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The purpose of this document is to outline all of the transformative work that Camrose, Gillies and Hackwood Partnership have undergone since the three former Practices merged in July 2018 to become one large Practice operating across three sites.
Duty Hub
Prior to the merge, each Practice operated its own, different, duty service. At the point of merge we quickly established that the patients were receiving a different level of service depending on which site they were historically registered at. We decided to pool our on the day workload but still operate from our three separate sites. We soon realised that in order to offer a supportive and learning environment, we needed to relook into this service provision. We decided to go down the route of a Same Day Access Service for our combined patient list size of ~45k.
This meant recruiting several additional Advanced Nurse Practitioners and supporting them through their independent prescribing courses. It also meant relocating this service in its entirety to our St Andrews Centre site, our central site with good access facilities. We decided to have a hub within this service where the Clinicians all sit together in order to carry out their telephone consultations. We have gone from no locum wanting to work in our duty clinics, to locums actively pursuing becoming a Salaried GP solely working in our Duty Team.
Our pre-merge model was a duty service predominantly covered by GPs, the most expensive resource. We now operate on around a 70% ANP/other Clinician and 30% GP basis. This has allowed us to free up GP time in order for them to manage the routine pre-bookable appointments as well as more proactively manage their chronically unwell patients.
We have a (job-share) Clinical Manager who oversees the smooth running of this service on a day to day basis as well as Line Manages the team. The Clinical Manager is an ANP and she gets involved with the telephone triage and face to face reviewing of patients.
We have also now included our Clinical Pharmacist in this team for three sessions per week. Our Clinical Pharmacist manages any medication queries that a patient might contact us about.
We also have a Mental Health Practitioner working in the Duty Team on a part time basis. Our Mental Health Practitioner calls back patients that have disclosed a mental health concern as their reason for their call. She will also then see them within an appropriate timeframe and manage their concerns appropriately.
We have a Paramedic Practitioner in this team and he works alongside the ANPs and GPs with the telephone consultations and face to face reviews. He will also go and visit patients deemed as clinically appropriate for his skill set. He will often visit four patients in a day, roughly ¼ of the visiting demand.
We now have a Healthcare Assistant working with our duty team. Their job is to assist with patient observations and to then flag them to the attention of the Clinical Lead should they feel they need to be seen quicker than the current wait time. The Healthcare Assistant takes ECGs, bloods, BP readings, pulse and carries out urine dipstick tests.
In terms of data, on an average day, our Duty Team speak to around 210 patients and see around 65 face to face, a conversion rate of around 31%. These figures have been known to increase to 300/130 after a bank holiday.
Looking at A&E data, we have received the following number of A&E reports for our patients. The data from August 2018 is since our Duty Team commenced:
Month & Year | Number of A&E reports received |
April 2017 | 897 |
May 2017 | 886 |
June 2017 | 1006 |
July 2017 | 902 |
August 2017 | 844 |
September 2017 | 822 |
October 2017 | 840 |
November 2017 | 784 |
December 2017 | 852 |
January 2018 | 823 |
February 2018 | 762 |
March 2018 | 902 |
April 2018 | 802 |
May 2018 | 920 |
June 2018 | 785 |
July 2018 | 783 |
August 2018 | 741 |
September 2018 | 775 |
October 2018 | 698 |
November 2018 | 673 |
December 2018 | 629 |
January 2019 | 787 |
February 2019 | 754 |
According to the number of A&E reports received by Camrose, Gillies and Hackwood Partnership, and the three Partnerships prior to the merge in July 2018, our A&E attendance figures have reduced by 17% from 17/18 to post-merge and commencement of our Duty Team. This is based on the 10,320 A&E reports received in 17/18 and the 4,303 received in the six months following the initiation of our Duty Team (doubled to reflect one year). This represents 1,714 less attendances in a period of one year.
