Aims and objectives:
With the new GP contract coming into effect, GPs were able to opt out of providing an emergency GP out-of-hours service, so this became the responsibility of PCTs. Gedling PCT is lead commissioner for the new service on behalf of the four Greater Nottingham PCTs, covering a population of 650,000 served by 130 GP practices. The strategy has been shared with the rest of the local health community. The new service is required to be safe, high quality, sustainable and trusted by the public, but must be used appropriately by patients.
Support for the change:
Key audiences were identified and consideration given to effective, cost efficient ways to target these groups. A network of OOH champions from various organisations was established to give strategic direction for the development of the new service and its communications and to disseminate information and influence opinion about the service change throughout the local health community. Cascade systems were put in place, utilising representatives from each PCT on the OOH commissioning group in addition and the Emergency Care Network. Gedling PCT strategically lead the communications for the new service and co-ordinates the other PCTs' communication teams to cascade information along with Nottingham Emergency Medical Services (NEMS - the service provider) and health professionals including practice staff and GPs. The second existing provider, a national company called PrimeCare also had to be sensitively communicated with as Gedling PCT had to disengage this long standing partner organisation.
Patient and public influence:
There was a three month consultation period for the development of the service. A local patient forum member was represented on the OOH commissioning group and the local patient forum inputted into communications materials being produced. All health professionals (including GPs and practice staff) could provide feedback and that of their patients, carers and the public, on the communications materials. This followed the distribution of an initial patient poster, designed to raise awareness of the service change (displayed in waiting areas of health venues). So the communications campaign was both proactive and responsive e.g. a staff communiqué was sent to practice managers publicising how deaf people can access the service following feedback from the Nottingham Deaf Society. Two-way communication has been key to the campaign.
Impact on the workforce:
Staff cascade mechanisms have improved and health professionals educated to become 'change agents'. Employees were given the tools to share key messages about the new service including core scripts for frontline staff and patient advice and liaison officers. These key messages were constantly reinforced via monthly staff communiqués, monthly letters to GPs and patient information.
Measuring the results:
None of the local PCTs received any complaints from patients. All press and broadcast media coverage generated was positive at a time when both national and regional coverage was generally negative towards new OOH service arrangements. There has been no negative or unexpected impact on the service provider (NEMS) or other OOH services e.g. the local emergency department, ambulance service and Walk-in Centre. Stakeholders were provided list of key messages (in a core script) to ensure a consistent approach and the communications tools used were uniform.
Improved performance:
Demand for the service didn't increase as patients were successfully educated how to access and use the service appropriately. Even though one provider (NEMS) took on 20% more patients there was no increase in demand for the service, outside of what was planned. Feedback from recent Quality and Outcomes Framework visits to practices (undertaken to monitor the implementation of the new GP contract) has a smooth transmission and the maximum points for this. The communications model is being used for other service changes within Gedling PCT e.g. Local Improvement Finance Trust. The positive sustained media coverage including all the key messages.
Reflecting diversity:
The PCTs in Greater Nottingham cover both inner city areas of high deprivation and with large ethnic minority populations and also more affluent rural areas. All this was taken into account when planning the campaign and the patient information was offered in alternative formats upon request. Staff responsible for diversity were engaged and consideration given to the needs of minority groups. The volume of patient information distributed was huge and were proved to be displayed appropriately during spot checks on practices. Many requests for additional copies of the leaflets to meet demand were received too. Other organisations' staff were also engaged to ensure the widest possible distribution to key audience such as the elderly, terminally ill patients and their carers, and also parents with young children. Leaflets were distributed via emergency department staff, social services teams, meals on wheels, local education departments which distributed leaflets via primary schools across Greater Nottingham, and leisure services departments who distributed patient information to all leisure and community centres, as well as libraries. Community pharmacies were also effective venues for raising public awareness.
Sharing the learning:
Gedling PCT successfully provided strategic communications direction and shared good practice by co-ordinating the other PCT communications leads to undertake tasks as appropriate. At least four other PCTs in Trent used the OOH communications campaign model. To date Gedling PCT hasn't entered the campaign into any awards.
Outstanding features:
The campaign was approached and undertaken in an enthusiastic and tenacious way, and provided extremely effective despite minimum resource (one communications professional working part time with minimum budget). A variety of innovative tactics were employed including key messages on repeat prescription slips and distribution of information to target audiences via other organisations such as Sure Start. The communications function displayed effectively leadership through its co-ordination of the other PCT communication teams and the efficient management of the sustained communications campaign which was also flexible.
