Implementing Collins at Frimley

Mrs. Geeta MenonDirector of Medical Education

Frimley Park Hospital NHS Foundation Trust

Collins report

Stakeholder Discussion Groups

• Chief Executive Officer and Medical Director

• Clinical Directors, Heads of service, FTPDs and Consultants in charge of rota

• Trainees

Initial response

• Changing the mind set of colleagues

• Discussion around training and service provision

Key themes and challenges• Options of integrating community placements

• Service delivery and effects on rota

• Links within the community

• Opportunities

Trauma & Orthopaedics

• Fracture neck of femur pathway

• Working with physiotherapist and occupational therapist

Surgeons

• Upper GI and Breast surgery

• Phyllis Tuckwell Hospice

Urology

• Community urology clinic with specialist nurse

• Incontinence clinic

Obstetrics &Gynaecology

• Community midwife

Paediatrics

• Community paediatrics

Ophthalmology

• Diabetic screening programme

Pilot• Urology

• Trauma and Orthopaedics

• Surgery

Results of Pilot

• Pilot in T&O and Urology

• Trainees views

NOF Fracture Pathway

Dr. Serjevan Kalsi, Dr. Leila Mohamed, Dr. Thorrmela Vijayaseelan

F1 Doctors Orthopaedics, Frimley Park Hospital

Pathway Outcomes

• Reduce variation in length of stay, reduce mortality and re-admissions

• Surgery within 24 hours at FPH• Early mobilisation• Multi disciplinary team• Discharge

– Farnham/Fleet– Home +/- Care package

Farnham/Fleet

• Rehabilitation Centres• Small Wards• Consultant Led Beds• F1 Review Daily• 1-1 Consultant Contact• Daily Physio/OT input• Experienced Nursing Staff

Home• No Orthopaedic follow up

• No further OT input – Extra facilities in place

• Physiotherapy Outpatients

Intermediate Care Team

• ‘Promotion of independence & Safety first’• Aims to build confidence in the home

– Initial Interview– Mobility– Transfers– Domestic activities and Activity tolerance

Advantages of Project• Realistic process of discharge

• Highlighted gaps in holistic care

• Not just a simple social history

• Are patients coping?

• Recognising potential follow up

Disadvantages of Project

• Difficult to get time off– Trauma, Post Trauma, Oncall Dedications

• Difficult to co-ordinate visits

Recommendations

• Incorporated into Rota/Taster Weeks • MDT Attendance

• Presentation at Trauma Meetings

Thank you

Community Experience

Dr Emma Humphreys

FY2 Urology

Frimley Park Hospital

1 day at Fleet Community Hospital Bladder Cancer CNS Haematuria Clinic Flexible Cystoscopy Intravesical BCG Consultant OP clinic

Advantages

Off-site so free from ward jobs Enthusiastic nurse willing to teach More time for learning Able to carry out procedures Observation of other OP Ix OP clerking new pts 1 to 1 with Consultant DOPS/CEX

Difficulties

Rota challenges Liaising with DNs Incontinence clinic proved impossible Relevance to job Mostly observation

Recommendations

Build into rota 5 days in 4 month placement sufficient Placements to be organised Utilise experience of Nurse Specialists

Thank you

Results of Pilot

• Trainers and service provision

• Community

• Roll out to all posts in August 2012

Take home message

• No easy answers• Engagement from

- Leadership i.e CEO Medical Director- Middle management i.e Clinical Directors, Heads of Service, FTPDs, Consultants in charge of rotas- Trainees

• Feedback