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Emergency Access a rounded view

Emergency Access a rounded view. Alastair Crosswaite Morningside Medical Practice Royal Infirmary of Edinburgh. Patient Expectations. Reassurance and prompt attention Effective and timely care Integrated services – not to be passed from one service to another Their GP to be kept informed.

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Emergency Access a rounded view

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  1. Emergency Accessa rounded view Alastair Crosswaite Morningside Medical Practice Royal Infirmary of Edinburgh MMP/RIE

  2. Patient Expectations • Reassurance and prompt attention • Effective and timely care • Integrated services – not to be passed from one service to another • Their GP to be kept informed MMP/RIE

  3. MMP/RIE

  4. Single point of access • For general practitioners/primary care team • For secondary care clinical team • Single phone number • Real time information provided • Services proactively provide data • Services 24/7 • Ownership MMP/RIE

  5. Understanding your local practice • Elective v emergency • Value general practice • Generalist skill mix • Continuity • Holistic approach • The gate keeper often misunderstood as this is not a barrier but a facilitator role • Patient into the right place to see the right person at the right time MMP/RIE

  6. Patient access • 5 phone lines • Up to 5 receptionists available MMP/RIE

  7. Patient access • Appointment type mix • 570/week List size 7500 • 34%-20% on day 66%-80% book 24hr/48hr/1 week in advance • Front load week no & on day appointments • Telephone consultations • e booking • On the day if routine slots unfilled, otherwise in advance • Extended working day • We cannot target patient groups MMP/RIE

  8. Patient access • Duty doctor • Reduced routine commitments (no medicals) • Urgent surgeries once daily (two routine) • Front load week with single GP visiting on Monday. • ‘No Triage’ • Reception staff will ask • ? Urgent ? Today ? Visit or same day appointment • Targeted triage works ? • Can convert visits to advice or scheduled care MMP/RIE

  9. Communication • Accurate & prompt data flow in both directions. • When this fails an outcome can be attendance at A&E. • IT ‘ joined up’ • The phone remains a useful tool if you know who to talk to & you can get prompt access. MMP/RIE

  10. GP contract • Anticipatory care service level agreement with general practice 2008/09 • Based on all age SPARRA data • Guided primary care led care plan • Care home anticipatory care plans (LES) • Palliative Care plans (DES) • COPD (LES) • Elms care home project • DNAR • Incapacity forms • Agreed care plans (lodged with care home & OOH) • Medical summary including medication MMP/RIE

  11. GP contract Chronic disease management n GMS 2004-8 • Improved intermediate outcomes for patients with CHD, stroke and diabetes will prevent vascular events including MI Stroke & sudden death over a five year period. • Therefore probably too soon to see impact on secondary care emergency activity. • Data trends are encouraging. MMP/RIE

  12. Patient sign posting • GP or A&E • Should A&E have access to GP appointments in hours ? (re-direct OOH) • GP need to ‘advertise’ services & improve patient knowledge. • Maybe we need a good TV drama MMP/RIE

  13. You will not stop all…. • Hospital front door needs to be slick at assessing patients in this group & returning them to primary care. • Shared clinical information • Primary care based services that secondary care can access • Competency based delivery of care • Multi professional team • Ambulatory care development • Complex needs usually older patients usually need > 4 hours • Communication (accurate & prompt) MMP/RIE

  14. GP role in secondary care services • Based at the hospital front door • Pre A&E • A&E • Acute medicine assessment units • Several models exist across the UK. • Understanding of how the ‘other side’ works on an ongoing basis & not ‘when I was Dr Bellshouseman’ • Common theme is to preserve/reintroduce gate keeping ( see & treat & discharge) MMP/RIE

  15. What is inappropriate attendance ? • We need • Clinical assessment • Diagnostics • Observation • Ideally emphasis should be to shift unscheduled to scheduled • Assessment area • OPD slots inc day hospital • Ambulatory care MMP/RIE

  16. In Summary • Learn from what primary care is already doing • Well & not so well • Communicate evidence based good practice • Design services around patients MMP/RIE

  17. Contact • Alastair.Crosswaite@luht.scot.nhs.uk • Alastair.Crosswaite@lothian.scot.nhs.uk MMP/RIE

  18. MMP/RIE

  19. MMP/RIE

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