Diabetes Consultant Clinics
The Practice have an arrangement with the local Hospital whereby a Consultant, Andrea Norris, comes to our Diabetic Hub site, Gillies Health Centre, and runs a Diabetes Clinic alongside one of our GPs. These clinics are run on a monthly basis and the GP supporting the clinic rotates. The idea of these clinics is to see patients who require specialist intervention closer to their home. It is also to upskill the GPs in Camrose, Gillies and Hackwood Partnership with a Specialist Interest in Diabetes as to reduce referrals into the Diabetic Department at the Hospital. The GPs working within these clinics, as well as the Consultant, host a Diabetes MDT following the clinic to which all Clinicians are invited. Specific patients and case stories are discussed and learning from these are there disseminated to all Clinical staff.
Diabetes Hub
Using the new Nursing Suite at Gillies Health Centre, Camrose, Gillies and Hackwood Partnership have pooled all diabetic services onto one site. The vision when planning this change was for registered diabetic patients to attend a ‘one stop shop’ for all of their diabetes care. Within this hub we now offer: Diabetic HCA appointments, Diabetic Nurse Appointments, the aforementioned Diabetic Consultant Clinics, Diabetes MDT meetings, Diabetic Eye Screening Clinics and Diabetes Education sessions.
Having our entire Diabetic team working together will enable our newer Diabetes Nurses to work alongside those who are move experienced in more complex diabetic care, such as the initiation of insulin. At present we have three Nurses who can initiate insulin and they are currently supporting a fourth Nurse to be able to do so.
Respiratory Hub
Using the top floor at our Essex House, we have pooled all of our Nurse Respiratory care into a hub on one site. In doing so, we have created a supportive learning environment which will increase recruitment and retention possibilities. Two of our experienced Respiratory Nurses are currently supporting another Respiratory Nurse in the completion of her COPD Diploma.
We are currently exploring the possibility of running a ‘breathe easy support group’ for those patients living with a lung condition.
Leg Ulcer Hub
Following Camrose, Gillies and Hackwood Partnership being the host for the North Hampshire Alliance Leg Ulcer Pilot, which was also staffed by solely Camrose, Gillies and Hackwood Partnership staff, we have implemented our own leg ulcer service. This service includes leg ulcer assessment clinics and well-leg clinics. These clinics are all offered from our St Andrews Centre site in our bespoke treatment room.
The premise behind the assessments is to provide a quicker and more thorough assessment of the wound to ensure appropriate and timely management to reduce heeling time. The premise behind the well-leg clinics is to prevent leg ulcers from reoccurring and to catch any wounds susceptible to ulceration quickly. Once treatment has been started, patients ongoing care is delivered through our Leg Ulcer Club.
Menopause Evening
Earlier this year, Camrose, Gillies and Hackwood Partnership wrote to all female patients turning 50 within the next 12 months in order to invite them to an evening educational meeting about the Menopause.
This meeting was conducted outside of core NHS hours and there were around 35 attendees. The feedback that we received was extremely positive and patients were highly appreciative of the information provided.
Mental Health Practitioner
Camrose, Gillies and Hackwood Partnership have a part time Mental Health Practitioner working within the Duty Team. She manages calls whereby a mental health concern is identified as the reason and she then sees the patients face to face as and when appropriate. The Mental Health Practitioner has 30 minute appointments and this allows her more time to listen and plan the care for the patient. Having a Mental Health Practitioner working in our Duty Team allows our ANPs and GPs to manage patients with physical problems. It allows patients to speak to the most appropriate Clinician within the most appropriate timeframe. We have also recruited a salaried GP with a special interest in mental health and her clinics have longer appointments to deal with complex patients.
Frailty Clinical Matron
We have a full time Clinical Matron who manages a caseload of severely frail patients. She proactively visits frail and housebound patients for future care planning and to reduce hospital admissions.
Paediatric Consultant Clinics
Camrose, Gillies and Hackwood Partnership has an arrangement with the local Hospital whereby a Consultant, Nick Ward, comes to our Essex House site and runs a Paediatric Clinic alongside one of our GPs. These clinics are run on a monthly basis and the GP is the same each month. The idea of these clinics is to see patients who require specialist intervention closer to their home. It is also to upskill the GPs in Camrose, Gillies and Hackwood Partnership in Paediatric care as to reduce referrals into the Paediatric Department at the Hospital. The GPs working within these clinics, as well as the Consultant, host a Paediatric MDT following the clinic to which all Clinicians are invited. Specific patients and case stories are discussed and learning from these are there disseminated to all Clinical staff.
