HTN Primary Care Awards 2025: Improvement Initiative of the Year

Here, we present the finalists for the HTN Primary Care Awards 2025 category of Improvement Initiative of the Year.

Think Healthcare – Focus Group

Overview: Analytics can sometimes feel like an area only applicable to a ‘big picture’ view, and not something that brings meaningful local change. We show how a simple but effective data analysis combined with modern digital communication tools helped one practice improve patient engagement & bring big benefits to the masses.

Why? The surgery faced several engagement and communication challenges common to many GP practices, including a lack of detailed data on patient interactions and service demand, and challenges in managing appointment bookings, prescription requests, and routine enquiries at scale and through differing communication routes.

What happened? The solution integrates Think Healthcare’s NHS Cloud Telephony module with Virtual Care Navigator (VCN). VCN enables 24/7 access to essential services, allowing patients to book, check, and cancel appointments, order repeat prescriptions, and access other vital services via phone. The NHS Cloud Telephony System enhances communication with features like auto-callback, dynamic call routing for vulnerable patient groups, and advanced patient demand analytics to show ‘why’ patients call, not just call volumes. The implementation was a comprehensive process designed to ensure seamless integration and optimal performance, with customised data collection and integrating with practice total triage priorities to enable a consistent approach to triage questions & data collection. Results showed that 43 percent of patients wanted to request medication over the phone. A third of calls are now handled by VCN daily, with automated handling of prescription requests reducing calls by 30 percent, significantly decreasing wait times, and 80 percent of patients using the triage form. Evidence shows reallocation of 3.5 FTE of admin funding into clinical staff.

Looking ahead. This case study demonstrates a blueprint of how strategic use of the right data & digital tools can address widespread NHS priorities and deliver meaningful benefits to both patients and healthcare providers at scale.

Vertis Health, Commissioned by NHS Herefordshire & Worcestershire and Worcestershire County Council

Overview: The Your Health programme delivers vital health checks and screenings to underserved communities in Worcestershire. Using mobile outreach and data-driven care pathways, in 9 months we’ve engaged 1,756 patients, and conducted 606 NHS Health Checks, reducing GP and A&E pressure.

Why? To reduce health inequalities, signpost local services, and provide advice to patients from across Worcestershire.

What happened? At Vertis Health, we are proud to have been commissioned by NHS Herefordshire & Worcestershire and Worcestershire County Council to deliver the Your Health programme—a roving outreach service designed to provide essential health checks and screenings to communities facing the greatest barriers to care. By offering services such as NHS Health Checks, cardiovascular disease (CVD) risk assessments, lipid and HbA1C testing, blood pressure monitoring, and GP registration support, our team are transforming early detection and prevention strategies in our county’s most underserved areas. Built on an agile, data-driven approach designed to maximise, clinical impact, our model integrates targeted outreach with real-time analytics, ensuring that interventions are informed by local public health data and adapted to meet the evolving needs of our communities. With the support of partners from across our local community, we have been proud to implement and support with a range of clinical interventions, including remote cervical screening clinics and a direct bloods pathway in Redditch. In the period 5th April to 31st December 2024, Your Health delivered 1,756 patient engagements across Worcestershire, 606 full NHS Health Checks, 510 blood pressure checks, 322 lipid prevention tests, and 52 HbA1C tests.

Looking ahead. This service has delivered tangible benefits to our patients, with the team becoming a recognisable presence in areas most impacted by health inequalities—and we believe them to be a credit to our local health and care sector.

Staffordshire Training Hub GPN Foundation School

Overview: The Staffordshire GPN Foundation School offers a structured, standardised approach to recruiting and retaining general practice nurses (GPN). It mirrors the GP Training Scheme, addressing the need to reshape GPN recruitment culture, ensuring sustainable nursing and enhancing patient care in General Practice.

Why? Fit for the Future: a Vision for General Practice showed that whilst the practice workforce has grown over the last three years, GPN numbers have fallen. Challenges of recruitment and retention of General Practice Nurses (GPNs) are: inadequate support for new entrants; ageing workforce; and nurses lacking GPN experience to secure nursing positions.

What happened? At inception, no standardised training pathways were available for new GPNs. Founded in 2023, the Staffordshire GPN Foundation School (GPNFS) offers an innovative approach to GPN education. A proof-of-concept model, the GPNFS promotes essential changes to safeguard and enhance the GPN role, ensuring safe and competent service delivery in Primary Care, also supporting the national career and core capability framework. Unlike previous short-term recruitment initiatives, the GPNFS offers a sustainable model with key innovative elements for long-term impact. Key variations in the GPNFS initiative to previous models are: unique centralised recruitment and employment model; partnership working with PCNs/practices including financial support; and support and development for in-house and external practice supervisors and assessors. Key outcomes include an increase supply of nurses in GP settings, with 15 appointed from cohort one and 16 appointed from cohort two. A significant finding was that the programme enabled new GPNs to become competent and more confident in a shorter time than previous methods.

Looking ahead. Despite funding challenges, the programme has secured resources for two more years, supporting future sustainability.