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Mutuality, A&E and Primary Care

Mutuality, A&E and Primary Care. Dr Adrian Baker Clinical Lead Nairn & Ardersier. Carers & Voluntary AHP’s / Pharmacy Nursing GP’s Community Hospitals Secondary / Tertiary Care. 99 ? OR 999. Nairn and Ardersier c1997. The service has been in operation since March 1997.

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Mutuality, A&E and Primary Care

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  1. Mutuality, A&E and Primary Care Dr Adrian Baker Clinical Lead Nairn & Ardersier

  2. Carers & Voluntary AHP’s / Pharmacy Nursing GP’s Community Hospitals Secondary / Tertiary Care 99 ? OR 999

  3. Nairn and Ardersier c1997 • The service has been in operation since March 1997. • PCEC 250-400 calls to the service each month. • A&E 100 – 300 attendances a month • There is minimal use of protocols, referring instead to guidelines or a more experienced opinion when necessary. National guidelines are utilised when possible. • Each nurse uses their own clinical judgement and defines their own level of competence (and doctors respect this). • The PCEC service is fully integrated with A&E

  4. Localities / Parish ?

  5. Integrated response • GP • SAS / Home care alerts / telecare • A&E / PCEC integrated • Nurses for palliative care • Care plans, Alerts, Integrated IT (Vision) • Community Support Team / NHS Home Care, OOH home care • Patients call single number

  6. Journey of Dependence • Home Care - £6,000 per case per year (34M hours, 69,000 clients) • NHS 24 - £36.67 per call • OOH PCEC £68.00 • GP in hours contact £30.00 • District nurse / Health Visitor £40.89 • A&E £92.50 • Admission (Ave 10 days) £2,784 • 51x and other dispossessed patients • Long stay care £ 20,111 a year

  7. EEA by practice for Highland

  8. Pyramid to Oil Tanker

  9. EEA rates by Locality (>65, >75, >85)

  10. Local nurse talks to patient Same number – one point of contact 24/7 Can See & treat Local Knowledge - ALERTS Can discharge Can call in extended local Primary Care Team & Social Services Very Close, consistent working with GP’s Remote nurse American Algorithm 7% UK GDP vs 14% USA Advice Or GP Or A&E Or Ambulance Ice cream High cost (Effective?) Remote working Local vs National system

  11. Since Opt Out • NHS 24 1.5M calls a year • A&E increase 6% a year • Cost NHS 24 = £55M = £10 a patient • Lochaber / Nairn & Ardersier = £150,000 • With a locally based Telephone triage system could this money be put to better use? (NHS Highland £3.3M)

  12. “If difficult…..

  13. …….Don’t…….

  14. …….Do”

  15. Vision • Equity of funding and service • Local services to ensure local response • Clinically and socially appropriate response. Mental Health • Ability to stabilise and transfer to secondary care when necessary • Integration with Social Services

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