Welcome to Care UK · PDF fileReception and the OOH receptionist will be located on the ......
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Dr Ehsan Ahmadi Education and Training 2015 Welcome to Care UK
Transcript of Welcome to Care UK · PDF fileReception and the OOH receptionist will be located on the ......
Dr Ehsan AhmadiEducation and Training 2015
Welcome to Care UK
Setting today’s agenda
Introduction
• OOH sessions, Triage, HV, PCC, NQRs, Record keeping
• questions from MyCareUK website
ADASTRA Training
• A brief group introduction
• Hands-on with the training modules
Rotamaster – to instruct on bookings
Admin Team– to instruct on Trainee paperwork
Closure - Question/Answer session
Workshops
Tina – to instruct on bookings
Admin team– to instruct on Trainee paperwork
Clinical Lead on Adastra training
There are Six Key Competences for OOH Care
1. Ability to manage common medical, surgical and psychiatric emergencies in the
out-of-hours setting.
2. Understanding of the organisational aspects of NHS out of hours care.
3. Ability to make appropriate referrals to hospitals and other professionals in the
out-of-hours setting.
4. Demonstration of communication skills required for out-of-hours care.
5. Individual personal time and stress management.
6. Maintenance of personal security and awareness and management of the
security risks to others
Sessions in Out of Hours
36 hours for 6 month GP attachment, on average one 6 hours shift/session per
month.
Sessions are graded as suggested by the COGPED paper:
Direct supervision (red) - Sessions 2 &3
Supervised directly by the clinical supervisor and takes no clinical responsibility
Close Supervision (amber) - Sessions 4 to 10
Consults independently but with the clinical supervisor close at hand
Remote supervision (green) - Sessions 11 to 18
consults independently and remotely from the clinical supervisor who is available
by telephone
Pag
Sessions in Out of Hours
Base/Triage 4 - 5 hours, primarily Base patients, but if quiet then triage.
Mobile/Base 4 - 6 hours, primarily visiting, but if quiet then base or triage.
GP Triage 4- 5 hours mainly triage, but if needed for other resources, may be asked to see base patients or visit.
Do not book sessions and then cancel them. This will be noted.
The Patient Journey
• Patient telephones the surgery
• Phone should be diverted to NHS 111
• Patient speaks to a clinical advisor, who is non-clinical
• Clinical advisor records demographic details and entered the information to the
specific clinical complaint pathway.
Patient Pathway
Patient pathway
111 dispositions include:
• “Speak to GP – previously called triage”
• “Contact GP” face-to-face contact in either a “primary care centre” (PCC) or
home visit
• “Contact other healthcare professional” seeing another professional e.g. a
district nurse , pharmacist etc.
• “Home management advice”
Calls are recorded for medico-legal safety
Speak to GP shifts / Triage
The call centre for the service is based in Ipswich
• Provides the hub of the service
• Clinical triage (Speak to Doctor)
• Base for the local management team
• Training and meeting facilities
• Call centre designed to allow us to scale the service as required
• Each desk equipped for call handlers and triage clinicians
Telephone Advice & Triage Management
•Child with fever:
•If no redflag symptoms-advice,
but otherwise can be seen at PCC
•PV Bleed in early pregnancy:
•Refer to local EPAC/EPU by calling on call Gynae
•Pathology results! E.g. K+=6 with no tel no:
•Phone Lab, find out previous results, clinical indication.
Use BT. Com to track phone no. if all else fails organise visit.
•Elderly Person vomiting:
•Get them seen, ?MI
•Elderly Person with back pain:
•Get them seen ?pleurisy/LRTI
Telephone Advice & Triage Management
Telephone Advice & Triage Management
Methadone patient who has “run out” of methadone:
•See local policy, advise we do not get involved.
DO NOT send to A&E.
•Nursing Home reports patient is attacking staff:
•Get patient assessed ?refer to on call Social Worker.
