Leading questions: Harrow East PCN clinical director Dr Meena Thakur MBE

Dr Meena Thakur is clinical director of Harrow East PCN, London and GP partner at Honeypot Medical Centre in Stanmore and in May she was presented with her MBE at Windsor Castle by HRH Prince William for her services to the NHS. She talks to Victoria Vaughan about her work leading the PCN

Victoria Vaughan (VV): Congratulations on your MBE. Can you talk a little bit about why you received the award and what it means to you?

Dr Meena Thakur (MT): I was taken by total surprise and feel deeply humbled to be considered worthy of the King’s Honour, and also to have received this award personally from the Prince of Wales.

Awardees don’t get to find out who nominated them and the specific reasons, but I was advised it was for my contributions to the NHS and my services to General Practice and primary care in my roles as clinical director of Harrow East PCN as well as a GP Partner, serving my local community for 30 years.

As PCN clinical director, I led our Covid vaccination programme in North-West London from the first day the vaccines were made available in the community. We had to develop our own standard operating procedure (SOP), as no one had given a Covid vaccination in the community before. This later became a blueprint for many other centres and received considerable media attention including a visit from the Prime Minister at the time, Boris Johnson.

Covid had a devastating impact on our local community, where 70% of our patients are from ethnic minorities, and where we saw so much illness and deaths. Given the disproportionate impact of Covid on ethnic minorities, we adopted culturally competent approaches to increase uptake amongst our diverse population who were at greatest risk and vaccinated more than 60,000 patients in the first and second phase of the vaccination programme.

VV: What is unique about your PCN?

MT: I was clear from the outset that the primary function of our PCN was to support the sustainability of GP practices to have a manageable workload and achieve cost-efficiencies through collaborative approaches. It is only by having stable practices that the wider aims of the PCN to improve our population’s health can be achieved.

It’s particularly helpful that we are small, with only three member practices with a population of 39,000 in a defined geographically contiguous area. We have weekly board meetings where we can reach decisions in a timely and constructive manner.

We also believe in the individuality of GP practices, while also benefiting from collaboration. For example, the three practices use different online consultation tools, yet our remote e-hub supports all three systems.

VV: How have practices been supported by your PCN?

MT: We employ staff to provide dedicated individual practice support. We were one of the first PCNs to create a remote E-hub, where our PCN hub team supports practices with a range of administrative and back-office work, such as call-recall for QOF, national and ICB enhanced services. We also support practices on increasing childhood immunisations and cervical screening among ethnic groups, using culturally sensitive approaches. Such initiatives have reduced staff costs and patient calls into practices.

We also created a PCN Access Hub, which began with centralising our enhanced access service but has expanded to providing more capacity across six days. We have regular doctors and other clinicians providing tailored care for each practice, which member practices can book into equitably based on list size, providing practices with much-needed additional capacity. This provides further support and resilience for practices and has also reduced GP and staff costs for each practice.

We have also provided practices funding to avail of innovative digital tools, such as project management platforms, voice dictation and mobile phone access to EMIS.

We are supporting practices with SOPs and staff support to adhere to compliance requirements, including CQC standards.

VV: How does your PCN use the ARRS?

MT: We use ARRS roles in a way that supports individual GP and practice workload. We discuss every new ARRS appointment in our board meetings, to make sure that the roles will bring optimal support and value to our practices and PCN.

We have employed pharmacists, ANPs, first contact physiotherapists, paramedics, care coordinators and a mental health link worker. We also have a contract with a fantastic social prescribing service.

We want practices to feel that any ARRS member of staff is working for them rather than working for the PCN and ‘dipping in’ to practices.

We also provide training to ensure ARRS staff provide optimum general practice focused support. For example, we have significantly developed and expanded the role of our pharmacists to include long-term condition management, such as diabetes, heart failure, hypertension, asthma/COPD, high risk drug monitoring.

We are currently evaluating the value and effectiveness of the various ARRS roles, including auditing consultations and quantifying cost-effectiveness of ARRS roles, to enable us to make an informed decision on which ARRS roles to continue using or develop further.

VV: How is your PCN approaching the addition of GPs to ARRS?

MT: We are very positive about the addition of GPs to the ARRS scheme and have expressed our interest to our integrated care board (ICB). We are awaiting details on additional funds that will be available to our PCN from October. We are actively trying to recruit a GP to our PCN and we hope the scheme will extend beyond the initial six months. This is a great opportunity to offer newly qualified GPs secure employment in practices/PCNs and security for practices as well.

VV: What does your PCN think about the Darzi report?

MT: We welcome the report’s explicit recommendation to increase resources in primary care. In particular, addressing the deficit in primary care estate could give us vital space to house our staff and expand services. With increased funding, we know that our PCN can do so much more to enable tangible improvements in health and care for our community.

VV: How are you trying to improve the health of your community and address inequalities?

MT: We have one of the highest Romanian populations in the country, which has worse health outcomes and lower immunisation and screening uptake. As a consequence, we were recently at the heart of the measles epidemic. This also significantly affected all our practices’ childhood immunisation uptake and our PCN supported practices by dedicated engagement work with the Romanian community to address their concerns and health beliefs. We have appointed a Romanian care coordinator and produced culturally sensitive communications and strategies to educate them on the importance of immunisations.

Almost 70% of our population is of Asian origin with a high prevalence of diabetes and heart disease – 10% of our population have diabetes and a further 10% have pre-diabetes. We run regular diabetes group education sessions to educate patients on diabetes, knowing their numbers and empowering them with self-management and lifestyle advice.

VV: What are your future plans for your PCN?

MT: We want to ensure more appropriate use of GP appointments, to liberate capacity and improve access to seeing a GP. One strategy is to manage demand by expanding patient education, empowerment and self-care. This includes increasing patients’ use of the NHS App, enabling patients to view their own results rather than contact the practice by default, as well as the status of their own hospital appointments. We also plan to further improve care navigation to direct patients to appropriate support, where they don’t need to see a GP. This will be aided by increasing online consultation uptake and expanding the role of our hub team to support GPs, using online consultation pathways and SOPs, which we are currently developing.

We are further developing our training and mentoring programme to upskill other healthcare professionals to support with less complex clinical or clinical administrative work, releasing GP time for dealing with complexity, and to enable longer GP consultations. We hope this will go some way to reduce the stress of GPs and practice staff.

We also plan to address primary-secondary care interface issues, which are not only increasing GP workload but blocking appointments and reducing access. We are developing standardised templates and staff training to push back on inappropriate hospital-generated demand on GP appointments.