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Establishing a GP in A/E Service

Establishing a GP in A/E Service. Dr Laura Ryan Unscheduled Care Clinical Lead (Primary Care) Dr Sheena MacDonald Associate Medical Director Primary Care NHS Borders. Outline. Introduction Background Milestones Challenges Things to think about/planning. Introduction.

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Establishing a GP in A/E Service

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  1. Establishing a GP in A/E Service Dr Laura Ryan Unscheduled Care Clinical Lead (Primary Care) Dr Sheena MacDonald Associate Medical Director Primary Care NHS Borders

  2. Outline • Introduction • Background • Milestones • Challenges • Things to think about/planning

  3. Introduction • Other existing models-one size doesn’t fit all • Generic lessons can be learned • National Drivers eg T10 • ‘blurring of lines between secondary and primary care’

  4. Background • NHS Borders 113,000 population • Semi rural and rural with remote areas • Cross Border coverage • DGH approx 300 beds • Community Hospitals 135 beds

  5. Background • OOH GP service Borders Emergency Care Service (BECS) • 11.55 wte GP • Salaried Service (77% as of 8/2010) • One GP overnight with two OOH Nurses • PCEC daily in three Community Hospitals with MIU • GPs provide medical cover in MIU

  6. Milestone 1 – New GMS 2004 • Referral pathways from A/E to BECS • .e.g. Gynaecology patients • Nurse Triage – When BECS doctor on duty • A woman presenting with a gynaecological condition should be referred to the BECS doctor. • Exception: • Any woman presenting with a gynaecological condition that is likely to require in-patient care or resuscitation should be referred directly to the SHO on-call for Gynaecology.

  7. Milestone 2 - Unscheduled Care Collaborative • Local PDSA to look at Flow 1 • 50 % breaches in Flow 1 group • Orthopaedic junior/GP/Associate Specialist Orthopaedics /ENP • GP most effective at reducing waiting times

  8. Milestone 3- First GP A/E Feb 2007 • 13.00 – 21.00 • Subsequent capacity analysis • Shift better moved to 10.00 – 18.00 • Flow 1 100% compliant within months

  9. Milestone 4 - Clarity regarding patient groups • RCGP Curriculum Competencies • Placed in Triage • Consultant appointment November 2008

  10. Results 7 days a week 10.00 – 18.00

  11. Three Saturdays in May between 10-18.00

  12. Three Saturdays in May from 18.00 – 08.00

  13. Challenges • Accountability/professional management • Personality and change management • Training and development • Appraisal Revalidation-for those GPs who work only in this role

  14. What sort of Doctor? • Dedicated pool of ‘speciality doctors’ or • Interaction with OOH GP service or • Ad hoc sessional doctors

  15. Reflections for the future • Planning event • Stakeholders • Managers • Funding • Appraisal • Potential workload implications for OOH services

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