Transcript Background Info.

Chris Town
Peterborough PCT
Background Information
Peterborough Doctors On Call (PDOC)
• Established 1994
• 85 Doctors in Rota
• Peterborough NHS Walk-in Centre
• Established 2000
• 16 WTE nurses + support staff
Statistics
• OoH average 3000 calls per month
• 13% Home Visits
• 38% Surgery Consultations
• 48% Telephone Advice
• Av 160 Hospital Admissions/Month
• Walk-in Centre average 3000 per month all
face to face
‘Radical Solutions’ workshop Jan 2002 - ways
of reducing dependence on GP input OoH
SOLUTIONS GENERATED included
•
One call to central resource - locality based NHSD or call centre
(implement Carson recommendations)
•
Consistent information handling underpinned by Electronic Patient
Record communicating to and from Primary Care
•
Standardised triage/fast track emergencies - reduce duplication of effort
•
Standardised protocols and prescribing algorithms
•
Try to remove GP from ‘Red Eye’ equation
•
Extended day time access
•
Integration of available resources
•
Co-location
Project Plan
• Integrate clinical services
• Develop local model of care
• Nurse led first point of contact service
• Develop IT infrastructure – NHSD, WIC, GP
• Significantly reduce need for GP input
Project Team
• Chief Executive & representatives from A&E,
Ambulance, PDOC, Head of Primary Care, Director of
Nursing, Head of Modernisation, IT&T, Facilities Lead,
Non-Executive PCT Board member, Finance Director,
PCT Clinical Lead
• Communicating regularly with members at meetings
and monthly update newsletter
• Workshop on November 2002 to lay foundations for
integrated working OoH
• Workshop 29 July 2003 for action on next steps
Strategy
• Build on good working relationship PDOC
& PCT
• Range of options/partnerships considered
• Sell model to all partners particularly GPs
• Redevelopment of WIC into a bigger
building was the ‘key’
Key Steps to Success
• Strong internal leadership
• Appointment of Project Manager
• Communicating regularly with members at
meetings and monthly update newsletter
• Workshop on November 2002 to lay
foundations for integrated working OoH
• Workshop 29 July 2003 for action on next
steps post move to new premises
Key Principles Behind Solution
• GP role redefinition - advising supporting first
contact professional + dealing with more
complex cases
• Extending nurse role - autonomous working,
increased telephone triage, DNs and Rapid
Response Team to do home visits
• PCT to employ all staff + provide
infrastructure
• PDOC provide GPs until new contract opt out
Outcome
Decision to relocate Walk-in Centre to larger premises
Maintain & expand Dental Access at Midgate (Original
WIC)
Integrate
Peterborough Doctors On Call
Walk-in Centre
OoH community nurses
Rapid Response Team
Social Services
Paramedics
NHSD
Successes
• Kept the show on the road!
• Professionals gaining shared
understanding of respective roles
• Model of care attractive to nurses,
patients etc
• Reduction in financial burden on GPs
• Limited reduction in workload
• GP trainers employed to train nurses
Issues Raised Which Required
Resolution
- Palliative Care – access to controlled drugs
- Sudden death
- Security
- Training
- Recruitment & retention
- EPR/Communicating & alerting
- Catchment population
- Local trust/relationships/integration
- Isolation/discomfort for lone practitioners
First 12 Weeks
2002
2003
Reduction
(%)
Visits
1014
833
17.85
Surgery
3285
2583
22.8
Phone
4243
4014
5.28
Total
8542
7385
13.5
Difficulties Encountered
•
Separate starts with an evolutionary approach to integration
•
Strong local loyalties, initial desire to preserve own identity
and previous working style
•
Redefining of professional relationships and clinical
responsibilities with 85 GPs involved!
•
Linear design of building does not help side by side working
•
Lack of unified IT system
•
Under-estimated need for dedicated clinical leadership
nursing and medical
•
TUPE arrangements for staff comparative terms and
conditions