Chris TownPeterborough PCT

Peterborough Doctors On Call (PDOC)

• Established 1994

• 85 Doctors in Rota

• Peterborough NHS Walk-in Centre

• Established 2000

• 16 WTE nurses + support staff

Background Information

• 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

Statistics

‘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

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

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

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’

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

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

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

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

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

First 12 Weeks

13.55.2822.817.85Reduction (%)

7385401425838332003

85424243328510142002

TotalPhoneSurgeryVisits

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