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  1. 1. Developing the medical model in community hospitals – our experience
  2. 2. Overview  Introduction to Torbay  Background to improvements in older people’s services  Modernising community hospitals  Questions
  3. 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. 4. Recent developments in care of older people  Change Agent Team review of older people’s 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. 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. 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. 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. 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. 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. 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. 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. 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. 13. Learning experiences  Challenge of planning contingency for sickness/leave cover  Tendency for GPSIs to attempt to solve all patient’s 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. 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. 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. 16. Questions ?

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