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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 - PowerPoint PPT Presentation
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Chris TownPeterborough PCT
Peterborough Doctors On Call (PDOC)
• Established 1994
• 85 Doctors in Rota
• Peterborough NHS Walk-in Centre
• Established 2000
• 16 WTE nurses + support staff
Background Information
• 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
Statistics
‘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
13.55.2822.817.85Reduction (%)
7385401425838332003
85424243328510142002
TotalPhoneSurgeryVisits
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