•Patient who fell down stairs, can’t get up/head bleeding:
•This is a typical A&E case (we don’t carry bandages/stitches).
•60 year old man chest pain, sweating:
•Get him an ambulance
•Suicidal patient:
•Get them assessed by GP if safe and then get crisis team
Telephone Advice & Triage Management
PCC- Primary Care Clinic
• The room is fully equipped including medicine cassettes.
• We do not carry speculums, sonic aids, ECG machines.
• Patients given an appointment slot and are usually seen quickly.
• 15 minute appointments.
Suffolk Primary Care Centres operating information Suffolk
Central Weekdays Saturday Sunday Bank Holidays
EyeTel: 0118 990 2223
18:30 - 08:00 08:00 - 08:00 08:00 - 08:00 08:00 - 08:00
Hartismere Hospital, 26 Castleton Way,
IP23 7BHFax: 01379 871 981
From B1077 Victoria Hill/Lambseth Street, please turn into Castleton Way. Hartismere Hospital will be visible from Castleton Way. Please head to the Main
Reception and the OOH receptionist will be located on the right side. OOH signs are visible.
StowmarketTel: 0118 990 2228
19:00 - 23:00 08:00 - 23:00 08:00 - 23:00 08:00 - 23:00
Violet Hill House, Violet Hill Road, IP14
1NLFax: 01449 673602
From A1308 Bury Road turn into Violet Hill Road. Violet Hill House will be visible from Violet Hill Road. Please head to the Main Reception Entrance. OOH Signs
are visible
SudburyTel: 0118 990 2229
19:30 - 00:00 08:00 - 00:00 08:00 - 00:00 08:00 - 00:00
Walnut Tree Hospital, Walnut Tree
Lane, Sudbury, CO10 1BEFax: 01787 370208
From A131 Gregory Street, turn into Walnut Tree Lane. Walnut Tree Hospital is visible from Walnut Tree Lane. Please head to the Outpatients 1, through the
right door and the OOH reception is located on the left. OOH Signs are visible.
Suffolk Primary Care Centres operating information Suffolk
North Weekdays Saturday Sunday Bank Holidays
Bury St Edmunds Tel: 0118 990 2232 18:30 - 08:00 08:00 - 08:00 08:00 - 08:00 08:00 - 08:00
West Suffolk Hospital, Hardwicke Lane,
Bury St Edmunds, IP33 2QZFax: 01284 706054
From A1302 Cullum Road turn into Hardwicke Lane OR from A143 Horringer Road turn into Vinery Road and continue down onto Hardwicke Lane. West Suffolk
Hospital will be visible off Hardwicke Lane. Head to A+E Reception and take the door on the left hand side. Continue down and OOH Receptionist will be
there to greet. OOH signs are visible
Haverhill Tel: 0118 990 2224 20:00 - 23:00 20:00 - 23:00 20:00 - 23:00 20:00 - 23:00
Haverhill Health Clinic, Camps Road,
Haverhill, CB9 8HFFax: 01440 710455
From A1017 Lord's Croft Lane, please turn into Swan Lane and continue down onto Camps Road. Haverhill Health Clinic will be visible from Camps Road. OOH
Entrance is on the left side of the surgery. Head to the Main Reception. OOH Signs are visible.
Milldenhall Tel: 0118 990 2226 19:00 - 22:00 09:00 - 22:00 09:00 - 22:00 09:00 - 22:00
Milldenhall Health Centre, Chestunut
Close, Mildenhall, IP28 7NL
Fax: 01638 716938
From A1101 Kingsway, turn into College Heath Road and take the first right. Mildenhall Health Centre will be visible. Please had to the Main Reception upon
arrival. OOH Signs are visible.
