Chris Town Peterborough PCT

Peterborough Doctors On Call (PDOC) Established Doctors in Rota Peterborough NHS Walk-in Centre Established 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 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 Reduction (%) 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