“OPENING DOORS”

Morecambe PMCF Pilot Scheme

Project aims

To provide , through collaborative working with GP practices and other Health Care providers , , the most appropriate health care for our patients , 7 days a week. From 8 a.m. To 8 p.m.

To provide improved and extended types of access to our patients for routine presentations

To develop more extensive community based primary care services to prevent unnecessary and inappropriate hospital attendances and admissions

Scale of project

Population covered , 61000 patients from 8 a.m. To 8 p.m . , seven days a week .

All Morecambe practices (4) , largest practice , 32000 patients, smallest 6500 .

Other Organisations involved include the OOH service (Virgin H.C) , Morecambe Same day Minor illness /injury service(C.H.Care) , North West Ambulance Service (NWAS) , and Extended District Nursing Service ( BFWH)

Main Features of the Pilot

During the week , practices will offer extended opening hours from their own sites

At weekends services will be based at a central site , co-located with the other provider organisations involved in the pilot.

The new “team “ at this site will consist of receptionists and a doctor

They will have immediate access to the complete medical records through EMIS web of all the patients of the practices included in the pilot

When a patient rings the practice at weekends , they will automatically put through to this team.

Depending on their needs , they will be given either an appointment for the appropriate clinician or directed to the appropriate service , hence the “Opening doors “

Main features (contd)

Because we are collaborating with other providers on the same site , we can book patients directly into both the Same Day Service (minor illness/injuries) or the Out of Hours service for urgent doctors appointments or visits .

Minor urgent queries , not requiring an appointment , can be dealt with by the triage doctor (script queries , path lab results etc) .

More appropriate advice , care pathways and treatments are provided by having access to the patients records and by being able to book patients directly into the appropriate services

Routine appointments are also pre-bookable at weekends (16 per day)

Main features (contd)

Enhanced district nursing resource Allowed for increased district nursing

resource( both hours and staffing levels) to cope with the increased number of patient’s that will require care at home when acutely ill.

Enhanced access to a improved range of minor injury services , including treatment for un-displaced fractures , suturing ,local access to x-rays .

This service will also take pressure off Lancaster A and E by providing theses services locally

The scheme also allows for NWAS to execute its “pathfinder” scheme . I.E can contact a doctor immediately ( who has access to patients records) to assess most appropriate place of care .

New technical (IT) aspects of the Pilot

We are developing an “App” for smart phones/tablets. This will provide practice specific information but also information on urgent services and also self help advice on common conditions as well as useful contact details .

The availability of a simple SMS based tool for specific patient groups (eFlorence) to promote self care . With this , information can be recorded by the patient and uploaded to the GP clinical system. How that information is processed and acted upon depends on the clinical protocol at the practice . It can be used for example to set personal reminders to take medication ,or to contact their doctor if certain readings/ levels occur .

Advanced Care Planning

Following on from a local CCG initiative a Nursing team will continue to identify patient specific groups who would benefit with agreed care treatment plans (e.g. nursing homes ,those on LTC list , palliative care patients “frequent flyer”or revolving door patients etc to see if advanced care plans in notes may decrease unnecessary admissions .

Measuring outcomes/sustainability

Patient satisfaction. We canvassed our patient on what they wanted , will measure patient satisfaction rates

Pilot costs . In excess of £1 million .Sustainability , less than this but totally dependant on

decreased A and E ad Urgent hospital admissions.Need to measure above both before and after the pilot .If successful, our CCG has committed to diverting the

relevant funds from secondary care ( UHMB) to primary care and to roll the system out across the local CCG footprint .

Agree to measure activity 3 , 6 , 9 and 12 month intervals during the pilot