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    Click here to download Click here to download Presentation Transcript

    • Developing the medical model in community hospitals – our experience
    • Overview
      • Introduction to Torbay
      • Background to improvements in older people’s services
      • Modernising community hospitals
      • Questions
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • Questions ?