The Changing Vanguard Workforce

Whitstable Medical Practice

Dudley Multispecialty Community Provider

Better Local Care (Southern Hampshire)

Welcome Dr Nav Chana

Chair of National Association of Primary Care

Whitstable Medical Practice

Paramedics in the Community

Paul Sutton

Chief Executive

South East Coast Ambulance

NHS Foundation Trust

The Model

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Integration and improved clinical decision making are key

A higher skilled paramedic based in the community

(a Paramedic Practitioner or Paramedic with additional modules)

Improved clinical decision making skills

Supporting and being supported by the local

health economy (integration)

Objective Return the patient to

planned care

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Case Study We received several 999 calls to an elderly female

presenting with a range of symptoms over a short

period of time. She had a previous medical history of

TIA, epilepsy, postural hypotension and hypertension.

She was seen by a member of the Community

Paramedic Team who identified a possible high risk of

admission to hospital. Due to the relationships the

team have built within the Whitstable Health

Community, we were able to make prompt referral

within the local community.

An Admission Avoidance Plan was developed within a

short period of time. The Ambulance Service and

Community Teams now have access to this.

A member of the team visited on behalf of a GP an

elderly male who had an acute history of diarrhoea.

He was complaining of dizziness and not being able

to eat. Examination revealed he had a substantial

postural drop in his blood pressure.

The Community Paramedic was able to give

treatment and advice on scene and was therefore

able to avoid admission to hospital with the GPs

agreement. The same Paramedic reviewed the

patient the following day and found an improvement in

the patient’s condition with improved symptoms and

oral intake.

The patient expressed his appreciation for the service

provided.

Better outcomes are achieved when we work with others as a local team

Quotes

6 Patients and GPs are seeing the benefits

I was initially fairly sceptical about a pilot involving paramedics as I

could not see how we could maintain good standards of care, with continuity and timely decision making.

I was wrong. The experience of having paramedics attached to the

practice has been a very gratifying one. Contrary to fragmented care, I would say it is actually more joined up. Communication is excellent

with most visits followed by a face to face or telephone debrief and contemporaneous note keeping that both paramedic and GP can

see.

The high standard of assessment and readiness to diagnose has been the key together with a desire to respond to suggestions that

facilitate improvement.

It has improved the quality of my working day freeing me up to use my time efficiently, with no loss in continuity or good patient care.

This genuinely feels like an improvement in care where all parties

benefit.

Dr Natasha King (GP WMP)

Patrick and his…community paramedic …

team demonstrate remarkable efficiency,

knowledge and skill in the service they

provide, I shall be eternally grateful to

them.

Cecil Humphrey Smith OBE.

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Successes

• GP triage home visit requests ensuring that w e are sent to appropriate calls.

• Feedback to GPs either directly or via EMIS visit notes enable GP review of assessments, diagnosis and treatment.

• Use of Ipads w hile visiting gives access to patient history, medication, allergies, test results, etc. Also all visit notes can be uploaded to Emis for GP to

review before discussing treatment w ith the Paramedic.

• Know ledge of the GPs expectations prior to the visit.

• Incidental f indings - Additional time w ith the patient has resulted in f indings, eg. high blood pressure, to be found w hich had not been previously know n.

Also non compliance w ith medication unknow n to the GP.

• Freeing up of GP time.

• Willingness of the team to "go the extra mile" w hen necessary. e.g. returning later in the day to review patients progress, ensuring medication is

delivered by the Pharmacies.

• Quicker and more timely response to urgent visit requests.

• Carrying PP PGD based medicines has resulted in immediate dispensing of medication w hen appropriate.

• Greater aw areness and compliance w ith Admission Avoidance Plans.

• Flagging up, at an earlier stage, frequent 999 callers for Admission Avoidance Plan by the surgeries.

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Challenges

• Adjustments w ere necessary for a more eff icient and effective service. e.g. communication improvements.

• Continue to expand understanding of other community based services and how w e can w ork more effectively w ith them.

• Paramedics learning to improve their on scene time management. Lack of experience w orking w ith time constraints.

• Integration of 999 calls w ith GP visits.

• Governance

• Maintaining a quality service in the light of success producing increased demand..

