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North Denbighshire Minor Illness Service

Winter Pressure Scheme

Who are you and where are you from?

• Who is part of a cluster?

• What roles?

• What is the best thing about your cluster?

• What is the one thing you would change about your cluster?

• Who are your change agents?

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North Denbighshire Cluster

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North Denbighshire Cluster

• 6 practices

• 5 GMS and 1 Health Board Practice (Healthy Prestatyn Iach)

• 2 cluster leads since 2016

• Greatest resource is our Practice Managers!

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North Denbighshire Cluster

• Population aged 75 years and over is projected to increase to 7,500 by 2039

• 25% of children in Denbighshire live in poverty

• Those living in the most deprived areas of Denbighshire will live, on average, less years than those living in the least deprived areas of the county (11 years less for men and 8.4 years less for women)

• 62% of the North Denbighshire GP cluster population aged 16+, are of an unhealthy weight

• 32% of children age 5 in Denbighshire are overweight or obese, significantly worse than the Welsh figure (26%)

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North Denbighshire Cluster

• North Denbighshire practices have a high number of patients per GP WTE compared with other clusters; there are around 2,700 patients per GP compared with a central area average of 2,196 per GP

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Winter Planning Strategy

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• How to protect primary care and support sustainability through the winter, first and foremost

• Taking learning from an in hours project on Llyn Peninsula, the OOHs team provided a service for temporary residents in the summer months.

• North Denbighshire cluster focussed on extending the initial service in hours service to the evening and weekends to support OOHs and ED

Minor Illness Service

• Cluster ‘In Hours’ Service

-Creating capacity for practices

• Winter Pressure ‘Out of Hours’ Service

-Supporting the

unscheduled

care agenda

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Minor Illness Service

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Minor Illness Service

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ANP led

Minor Illness Service

Adastra vs EMIS

• Adastra is the OOHs clinical system

• One system for all practices

• Ability to identify and pull patients

• An upgrade prevented the system to be put in the service

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Minor Illness Service

Adastra vs EMIS

• EMIS is the practice clinical system

• Full medical record

• Multiple log ins for the ANP

• GDPR issues

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Minor Illness Service

GDPR Information Governance

• A Data Protection Impact Assessment

• Nurse Practitioner signed confidentiality user agreement forms for each practice within the cluster

• Service Level Agreement between the Health Board and the GP Practice for where the service was delivered

• At time of booking appointment patients were asked for verbal consent to their records shared with the Nurse Practitioner

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Minor Illness Service

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Cluster Members

• Cluster Team – Part 1

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Minor Illness Service

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Plan, Do, Study, Act

• Continual improvement

• Failures become learning exercises

• Ability to streamline processes

• Capture lessons learnt

Data

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In Hours and Out of Hours – Activity December 2018 –

September 2019

Numbers

Number of Consultations 3629

Patient Outcomes

Self-care advice 1187

Prescription given 2188

Referred to Emergency Department 54

Referred to GP 146

Refused Service 45

Referred to Physiotherapy 1

Referred to Enhanced Care 2

No Outcome Recorded 6

Patient Feedback

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Fantastic service!

Nurse very helpful!

The care was excellent!

Thank you for seeing

me!

Very thorough!

Post Winter Pressure Funding April 2019

• The service continued post Winter Pressure funding, supported through the cluster

• The service is paving the way for urgent care centres in North Wales which have had benefits across other areas of the UK

• The cluster will benefit from the re-development of the Royal Alex Community Hospital in Rhyl, of which has plans to include an urgent care centre

• The service continues to prove the importance of sustainability of primary care and the unscheduled care agenda

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Next Steps/vision

Multidisciplinary team within the service to include:

• Mental Health practitioners

• Third sector

• Local authority

• Community Resource Team

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Thank you!

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