTION & CONTROL LIMITATIONS INFECTION PREVENTION & CONTROL LIMITATIONS - - CEASED IN EARLY PART OF PANDEMIC CEASED IN EARLY PART OF PANDEMIC - - MORE REMOTE WORKING MORE REMOTE WORKING - - PATIENTS FRIGHTENED TO ATTEND FOR SCREENING PATIENTS FRIGHTENED TO ATTEND FOR SCREENING LED IN COVID VACCINATION PROGRAMME IN HARROW LED IN COVID VACCINATION PROGRAMME IN HARROW THE HIVE THE HIVE
Initiatives chosen Initiatives chosen Non Non- -attenders attenders- - identify and contact all women who are at least six identify and contact all women who are at least six- -months overdue screening: overdue screening: Audit reasons for non-attendance and develop and implement a plan to address primary care-specific barriers to screening Schedule screening appointment months Text messaging: Text messaging: use text messages to remind women of scheduled cervical screening appointments (at least 90%) Using data provided by NHSE, improve the completeness and accuracy of mobile phone numbers of women aged 24 to 70
REFRESH AND RESTART METHODOLOGY - - - Purchased Purchased Ardens Identified women with mobile phone numbers as baseline Identified women with mobile phone numbers as baseline Ardens Ardens search helped to identify women whose mobile phone search helped to identify women whose mobile phone number was recorded in home number field number was recorded in home number field Proportion with no mobile phone number recorded at all Proportion with no mobile phone number recorded at all required phone call to every patient on landline or household required phone call to every patient on landline or household member s phone number to ascertain correct mobile phone member s phone number to ascertain correct mobile phone number for patient number for patient Ardens Software for useful searches Software for useful searches -
SAMPLE RESULTS FOR ONE OF THE 3 PCN PRACTICES TOTAL ELIGIBLE POPULATION -WOMEN AGE 24-70 4323 87% WITH MOBILE PHONE NUMBER RECORDED TEST MJOG UNABLE TO SEND TEXT TO 588 13% MOBILE PHONE NO FOUND IN INCORRECT FIELD 425 NO PHONE NUMBER AT ALL 163 END RESULT MISSING PHONE NUMBERS AFTER INTERVENTION 81 98.20%
STUDY OF OUR PCN POPULATION - - WORKED WITH PUBLIC HEALTH DEPT AND FINGERTIPS TO UNDERSTAND OUR WORKED WITH PUBLIC HEALTH DEPT AND FINGERTIPS TO UNDERSTAND OUR POPULATION POPULATION - HIGHEST ROMANIAN POPULATION IN OUR BOROUGH (11% IN HARROW EAST VS HIGHEST ROMANIAN POPULATION IN OUR BOROUGH (11% IN HARROW EAST VS 7% IN REST OF HARROW) 7% IN REST OF HARROW) - HIGH SOMALI POPULATION HIGH SOMALI POPULATION - 66% POPULATION IS ASIAN WITH MANY NOT SPEAKING ENGLISH 66% POPULATION IS ASIAN WITH MANY NOT SPEAKING ENGLISH - MAIN LANGUAGES CHOSEN TO COMMUNICATE IN: MAIN LANGUAGES CHOSEN TO COMMUNICATE IN: - ENGLISH ENGLISH - ROMANIAN ROMANIAN - URDU URDU - SOMALI SOMALI - GUJARATI GUJARATI
ENGAGEMENT WITH ROMANIAN COMMUNITY WORKSHOP WORKSHOP WITH LOCAL AUTHORITY, PUBLIC HEALTH AND PRACTICE TEAMS FROM 3 WORKSHOP WITH LOCAL AUTHORITY, PUBLIC HEALTH AND PRACTICE TEAMS FROM 3 PCN PRACTICES PCN PRACTICES PCN CD LEAD IN TACKLING INEQUALITIES & PREVENTION WORKSTREAM IN OUR ICP PCN CD LEAD IN TACKLING INEQUALITIES & PREVENTION WORKSTREAM IN OUR ICP EACH OF OUR 3 PRACTICES HAS ROMANIAN SPEAKING STAFF EACH OF OUR 3 PRACTICES HAS ROMANIAN SPEAKING STAFF WORKED ON HOW BEST TO ENGAGE WITH ROMANIAN COMMUNITY WORKED ON HOW BEST TO ENGAGE WITH ROMANIAN COMMUNITY FACEBOOK GROUPS FACEBOOK GROUPS LOCAL ROMANIAN CHURCH LOCAL ROMANIAN CHURCH VIDEOS MADE FEATURING OUR HCAS VIDEOS MADE FEATURING OUR HCAS
