PRACTICE PROFILE  MIRIAM PRIMARY CARE GROUP


Jim Killgore visits a Birkenhead practice group with a reputation for forward thinking in healthcare


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T’S a complaint heard increasingly often in NHS hospitals – an inordinate number of people turning up at accident and emergen- cy with minor problems such as chest infections or cuts and sprains or stitches needing removal. Indeed it has recently sparked talk of a national crisis in emergency care. No one benefits as patients can end up spending hours waiting to be seen while overstretched A&E staff are dis- tracted from dealing with more complex cases. Such was the dilemma faced by Arrowe Park Hospital on the Wirral Peninsula. In 2008 the local PCT (through the local PBC Group) decided to set up a pilot scheme for dealing with minor injuries and illness within a primary care setting. This would extend access in addition to three local walk-in centres. It would be a nurse-led service with GP support. Patients could “drop-in” without an appointment and be treated on the spot or referred to a doctor if necessary. Among local practices tendering for the ser-


vice was one with a reputation for innovation. The Miriam Primary Care Group is headquartered in a purpose-built medical centre based in Birkenhead and run by an ebullient GP named Dr Abhi Mantgani. Spearheading the bid was his practice partner and senior nurse practitioner Philomena Potts. The Miriam bid was successful and the pilot


kicked-off in January 2009 at two locations. It was promoted among the 58 practices across the Wirral. Five years on the drop-in clinics are now open seven days a week at one site and five days at the other. Following this success the local commissioning consortia have piloted the service at three other sites. Conditions treated include bites, stings, burns, cuts, ear and throat infections, UTIs, minor eye or head injuries. The clinics also offer emergency contraception, dressings and removals of stitches and staples. “We started off seeing about 10 or 15 pa-


tients on a week day and now we see between 50 and 60 in this one practice alone,” says Philomena. Wirral CCG estimates that the service is


averaging around 23,000 to 24,000 patient encounters per year. The average cost is around £20 per patient episode. This is about half the per-patient cost of a walk-in centre and a third of the cost of an A&E visit. The Miriam team is immensely proud of what has been achieved. “A&E attendances in the Wirral have re- mained static over the past three years whereas nationally you hear about 10 to 12 per cent more people attending A&E annually,” says Dr Mant- gani. “I think the minor injury and illness service has helped reverse the trend here.” The success of the service has also earned the Miriam Primary Care Group numerous plaudits, including nominations for HSJ and GP


10


Wirral ”


Awards and most recently a shortlist place in the Primary Care Team category of the 2014 BMJ Awards.


SERVICES ON THE DOORSTEP Recently I visited Dr Mantgani and his team at the Birkenhead Medical Building. Walking from Park Station the large three-story centre appears almost incongruous rising among the small terraced houses. Here Miriam shares facili- ties with the Cavendish Medical Practice along with a range of secondary care services run by Peninsula Health. The new building was opened in 2010. Passing through the front doors you enter an open and spacious ground floor recep- tion and waiting area with almost the feel of a small hospital. The centre is a far cry from Miriam’s previous


premises, says Practice Manager Jackie Ireland. “It looked a bit like Colditz,” she says – a one- story building with barbed wire along the roof edge. “It was a bit of a shock when I first drove up for an interview.” But she has now worked at Miriam for 23 years – first as receptionist and then a secretary and practice administrator be-


innovation “


THERE IS A LARGE WORKFORCE OF NURSES WHO WANT TO BE EMPOWERED AND UP-SKILLED


Philomena Potts


fore becoming a practice manager 10 years ago. Dr Mantgani came to Birkenhead in 1986,


employed as a young GP at a local practice, but within a year he had founded his own practice in a small neighbourhood health clinic. It was a brave move. “Most practices would not have even set foot


in this area back then because the reputa- tion was pretty dire to say the least,” says Paul McGovern, a commissioning support manager at Wirral CCG. The area suffered chronic long-term unemployment and was number one for child poverty in the whole of the UK. Among the older male community there was a legacy of industrial disease with a high incidence of respiratory illnesses. Drug and alcohol misuse was common among the youth, fed by the lack of work and low self-esteem. But Dr Mantgani embraced the challenge and within a few years the practice had grown from just under a 1,000 patients to 5,000. Many of the problems remain but things have improved locally. In subsequent years Dr Mantgani and the


staff at Miriam pioneered new ways of improv- ing healthcare services in the area. It was one


SUMMER 2014  ISSUE 10


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