Introduction

Formerly known as the Ashtons Virtual Hub, our large, multi-disciplinary team is purpose-built to support primary care providers in tackling the evolving challenges around capacity, access, backlog, new care models and workforce development. We’ve  been supporting West Devon Primary Care Network since 2021 – with transformative results.

The Challenge

Covering a rural population of 36,500 patients across just three practices, West Devon Primary Care Network was under significant strain from increasing demand for GP appointments post-COVID. Patient demand peaked in January 2024 when the practices collectively delivered 569 appointments in a single day, representing an 11% increase in GP access requests compared to pre-pandemic levels.

This escalating demand intensified administrative backlogs and stretched the capacity of clinicians, particularly GPs responsible for overseeing long-term condition management. Performance was further hindered by geographic isolation, with many patients facing difficulty in accessing services. The PCN approached Agentis Healthcare as a prospective partner to deliver targeted improvements in efficiency, patient access and overall quality of care.

Our Approach

Working closely with the PCN to explore and understand challenges, we identified opportunities to:

• Alleviate administrative pressure on GPs
• Enhance long-term condition management
• Improve patient access and experience
• Reduce the number of unplanned clinical interventions, e.g. hospital admissions

We began by engaging our specialist clinical pharmacy team to focus on the proactive management of long-term chronic conditions. Key activities included:

• Reviewing treatment plans and arranging appropriate monitoring, e.g. blood pressure checks, Quality Outcomes Framework (QOF) aligned assessments, blood tests.
• Optimising therapy for chronic conditions such as hypertension, cardiovascular disease and asthma.
• Undertaking medication reviews at regular intervals to ensure ongoing safety and efficacy.
• Providing lifestyle advice and signposting patients to relevant services, such as smoking cessation and community-based support.
• Educating patients about their Q-risk score and advice on lipid-lowering therapies (both primary and secondary prevention) helping them to make informed decisions.
• Applying consistent SNOMED coding to aid accurate clinical documentation and performance monitoring.
• Scheduling patient follow-ups with our pharmacist team.
• Launching specialist deprescribing clinics to address polypharmacy proactively and reduce harm from high-risk medications.

The Impact

Our intervention delivered measurable improvements in both clinical outcomes and practice efficiency:

• Boosted GP capacity by 13%, freeing up more clinical time to spend on direct patient care.
• Lipid therapy compliance rose from 0% to 95%, with 35% of patients achieving non-HDL cholesterol levels under 2.5 mmol/L through dose titration, alternative therapies, and structured follow-up.
• Reduced administrative burden, allowing clinicians to focus on clinical decision-making and patient care.
• Improved medication optimisation, reducing the need for unplanned interventions
• Enhanced patient outcomes for those with long-term conditions, through consistent review and personalised care plans.
• Our digital solutions streamlined appointment booking and supported continuity of care.

We delivered results at both scale and local project level — for example, supporting the reduction of benzodiazepine and Z-drug prescribing, and surpassing national targets in lipid management and statin prescribing.

The success of our programme led to a four-fold increase in the PCN’s commissioning of Agentis Healthcare services. Our remit has since expanded to include regulatory support, such as regular clinical audits aligned with Care Quality Commission (CQC) standards.

Client Feedback

“I would not hesitate in recommending Agentis to other organisations facing similar challenges. The value lies in their ability to tailor services, promote teamwork and bring efficiency to primary care. Agentis’ flexibility and patient-focused approach make it a trusted partner in navigating the complexities of modern healthcare delivery.”

Darren Newland, Operations Lead, West Devon PCN