British Association of Health Services in Higher Education Conference 6 th July 2005 The

1. British Association of Health Services in Higher Education Conference 6th July 2005 The Minor Illness Nurse

2. Our PracticeWigmore Lane Health Centre • Luton North east (near the Airport) • Three full time doctors (many outside commitments) • Two sessional doctors • Two part-time practice nurses (50 hrs) • One Nurse Specialist (30 hrs) • 6,100 patients • 10% under fives

3. The Problem • Too many patients • Too little time

4. Increasing GP Workload Increasing patient Demand Increased transfer from secondary care “Care in the community” PCT’s

5. Decreasing GP Workforce Recruitment crisis Part-time working Few reliable locums

6. The Extras - Patients Requesting Same Day Appointments >Uncontrollable workload fluctuations >Major source of GP and receptionist’s stress

7. Who Were They? 33%Children under 5 19% Children 6-10 years 48% 10 years and over (72% female) 1,630 “Extras” per GP per year

8. Which Problems? Of the requests for same day appointments • 57% URTI / ears/ cough • 20% Eyes and skin • 8% Abdominal / D&V / Cystitis

9. The Raw Deal • Reluctantly squeezed into over-booked surgeries • Long waits • Harassed GP who has little time for explanation • Maybe, unnecessary antibiotics

10. The Solution?

11. The experienced Practice Nurse

12. The Nurse’s “Emergency” Clinic

13. Protocol Regular, daily for 3.5 hours in the morning and some afternoons Book on the day Requires sensitive questioning by receptionists

14. 15 minute appointments • Doctor on hand for discussion or referral • Prescriptions (if needed) written and signed by nurse (if clinical condition and drug on ENPF) or signed by GP

15. Responsibility • Professionallyaccountable to the NMC • GP employer is legally liable • Indemnified by practice defence organisation MPS and RCN

16. Does it Work? YES!

17. Analysis of the clinic after 1 year (June1996-May 1997) 1,535 patients seen by Nurse Specialist 45% - received a prescription 7% - immediate referral to GP

18. Benefits to Patients • Fixed appointment time so shorter wait • Nurse spent more time with patient than GP initially but GPs now have 15 minute appointments • Emphasis on self care supported by written material, not prescription drugs

19. Benefits for the practice • Happier receptionists • More satisfied patients • Better health education • Patient less likely to return next time? • More job satisfaction for the nurse • Reduced need for locums

20. Problems • Training very time consuming • Confusion over different practice nurses’ roles • A few patients objected • Holidays / Sickness

21. Nurse Specialist Minor Illness Course

22. Minor Illness Course Accredited by the University of Luton (45 credits level 3) One week full time seminars From September 1997 – March 2003, 6 months course with clinical sessions based at WLHC (no longer available)

23. Also available………….. Flexible training opportunities – • 5 day Seminar week at based at WLHC or satellite locations around the country • Open learning programme at Level 2 available through Radcliffe Publishers • Combination of seminar week and open learning programme to attain accreditation

24. The Course - ingredients • Consultation and Communication skills • Clinical skills • Examination techniques • Infections • Clinical Pharmacology • Prescription writing • Managing change • Evidence based practice

25. ………..The clinical sessions • 8 weeks observation • 12 weeks supervised • 6 weeks solo

26. Extra ingredients Assignments: • Pharmacology scenarios • Case studies - 1 Adult & 1 Child • Practice Administration • Evidence Based Practice topic Skills Manual Video 4 consultations (not assessed) Own practice support

27. …………resulting in • Competent, skilled, highly trained nurses able to manage patients requesting same day appointments. • An understanding of the relevant theoretical background in the management of minor illness • A holistic approach with insight into the possibility of a hidden agenda • The knowledge when to seek appropriate medical assistance

28. Does it work for other practices? • 63 nurses trained on the 6 month course • A further 600 nurses attended seminar weeks • Practice audits show very high patient satisfaction (98 - 100%) • Similar prescribing patterns to GPs • 3.1 - 12.5% referral rate to GP during clinic • 1.2 - 10% re-consultation to GP with same complaint within 2 weeks

29. June 2005 Auditn=164 (over 2 weeks)F/M 2:1 URTI 39% Abdo/UTI gynae 13% Skin/rashes/eyes 35% Musculo/skeletal 10% Others 4%

32. References Chau S, Humphries A, Wheeler D, et al. Nurse management of patients with minor illness in general practice: multicentre, randomised controlled trial BMJ 2000; 320:1038-43 Kinnersley P, Anderson E, et al. Randomised controlled trial of nurse practitioner versus general practitioner care for patients requesting ‘same day’ consultations in primary care.BMJ 2000; 320:1043 Marsh G N, Dawes M L. Establishing a minor illness nurse in a busy general practice. BMJ March 1995; 310:778-780 Venning P, Durie A, Roland M, Roberts C, Leese B. Randomised controlled trial comparing cost effectiveness of general practitioners and nurse practitioners in primary care.BMJ 2000; 320:1048-53

33. www.minorillness.co.uk Contact Sheila McLaughlin on 01582 481914 For details and an application form