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Chris Town Peterborough PCT

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

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Chris Town Peterborough PCT

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  1. Chris TownPeterborough PCT

  2. 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

  3. 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

  4. ‘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

  5. 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

  6. 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

  7. 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’

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. Visits Surgery Phone Total 2002 1014 3285 4243 8542 2003 833 2583 4014 7385 Reduction (%) 17.85 22.8 5.28 13.5 First 12 Weeks

  14. 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

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