Drivers

• Clinical outcomes

• Local performance

• Conveyance – alternative pathw ays

• PP attrition/satisfaction

• Productivity

• Clinical career framew ork for paramedics

• Reduce transport units and enable ITV

• Mileage

• Relevance to new commissioning models and architecture

• CFR management

• Strategic f it – urgent care

Dudley Multispecialty Community Provider

Teams without Walls

Paul Maubach, Chief Executive Officer, Dudley CCG

Paul Bytheway, Chief Operating Officer, Dudley Group FT

Dudley Multidisciplinary Team Members

NHS Partners include, Dudley Clinical Commissioning Group, Dudley Group Foundation Trust, Black Country Partnership Foundation Trust & Dudley and Walsall Mental Health Partnership Trust.

Our model is based on the following principles:

1. Shared ownership

2. Shared responsibility

3. Shared benefits

Maximising the potential of:

• The individual (in their community)

• Our staff in supporting the individual

• Our staff working effectively with each other

The difference to our patients “I feel safer now, really secure. The service is fantastic - although my GP had tried to help I was getting nowhere. They are someone to turn to when you feel you have no one and I can’t thank the Voluntary Sector Link Worker enough.

“Since he came on the scene it’s all gone one way, and that’s up. He made me aware of places I didn’t even know existed and I dread to think what my situation would be if he hadn’t helped me. If I can give a mark to represent his support it would be 10 out of 10, he has given me a lot of backing. I’m really chuffed”. (Mr Ivan Carter, patient)

“I am really pleased with all the Link Officer has done for me. I have now lost

weight and feeling happy about that. Having this bus pass means I can get out and about more and do not have to worry about the cost of bus fares. I can

now visit my Dad more often and he says the Link Officer has been a big help to me. I really enjoy volunteering at the community centre, sometimes we play

quizzes and I really enjoy that. (Jayne)

In the past as a case manager it was often

hard to access the services and the help you felt your patient would benefit from. It

could be very time consuming finding out the appropriate service and then the

appropriate person to refer to, however with the MDT meetings this has improved

considerably. I now have a network of colleagues to whom I can refer or simply

ask for advice. This has improved my efficiency greatly and lead to a service

improvement for patients and their carers

It is rewarding seeing how

integration has re-energised team members and the enthusiasm of

key professionals in the service has encouraged more staff to

want to become involved in this new way of

delivering health and social care.

The new integrated way of working has helped

me: better integrate with teams, understand what services

can offer and has given me greater autonomy this has directly

improved patient pathways of care and reduced unplanned admissions to hospital.

The difference to our staff

Why this has been successful • Clinically led, person centred

• Bottom up approach

• Different mix of workforce used to their maximum potential

• Teams without walls, working beyond organisational boundaries • Staff driving the pace of change

• Confirmed by successful outcomes

Our challenges

For our teams

• Engaging everyone to see the benefits of the model and

take them with us

• Not having single patient record • Expanding the workforce (e.g. shortage of ANPs)

Better Local Care (South Hampshire)

The Changing Vanguard Workforce

Dr Nigel Watson

GP Lead

Our Multi-Specialty Community Provider in

Southern Hampshire

• Around 30 GP practices working in partnership with Southern Health

NHS Foundation Trust.

• Supporting population of 220,000 in three initial localities (Gosport, East

Hampshire and South West New Forest).

• Supported by 16 local health providers, commissioners,

local authority and third sector partners.

• Significant growth across Hampshire anticipated…

Better. Local. Care.

• Better Local Care aims to provide better access, experience and outcomes for patients closer to their homes.

• This means fewer people will need to go to hospital, but more will be supported to take control over their own health and wellbeing.

Breaking the Mould • Direct access to a specialist at a surgery for patients with musculoskeletal pain

thanks to partnership between GPs and Southern Health NHS Foundation Trust.

• Consultant Physiotherapist for Musculoskeletal Services provides sessions at the Arnewood Practice as extended scope musculoskeletal practitioner.

• Among the first Better Local Care developments in South West New Forest.

• More rounded MSK pathway for patients.

• High level of assessment, diagnosis and management, quicker assessment and treatment, and longer appointments.

• Empowering patients.

• Scheme started on 1 July - so far achieved an 100 per cent patient satisfaction rate of “very satisfied.”

Improving Access • Patient experiencing a mental illness offered quicker, longer

appointments with an appropriate nurse at a Gosport surgery.

• Southern Health Community Psychiatric Nurse on-hand at Forton Medical Centre in Gosport for two-half-day sessions a week.

• Aims to improve access to an appropriate mental health professional in a GP surgery, offer longer appointments and further improve patient care.

• Prior to the scheme, GPs referred up to 12 patients a month to a hospital clinic. Since it started two patients referred.

Discussion