Clinical Pharmacist
Camrose, Gillies and Hackwood Partnership have a full time Pharmacist who works from the Gillies Health Centre site. Our Pharmacist assists with medication query telephone consultations alongside the Duty Team three sessions per week. She also does two face to face polypharmacy clinics per week looking at those patients on multiple medications to ensure appropriateness and correct usage.
In addition to her patient contact work, our Pharmacist manages all of the prescription requests for supplies and consumables such as dressings and catheter bags, saving the GPs time. She also works closely with our prescription team and is upskilling them.
Nursing Home Pilot
Camrose, Gillies and Hackwood Partnership took part in the Nursing Home Pilot commissioned by the North Hampshire Alliance for which GP and Clinical Matron time is utilised to carry out Nursing Home rounds including MDTs and care planning. The premise behind this service is to reduce admissions and increase patient choice around their care as well as their wishes surrounding end of life care and death.
This pilot was funded on a sessional basis but came to an end in October 2019.
Social Worker
We have a Social Worker working from Camrose, Gillies and Hackwood Partnership in order to improve and expand Network and MDT working. He works on a Monday afternoon and rotates the site at which he works from so that all employees get used to seeing him and including him as appropriate.
The Social Worker also attends our Integrated Care Team Meetings on a monthly basis. Whilst he cannot accept new referrals, as there is a very specific route for these, he does provide advice and support to the Practice as required.
Specialist Link Programmes
We currently have three GPs taking part in the GP Speciality Link Programme. The idea behind these programmes is for the GPs to work alongside Secondary care to upskill and gain experience in more complex presentations in order to manage them in Primary Care (where appropriate). The desired outcomes include: better recruitment and retention as we are able to offer a ‘different’ kind of role from the norm, upskilling of the individual taking part as well as them sharing their learning to upskill the wider team, reduction in referrals to Secondary Care and more specialised care being offered to our registered patients. Our GPs are linked to Gynaecology, Neurology and Diabetic Care.
Women’s Health Hub
Camrose, Gillies and Hackwood Partnership has created a Women’s Health Hub. This means that we provide streamlined women’s health clinics from one site, these clinics are directly bookable by patients and other GP colleagues. They are staffed by GP’s with additional qualifications and interest in women’s health and contraception. They offer coil and implant fitting with health care assistant support where needed, specialist menopause advice and can deal with all women’s health issues in an environment where all the appropriate equipment is to hand.
Camrose, Gillies and Hackwood Partnership has also set up an arrangement with the local Hospital whereby a Consultant, Christian Phillips, comes to the Practice and runs a Gynaecology Clinic alongside two of our GPs. These clinics will be run on a monthly basis. The idea of these clinics is to see patients who require specialist intervention closer to their home. It is also to upskill the GPs in Camrose, Gillies and Hackwood Partnership in Gynaecology with the hope of reducing referrals into the Gynaecology Department at the Hospital. For those who may need referral for a surgical procedure this will reduce the need for first outpatient appointments as the work will already have been done in primary care. The GPs working within these clinics, as well as the Consultant, will host a Gynaecology MDT either before or after the clinic to which all Clinicians are invited. Specific patients and case stories are discussed and learning from these are there disseminated to all Clinical staff.
Leg Ulcer Club
In January 2020 we are launching our leg ulcer club based at the Church Centre at St Andrews. The plan is that this will meet the huge demand arising from leg ulcers but also to help remove some social isolation and home visits being made. Our Social Prescriber will be part of the team that meets these patients on a Friday morning, along with the lymphedema nurse, community nurses and our practice nurses.
Social Prescriber
We have a Social Prescriber for our Network via the Red Cross and with assistance of the CCG. This is a completely new role to Primary Care and we are very interested to understand the benefits to our patients of having this professional in post. They are based at Essex House.
Andover MIND
Two mornings a week we have a wellbeing worker from Andover MIND based at Essex House to provide the first point of contact for patients who are beginning to suffer with low mood. They are also based at Essex House with our social prescriber.
Mental Health Hubs
We are launching monthly Mental Health Hubs at Essex House combining face to face consultations with a consultant from HHFT and an MDT at the end. These will start in November 2020, running much like the Paediatric MDT.