Suffolk Primary Care Centres operating information Suffolk
South Weekdays Saturday Sunday Bank Holidays
Ipswich 18:30 - 08:30 08:00 - 08:30 08:00 - 08:30 08:00 - 08:30
Ipswich Hospital, Entrance 5-
Rheumatology, Heath Road,
Ipswich , IP4 5PD0118 990 2254 -
Reception
01473 219866 - Fax
Follow signs to Ipswich Hospital A&E. On arrival, please head to Entrance 5- Rheumatology
SAXMUNDHAM 07825 240091 (Interim
number) 18:30 - 23:00 08:00 - 23:00 08:00 - 23:00 08:00 - 23:00
Lambsdale Meadow
Saxmundham
Ipswich
IP17 1AS
01728 605928 - Fax
Home Visit
Visits are reserved for the Elderly, Infirm, Disabled, Terminal Care
e.g. Nursing Homes, Residential Homes, Prisons, Special Needs Institutions.
•Nursing Home – Patient with breathing difficulty.
•Housebound elderly patient vomiting.
•M/S patient with recurrent UTI.
•Cancer patient requiring analgesia/antiemtic.
•Psychiatric patient who is suicidal.
•Special Needs patients who become aggressive.
•Confirming Death.
Home Visit - Equipment
Doctors Bag.
Drug cases (not CDs).
Nebuliser.
Referral Paperwork, No reply Paperwork.
Defib/AED
Drug Cassettes
Drug Cassette containing
tablets and syrups
Injection Cassette including
palliative meds
No CDs
Ensure you are aware of what we carry and how to use them
E.g. IM anti-emetics
Complete paperwork correctly
Care UK_EMERGENCY_CASE.xls
Suffolk_Areas_Case_A_B_VC_I_Oct10.xls
National Quality Standards for OOH
.1Providers must report regularly to CCG’s on their compliance with KPI’s
2 Providers must send details of all OOH consultations to the practice where the
patient is registered by 8.00 a.m. the next working day.
3Providers must have systems in place to support and encourage the regular
exchange of up-to-date and comprehensive information for patients
with predefined needs (including, for example, patients with terminal illness or
special patient notes).
4Providers must regularly audit a random sample of patient contacts
5 Providers must regularly audit a random sample of patients’ experiences of the
service (for example 1% per quarter)
6 Providers must operate a complaints procedure that is consistent with the principles
of the NHS complaints procedure.
7 Providers must demonstrate their ability to match their capacity to meet predictable
fluctuations in demand for their contracted service, especially at periods of peak
demand, such as a Bank Holiday weekend.
National Quality Requirements – KPI’s
9a Urgent cases advised within 20 minutes
9b Urgent cases advised with 60 minutes
9c Routine cases advised within
9d Routine cases advised within 6hours
11 GP cons available at all times & all places
12b Contact GP bases visit – urgent cases completed within 2 hours
12b.2 Contact GP bases visit – routine cases completed within 6 hours
12b.3 Contact GP bases visit - Routine cases completed within 12 hours
12b.4 Contact GP bases visit - Routine cases completed within 24 hours
12v Contact GP home visit – urgent cases completed within 2 hours
12v.2 Contact GP home visit – routine cases completed within 6 hours
12v.3 Contact GP home visit - Routine cases completed within 12 hours
12v.4 Contact GP home visit - Routine cases completed within 24 hours
13 Patients unable to communicate effectively in English will be provided with an
interpretation service within 15 minutes of initial contact. Providers must also make
appropriate provision for patients with impaired hearing or impaired sight.
