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Open the door to infinite possibilities for integrated health

Written by Jenny Cocking on 25-Sep-2018 11:09:47

In October 2016, a set of requirements for extended access was published. This was in response to the government's mandate to NHS England: "To ensure everyone has easier and more convenient access to GP services, including appointments at evenings and weekends."

For GP practices to be able to deliver extended access, they formed or used existing networks. These working groups are known as federations, networks, alliances or clusters. They provide a perfect platform to share the responsibility to develop and enhance the quality of services they provide to their patients.


The Richmond GP Alliance (RGPA) was formed in 2014. They offered extended access to their patients in 2016 and were the first federation in the country to use end-to-end interoperability. They enabled patient record and appointment sharing for GP practices using Vision and EMIS systems.

In year 1, the RGPA realised the following results:

  • 208,000 patients connected
  • appointments available to all patients 8am to 8pm, 7 days a week
  • 16% of Richmond population was seen in one of the 4 hubs
  • 650+ extra patients are being seen per week (a possible extra 34,000 per year)
  • 25% reduction in walk-in centre attendances
  • 0% increase in A&E attendance compared to 10% national increase

Download the infographic that showcases their first year's results.

The RGPA uses Vision 360 to help provide extended access to patients. Vision 360 can:

  • make patient information from GP systems available for shared care services
  • centralise appointments for federated services
  • maintain sharing agreements to control access to different aspects of patient records

Better access to patient-focused services

So, if clinicians can perform one search to read and update any patient record across an area and use the same search to book an appointment for that patient, what else is possible?

Over the last two years, there has been a sharp rise in how federations are improving access to patient-focused services.

Federations (clusters, networks or alliances) aren't just offering evening and weekend appointments. They are providing access to other specialist health services and letting clinical teams collaborate. This is enhancing the quality of care for patients and at the same time reducing pressure on GPs.

Here are 5 alternative uses for shared care, using Vision 360.

1. Complex wound care clinics

A federation in the South of England opened a shared clinic to deal with complex wound patients. GP practices in the area can book patients into the clinic. The specialised nurses use Vision 360 to see the patient's record, treat and assess the patient and record their consultation on their GP patient record.

Complex wound care is difficult to resource. Patients often present with multiple risk factors and need appropriate management and reliable long-term care to reduce hospital admissions. This service is easing the pressure on GPs and reducing the number of patient visits to the hospital. Patients are enjoying the improved access and reliability of the service.

2. Musculoskeletal (MSK) health issues management

A GP cluster in South Wales opened a hub in 2017 and employed two-part time physiotherapists. The cluster allows the physiotherapists to access GPs' MSK caseload. Any GP practice in the area can book appointments for patients with the physiotherapists at the central hub, using Vision 360.

Previously, GP practices were trying to meet the need of the patients in the GP practice and when they couldn’t do that they referred them to secondary care. The cluster saves time diminishing the need for paper-based referrals.

Over 3 months, 574 patients have been referred directly to the physiotherapists. This has drastically reduced the workload at the practice and improved the treatment. Patients are seeing the benefits too:

  • avoids the outpatient wait at hospitals
  • better access to specialist care
  • reduces travel time as the central hub is closer to home
  • easy referrals and available appointments

Read more about how this cluster in Wales is using Vision 360 to help thousands of patients get faster and more direct access to treatment.

3. Centralised mental health services

A federation in England and a cluster in Wales recognised that when patients had better access to mental health services, pressure on GPs would reduce.

The cluster opened a primary care hub and employed a mental health therapist. The cluster uses Vision 360 to share patient records with the therapist and manage appointments.

The federation in England opened a mental health listening service using Vision 360 to share the GP record and book appointments. It's aimed at people who are feeling vulnerable out of hours and as they approach the weekend. Patients suffering from mental health issues often struggle to wait a few days or weeks for a GP appointment. The GP practice can trigger intervention by a mental health service if they think they are at risk.

Read the blog that explains how a more integrated approach to physical and mental health treatment improves care and reduces pressure on the NHS.

4. Managing caseloads for vulnerable patients

A federation in West Hampshire CCG is using Vision 360 to provide collaborative care to high risk patients. A team of specialists manage the patient caseload. The team includes a GP, specialist outreach nurses, a pharmacist and staff with social care experience. They use Vision 360 to access the patient record and manage their caseload.

This project is helping to avoid unnecessary hospital admissions, by keeping care in primary care setting.

5. Diabetic service

West Kent CCG has identified the need to integrate care to improve diabetic care and improve resource utilisation. To deliver the plan, they are using Vision 360, which enables IT connectivity and interoperability for all providers across the integrated diabetes pathway. Vision 360 allows for the exchange of electronic patient information between primary care, community and secondary care providers.

The proposed plan is to redesign the diabetic care pathway and include local primary care services under a single integrated service model. Local secondary and primary care services are able to provide the new model of care because they have local knowledge and access to complete patient records. They will use the 'hub and spoke' model.

Diabetes treatment and care is a key priority for the NHS. It is estimated that by 2030 diabetes will affect almost 9% of the population. The way diabetes is currently managed across an area is fragmented. Diabetes services are delivered by different organisations in the NHS, for example, GP practices, hospitals and community care. To improve diabetes management, a more 'joined-up' approach is needed.


Vision 360 isn't just about providing your patients with extended access to your GP surgery at evenings and weekends. The functionality that Vision 360 provides allows you to give patients other services they need:

  • better access to specialists
  • joined-up collaborative care from the whole healthcare community
  • avoiding unnecessary hospital admissions
  • care is closer to home
  • a more integrated approach to healthcare

The benefits to any federation, network, cluster or alliance are dramatic: 

  • share resources to enhance the quality of care
  • reduce unnecessary hospital admissions
  • reduce travel time
  • make more appointments available to patients
  • clinicians can make informed decisions about patients
  • save time without having to produce paper-based referrals
  • reduce workload at the practice with direct referrals

I'm excited to live in a world where I do not have to tell my physio, dermatologist and GP about my clinical outcomes and current medical information. They can see all the information they need, to give me the most appropriate care. Moreover, they can even tell me when my next appointment is.

What's next?

The possibilities are infinite when you can use software for shared care. Other areas across the UK use Vision 360 for vaccinations, flu and cervical cytology clinics. And Nurses in rural Scotland even use Vision 360 to run clinics to support people with long-term conditions.

Are you from a federation, network, cluster or alliance that uses Vision and or EMIS GP software? Get in touch, and we'll tell you how you can reduce pressure on your GP practices and improve patient care.

Ask about shared care with Vision


Topics: record sharing, shared care


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