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David Rose smiling in front of a view over London's skyline

BY Leo Hynett

Healthcare

Modality: Primary Care ‘Super Partnership’

Distilled Post sits with Modality CEO Vincent Sai to discuss what their work means for patients, and how they can support the healthcare sector’s return to (a new) normal.

JUNE 23  2022

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In 2009, in one of the most deprived areas in the UK, Modality began looking at how general practice can work at scale by merging two practices that resulted in a combined list of 25,000 patients.

Fast forward to today, and Modality has a large group of practices serving 450,000 patients and is working hard to meet demand whilst maintaining quality, facilitating more joined-up care between primary and secondary care, and embracing technology to reduce administration that is clogging up clinician time.

Modality Partnership is an award-winning GP super-partnership that helps build innovative and sustainable services in General Practice and across the system. Their core mission is to deliver resilient community-based services to improve population health across the system.

 

Rising demand

‘In an ideal world, we can get to everybody whenever they want,’ Commented Vincent Sai, Modality CEO. ‘I believe our job is to be accessible to patients based on their health needs, but right now there’s not much patient understanding about what general practice should be.’ Last year alone, Modality received 4.8 million calls. With 450,000 patients, that was more than 10 encounters per patient. That level of demand is something GP practices simply aren’t set up to handle:

‘With demand spiralling out of control, we’re needing to get smarter and distinguish between patients who are looking for transactional care – those who just need a quick answer – and those who have more conditions or long-term conditions that need a different kind of care and greater continuity.’

People frequently seek face time with doctors for things a pharmacist or other health professionals on the team could help with. Patients should be signposted to appropriate alternatives to calling their GP wherever possible so that valuable clinician time can be used to support patients with more urgent or complex needs.

As well as supporting teams in identifying and supporting patients with more complex queries, Modality takes bureaucratic-type functions – back office, finance, governance – off clinicians’ plates, enabling GP practice teams to concentrate their energies on providing excellent personal care to patients. This has been invaluable in tackling the backlog that has arisen in the wake of the pandemic.

 

Reducing health and social inequalities in the community

Modality strives to help people live generally healthier lives, as opposed to solely supporting them in moments of illness or crisis.

‘We would love to do more, there’s never enough that one can do to contribute back to the community. The challenges we face are multifaceted, and so is our thinking.’

In Airedale, Wharfedale & Craven, Modality partners have taken over park runs as a way to promote more awareness about wellbeing in the community. The team also uses that opportunity to do health checks on site. While things like park runs and unconventional routes to health checks won’t reduce inequalities overnight, they have long-term health benefits and help teams reach patients they might not get to otherwise.

‘There are a lot of people who are just not on the radar,’ noted Vincent. ‘We’ve done a variety of different things to keep vulnerable patients from falling through the cracks; we have a homeless service in Hull, we ran pop-up clinics for COVID vaccinations across the country, and we run several zero-tolerance units for patients who may not be welcome on GP lists. These aren’t all easy jobs, but they’re crucial.’

Ensuring solutions reach the entire community is an immense challenge as there is never one single method that will get to all of the hard-to-reach patients.

 

Community variation

A major part of actually supporting hard-to-reach patient communities is acknowledging that things don’t work the same way for everyone:

‘We have a national footprint, but what works in Airedale doesn’t necessarily work in Birmingham. That makes it tricky because then you need to invest differently, and there’s no single answer to the challenges people are facing. If we keep learning and sharing best practices, that’s how we’ll make a change over time.’

Vincent identified that another major component is identifying what “community” actually means and putting an end to the idea that community and health are separate things. In reality, community is central to health – and vice versa. For example, during the COVID vaccine rollout, it was the phenomenal efforts of volunteer vaccinators that made the rollout possible.

‘I think if we can find a way to harness the community spirit of the first lockdown and the selflessness we saw early in the pandemic, that will make a world of difference.’

On top of these challenges, there is the issue of digital exclusion. Everything became much more tech-based during the pandemic, but not everyone has the technology – nor the technological know-how – necessary to access digital solutions. Providers must ensure they don’t assume these technologies will eliminate the need for more ‘old school’ access options.

Modality has a few possible ideas to make these digital solutions accessible to a wider patient population:

‘In Lewisham, we participated in the government’s kickstart programme to bring some younger people into healthcare. Some of them were tasked to be on the phone to assist patients in filling out e-consults that way. Since then, we’ve recruited some of these youngsters into our permanent workforce.’

Modality has considered gifting iPads to those who need them – either directly or through places such as homeless shelters – but there is the added complexity of ensuring people have the technical knowledge to sufficiently access solutions unsupported. An alternative they’ve proposed is digital hubs in surgeries where patients can access digital knowledge bases. Reducing the exacerbation of the digital divide is an integral component in addressing health inequalities, but it’s far from a simple task.

 

Looking forward

The Modality team is incredibly positive about the future. They believe collaboration across the system (including patients) will drive long-term success and sustainability. They have ambitious goals, but none are tied to targets. Positive outcomes have always followed, sometimes even as a by-product, when they have applied critical challenges and planning that puts patient-centred care first.

‘A side benefit of improved pathways when working with secondary care trusts to tackle the elective backlog is that new career opportunities have opened up for GPs who are keen to develop a specialist interest. It’s a positive cycle; this helped with recruiting and retention, which in turn have helped us improve access for patients.’

When GPs can spend their time on more complex and challenging cases (as opposed to simply dealing with transactional care or issuing prescriptions that could have been obtained via a pharmacy) their job satisfaction improves. ‘As is the case with any work, you do much more when you love what you’re doing,’ notes Vincent. ‘If you feel like you’re making a difference and can do work that challenges you and helps develop your skills, you have the chance to really thrive in your role.’

‘No work is beneath anyone, I think that’s arrogant thinking, but time is precious. If everyone supports one another to work at the top of their licence, that will be phenomenal.’

The final pieces of the puzzle are educating patients about how they can be empowered for more self-care, and optimising rotas and various technical elements of practice to get more throughput.

‘We’ve got the technology, if we’re smart about it, to make much more seamless pathways for patients. We’re already embracing automation and have bots doing mundane tasks like sorting through COVID test results. I’m not looking at technology to replace humans, empathy is essential and that’s not something AI can replicate, at least not yet.’

 

Final thoughts

NHS demand is virtually unlimited at the moment and there is a clear urgent need for the broader system to rally around the real needs of the population. In the current fight to clear the COVID backlog, many people seem to be searching for a silver bullet that will lead to a miraculous overnight return to pre-pandemic levels. Vincent’s stance is more of a realistic one that still carries his characteristic optimism:

‘There’s no magic solution out there, there’s just a lot of hard work, grafting, and working alongside people who are willing to put in that work. People in primary care in the NHS work there for a reason, and a lot of that is the joy you get from helping people through your job.’

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