Transcript Primary Care - Introduction

Emergency Access
a rounded view
Alastair Crosswaite
Morningside Medical Practice
Royal Infirmary of Edinburgh
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Patient Expectations
• Reassurance and prompt attention
• Effective and timely care
• Integrated services – not to be passed from
one service to another
• Their GP to be kept informed
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Single point of access
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For general practitioners/primary care team
For secondary care clinical team
Single phone number
Real time information provided
Services proactively provide data
Services 24/7
Ownership
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Understanding your local practice
• Elective v
emergency
• Value general practice
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Generalist skill mix
Continuity
Holistic approach
The gate keeper often misunderstood as this is
not a barrier but a facilitator role
• Patient into the right place to see the right person at
the right time
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Patient access
• 5 phone lines
• Up to 5 receptionists available
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Patient access
• Appointment type mix
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570/week List size 7500
34%-20% on day 66%-80% book 24hr/48hr/1 week in advance
Front load week no & on day appointments
Telephone consultations
• e booking
– On the day if routine slots unfilled, otherwise in advance
• Extended working day
– We cannot target patient groups
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Patient access
• Duty doctor
– Reduced routine commitments (no medicals)
– Urgent surgeries once daily (two routine)
– Front load week with single GP visiting on Monday.
• ‘No Triage’
– Reception staff will ask
• ? Urgent ? Today ? Visit or same day appointment
• Targeted triage works ?
– Can convert visits to advice or scheduled care
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Communication
• Accurate & prompt data flow in both directions.
• When this fails an outcome can be attendance at
A&E.
• IT ‘ joined up’
• The phone remains a useful tool if you know who
to talk to & you can get prompt access.
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GP contract
• Anticipatory care service level agreement with general
practice 2008/09
– Based on all age SPARRA data
– Guided primary care led care plan
• Care home anticipatory care plans (LES)
• Palliative Care plans (DES)
• COPD (LES)
• Elms care home project
– DNAR
– Incapacity forms
– Agreed care plans (lodged with care home & OOH)
– Medical summary including medication
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GP contract
Chronic disease management n GMS 2004-8
– Improved intermediate outcomes for patients with CHD,
stroke and diabetes will prevent vascular events including
MI Stroke & sudden death over a five year period.
– Therefore probably too soon to see impact on secondary
care emergency activity.
– Data trends are encouraging.
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Patient sign posting
• GP or A&E
– Should A&E have access to GP appointments in
hours ? (re-direct OOH)
– GP need to ‘advertise’ services & improve patient
knowledge.
– Maybe we need a good TV drama
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You will not stop all….
• Hospital front door needs to be slick at assessing
patients in this group & returning them to primary
care.
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Shared clinical information
Primary care based services that secondary care can access
Competency based delivery of care
Multi professional team
Ambulatory care development
Complex needs usually older patients usually need > 4 hours
Communication (accurate & prompt)
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GP role in secondary care services
• Based at the hospital front door
– Pre A&E
– A&E
– Acute medicine assessment units
• Several models exist across the UK.
• Understanding of how the ‘other side’ works on an
ongoing basis & not ‘when I was Dr Bells houseman’
• Common theme is to preserve/reintroduce gate
keeping ( see & treat & discharge)
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What is inappropriate attendance ?
• We need
– Clinical assessment
– Diagnostics
– Observation
• Ideally emphasis should be to shift unscheduled to
scheduled
– Assessment area
– OPD slots inc day hospital
– Ambulatory care
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In Summary
• Learn from what primary care is already doing
– Well & not so well
• Communicate evidence based good practice
• Design services around patients
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Contact
• [email protected]
• [email protected]
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