RESOURCES JO S TRUST, LEAFLETS, VIDEOS JO S TRUST, LEAFLETS, VIDEOS YOUTUBE VIDEOS IN DIFFERENT LANGUAGES YOUTUBE VIDEOS IN DIFFERENT LANGUAGES MESSAGING TO PATIENTS MESSAGING TO PATIENTS DIFFERENT NUGGET OR MYTHBUSTER SENT EVERY DAY DIFFERENT NUGGET OR MYTHBUSTER SENT EVERY DAY TEXTS SIGNED OFF BY SENIOR FEMALE GP IN PRACTICE TEXTS SIGNED OFF BY SENIOR FEMALE GP IN PRACTICE GAVE OPTION OF SELF GAVE OPTION OF SELF- -BOOKING ONLINE VIA NHS APP OR PATIENT ACCESS BOOKING ONLINE VIA NHS APP OR PATIENT ACCESS OR REPLY YES TO TEXT FOR PRACTICE TO CALL PATIENT TO BOOK APPT, SO OR REPLY YES TO TEXT FOR PRACTICE TO CALL PATIENT TO BOOK APPT, SO PATIENTS DID NOT HAVE TO STRUGGLE GETTING THROUGH TO THE PRACTICE PATIENTS DID NOT HAVE TO STRUGGLE GETTING THROUGH TO THE PRACTICE (FURTHER BARRIER) (FURTHER BARRIER) EACH OF THE PRACTICES WITHIN MINUTES OF SENDING TEXTS INITIALLY ABOUT EACH OF THE PRACTICES WITHIN MINUTES OF SENDING TEXTS INITIALLY ABOUT 18 RESPONSES EACH PRACTICE 18 RESPONSES EACH PRACTICE
NON-ATTENDERS MANY, POSSIBLY 50% INITIALLY MANY, POSSIBLY 50% INITIALLY DISHEARTENING DISHEARTENING FOLLOW UP INTERVIEWS OF NON FOLLOW UP INTERVIEWS OF NON- -ATTENDERS PHONED ON THE DAY THEY ATTENDERS PHONED ON THE DAY THEY DNA D DNA D MANY GENUINE E.G. PERIOD STARTED, SOMETHING CAME UP, WERE MANY GENUINE E.G. PERIOD STARTED, SOMETHING CAME UP, WERE REBOOKED AND MANY DID ATTEND SUBSEQUENTLY REBOOKED AND MANY DID ATTEND SUBSEQUENTLY PERSONALISED ATTENTION PERSONALISED ATTENTION DIFFERENT MESSAGING WITH EACH CONTACT DIFFERENT MESSAGING WITH EACH CONTACT FOLLOW UPS HAVE BEEN INDIVIDUAL PHONE CALLS FOLLOW UPS HAVE BEEN INDIVIDUAL PHONE CALLS LABOUR INTENSIVE PLAN TO DEVISE SIMPLE QUESTIONNAIRE WITH TICK BOXES OF POSSIBLE PLAN TO DEVISE SIMPLE QUESTIONNAIRE WITH TICK BOXES OF POSSIBLE REASONS WHY PTS DNA D REASONS WHY PTS DNA D OPPORTUNITY TO REBOOK OPPORTUNITY TO REBOOK THOUGH PERSONAL ENGAGEMENT WILL ACHIEVE THOUGH PERSONAL ENGAGEMENT WILL ACHIEVE GREATER RESULT, THAN AN IMPERSONAL TEXT GREATER RESULT, THAN AN IMPERSONAL TEXT LABOUR INTENSIVE
INCREASING ACCESS TO SMEARS New trainee nurses New trainee nurses Nurse mentors in practices Nurse mentors in practices We trained them up in smears We trained them up in smears On line accessibility allowing patients to self book On line accessibility allowing patients to self book Ability for patients to speak to the nurse to discuss questions and Ability for patients to speak to the nurse to discuss questions and concerns and removing pressure to have smear straight away concerns and removing pressure to have smear straight away
RESOURCES Hours per week Weeks per pilot Staff Costs Rate Oncosts Total Management time 971.77 29.2 8.176 37.376 1 26 Admin/Coordinat or time 8524.8 9.25 2.59 11.84 15 48 Nurse time 2649.6 15 4.2 19.2 3 46 HCA Clinical Director/Lead time 3194.88 13 3.64 16.64 4 48 1664 50 14 64 1 26 Expenses Advertising literature 500 Overheads 1,600
CERVICAL SCREENING UPTAKE 24-49 YRS 2017 2017 average between PCN practices average between PCN practices 61% 61% September 2020 September 2020 PCN average PCN average 67% 67% JUNE 2021 PCN average JUNE 2021 PCN average - - 70% 70% Improvement, (but not as much as would have been the case, due to COVID) Improvement, (but not as much as would have been the case, due to COVID) Restrictions in accessing general practice Restrictions in accessing general practice IPC requirements IPC requirements Patient fears Patient fears Focus on COVID vaccination Focus on COVID vaccination programme programme Trend in increased uptake over recent months is higher than previous Trend in increased uptake over recent months is higher than previous
