1. Developing the medical model in community hospitals – our experience

2. Overview Introduction to Torbay Background to improvements in older peoples services Modernising community hospitals Questions

3. Overview of Torbay Population of 140,000 High percentage of elderly people Three population centres – Torquay, Paignton, Brixham Torbay Council – unitary authority with co-terminous boundaries with PCT Close working with South Devon Health Care Trust, Teignbridge PCT and South Hams/West Devon PCT

4. Recent developments in care of older people Change Agent Team review of older peoples services Dec 02 and subsequent action plan One of 8 PCTs exploring new ways of managing chronic disease First wave site for accelerated development programme in support workers for intermediate care Funding from DOH for specialist nurses to improve elderly care in Torbay Hosptial in line with standard 4 of the NSF Decision to form Care Trust from Oct 05 for all adult services across health and social care

5. Older Peoples Services – the future Community services for older people being developed as part of integration of PCT / Social Services Plan to group services around clusters of GP practices serving approx 25,000 populations Services to include social workers, dom care, OT, physio, district nurses, community hospitals managed by General Manager

6. Paignton Hospital Paignton – 2 wards Coverdale – medical step up/down, terminal care, rehab, treatments (e.g.transfusions) – GPSI led Fairweather Green – consultant led rehabilitation Outpatient clinics Medical, surgical, paediatrics, dermatology… MIU – Mon-Fri 9-5 (2,406 attendances in 2003/04) X-ray – Mon-Fri mornings

7. Brixham Hospital 20 beds – medical step up/down, terminal care, treatments (e.g. transfusions) Outpatients – e.g. medical, gynae, orthopaedics, surgery, dermatology MIU – 24 hours, 7 days a week (6651 attendances in 2003/4) X-Ray Mon-Fri mornings GP led – 12 doctors from 3 practices

8. Reviewing the medical model at Paignton Coverdale was GP led with 31 local GPs providing medical cover Bed fund annual budget - £125K Frustration of ward staff getting medical input Delays to patient discharge Lack of coordinated care planning

9. Aims of review Improve quality of patient care Provide focussed medical input to ward Support nursing staff whilst retaining empowered ward team Improve through-put of patients Reduce delayed discharges More effective use of funding

10. Process of review Proposal to terminate existing GP arrangements and replace with GPSI in Care of the Elderly Discussed with local GP committee and LMC Redundancy payments made to existing GPs Request for applications for new post made to GP community

11. Implementation of new arrangements One practice (3 GPs) applied along with associate GP from another practice Appointed one GPSI for 0.5 WTE 3 GPSIs share remaining 0.5 WTE GPSIs work Monday-Friday 9-5 WTE salary - £65k

12. Impact of changes Improved proactive patient care with dedicated attention from GPSIs Ward staff morale improved and they are benefiting from on-site medical cover (e.g.prescribing) Medical input into multi-disciplinary team meetings Closer links with DGH geriatricians Delayed discharges reducing Improvement in discharge summaries Through-put of patients improving

13. Learning experiences Challenge of planning contingency for sickness/leave cover Tendency for GPSIs to attempt to solve all patients medical problems Balancing hospital/practice commitments Develop medical input across community hospitals and intermediate care units Encourage all staff to plan for discharge as soon as possible

14. Other service improvements Modern Matron appointed across hospitals Patient satisfaction questionnaires/follow up phone calls Education programme for nursing auxiliaries on caring for older people Improving MDT meetings and discharge planning Dedicated PCT/social services discharge team working across acute/community hospitals

15. Future Plans for Community Hospitals Plans to develop other ward in Paignton as nurse/therapist led intermediate care Telemedicine links for MIUs Co-locate the therapy/social work team Implement Essence of Care across the hospitals Independent skill mix review of ward staff Review PCT medical cover across community hospitals/intermediate care Joint appointment of new COTE consultant

16. Questions ?