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Out-of-Hours Care

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Out-of-Hours Care

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    1. Out-of-Hours Care Presentation to GP Specialist Trainees 2nd October, 2008

    2. OOH Care - Topics Introduction History of OOH Care OOH Care Today Registrar Training OOH Creation of Protocols / Guidelines The Art of Telephone Triage

    3. Who am I? Dr Keith Grimes Clinical Lead, South East Health ltd 2/3 Clinical Lead work 1/3 actual clinical work

    4. OOH - History

    5. History of OOH – The Beginning 1948 – Birth of the NHS Named GP personally and legally responsible for patient care 24 hours / day Managed either by personal lists, or rotas within practices Demand increased over the years GPs on call 5 or more nights / week 1964 – 39% 1977 – 9 %

    6. Growth of Cooperatives 1980’s saw increased use of deputising services and cooperatives Amendments to GMS mid 90s facilitated this Venue of consultation Changes to visiting fees Shift to co-ops lead to: Greater use of Primary Care Centres The increased role of telephone for triage Decreased exposure to OOH work

    7. Carson report & nGMS ‘Raising Standards for Patients: New Partnerships in OOH Care’ David Carson October 2000 Single point of access for patients Build infrastructure to meet proposed QRs Share information Record calls Assure Quality nGMS contract allowed GPs to opt-out (April 2004) National Quality Requirements (1 January 2005) Standards for Better Health (1 June 2005)

    8. OOH Today

    9. How is it organised? PCT separate commissioner and provider role Numerous providers GPs who haven’t opted out (usually coops) Not-for-profit orgs /For profit orgs (APMS) PCTs providing their own service (PCTMS) Others Increasing competitive market forming Greater integration with other services

    10. Formed by the mergers of: Seadoc & Brightdoc (April 2005) ->SEHL Stourcare & SEHL (April 2008) On Call Care & SEHL (August 2008) Main base Ashford 2.2 million patients 21 primary care centres / 400 doctors / 100 nurses 500’000 calls / annum Additional services

    11. Quality Requirements Regularly report to PCT Send details of consultation to registered practice by 8am ‘Special notes’ system Regularly audit sample of contacts Regularly audit patient experience Operate NHS compliant complaints procedure

    12. Registrar Training OOH

    13. OOH Training ‘…the generalist role of the GP should be maintained and that newly accredited GPs will be expected to have demonstrated their ability to perform competently in OOH primary care’ OOH Training for GP Speciality Registrars, Position Paper COGPED 2007 Suggest 1 session /month over 12 months (72 hours) Educational supervision led by Trainer Clinical Supervisors oversee registrars OOH

    14. 6 Key Competencies Ability to manage common medical, surgical and psychiatric emergencies in the out-of-hours setting. Understanding of the organisational aspects of NHS out of hours care. Ability to make appropriate referrals to hospitals and other professionals in the out of-hours setting. Demonstration of communication skills required for out-of-hours care. Individual personal time and stress management. Maintenance of personal security and awareness and management of the security risks to others Novice –> Competent -> Proficient

    15. Overview of supervised sessions Attend OOH session, supervised by named Clinical Supervisor or Trainer Progress from Red, through Amber, to Green CS/Trainer completes OOH worksheet GP registrar logs this in e-portfolio Evidence reviewed by trainer

    16. Responsibilities GP Registrar Organise your OOH sessions Work OOH sessions, under supervision, as part of your contract of employment Maintain a portfolio of evidence OOH Organisation Offer induction to registrars Make sessions available Provide access to trained supervisors

    17. Reference Material www.southeasthealth.com gp.kssdeanery.org DEMO (if possible!)

    18. The Art of Telephone Triage

    20. Purpose of Telephone Triage Identify Immediately Life Threatening Conditions Provide advice Establish need for face-to-face consultation Establish venue for face-to-face consultation Facilitate access to other healthcare providers Manage workload/workflow “Other”

    21. Over to you...

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