NQR – National Quality Requirements
Sum of % Column Labels
NQR09 NQR12 Base NQR12v
Date
Urgent
cases
advised
within 20
minutes
Urgent
cases
advised
within 60
minutes
Routine
cases
advised
within 2
Hours
Routine
cases
advised
within 6
Hours
Urgent
Cases
completed
within 2
Hours
Routine
cases
completed
within 6
Hours
Routine
cases
completed
within 12
Hours
Routine
cases
completed
within 24
Hours
Urgent
Cases
completed
within 2
Hours
Routine
cases
completed
within 6
Hours
Routine
cases
completed
within 12
Hours
Routine
cases
completed
within 24
Hours
01/01/2014 100.00% 100.00% 100.00% 100.00% 97.14% 100.00% 100.00% 100.00% 97.50% 100.00% 100.00% 100.00%
02/01/2014 100.00% 90.91% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 83.33% 100.00% 100.00%
03/01/2014 85.71% 100.00% 90.48% 100.00% 93.33% 100.00% 100.00% 100.00% 90.00% 87.50% 100.00%
04/01/2014 96.15% 90.14% 93.85% 100.00% 95.58% 100.00% 100.00% 100.00% 82.14% 93.02% 100.00% 100.00%
05/01/2014 94.12% 98.85% 95.83% 100.00% 92.65% 100.00% 100.00% 100.00% 95.35% 97.78% 100.00% 100.00%
06/01/2014 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%
07/01/2014 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%
08/01/2014 75.00% 92.86% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%
09/01/2014 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%
10/01/2014 100.00% 73.91% 94.12% 100.00% 100.00% 100.00% 100.00% 100.00% 83.33% 72.73%
11/01/2014 95.45% 100.00% 100.00% 100.00% 97.50% 98.64% 100.00% 100.00% 95.92% 93.18% 100.00% 100.00%
12/01/2014 94.12% 98.68% 100.00% 100.00% 96.77% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%
13/01/2014 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%
14/01/2014 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%
15/01/2014 100.00% 96.55% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%
16/01/2014 100.00% 100.00% 100.00% 100.00% 90.91% 100.00% 100.00% 100.00% 90.00% 100.00%
17/01/2014 100.00% 89.47% 87.50% 100.00% 100.00% 100.00% 100.00% 100.00% 90.91% 100.00% 100.00%
18/01/2014 94.44% 96.92% 91.43% 100.00% 92.19% 99.38% 100.00% 100.00% 96.30% 100.00% 100.00% 100.00%
19/01/2014 93.75% 100.00% 94.29% 100.00% 90.41% 100.00% 100.00% 100.00% 94.74% 100.00% 100.00% 100.00%
20/01/2014 100.00% 100.00% 100.00% 100.00% 95.83% 100.00% 100.00% 100.00% 50.00% 100.00%
21/01/2014 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 66.67% 100.00% 100.00% 100.00%
22/01/2014 100.00% 92.31% 100.00% 100.00% 91.67% 100.00% 100.00% 100.00% 70.00% 100.00% 100.00%
23/01/2014 100.00% 100.00% 100.00% 100.00% 92.31% 100.00% 100.00% 100.00% 61.54% 100.00% 100.00%
24/01/2014 88.89% 100.00% 100.00% 100.00% 89.29% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%
25/01/2014 97.06% 80.72% 90.70% 100.00% 97.50% 100.00% 100.00% 100.00% 93.44% 100.00% 100.00% 100.00%
26/01/2014 100.00% 100.00% 100.00% 100.00% 95.00% 100.00% 100.00% 100.00% 82.22% 97.44% 100.00% 100.00%
27/01/2014 83.33% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%
28/01/2014 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%
29/01/2014 100.00% 96.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%
30/01/2014 100.00% 95.83% 83.33% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%
31/01/2014 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 92.86% 100.00% 100.00%
NQRs: Routine Vs Urgent
Record-Keeping and Medical Notation
To ensure patients are treated efficiently and effectively by clinical teams
As an indispensable element in responding to complaints
Ensures high quality care for individual patients (ie via audit)
Notes must be:
• Clear
• Objective
• Contemporary
• First-hand
• Original
Do not use any abbreviations
Patients, relatives or legal representatives may read your notes
Record-Keeping and Medical Notation
Content of Medical Records - Notes should include:
History – relevant to the condition including answers to direct questions and
important “negatives”
Examination of the patient – any important findings, both positive and
negative, and details of objective measurements such as pulse, blood
pressure, respiratory rate, temperature, capillary refill time and peak flow as
relevant
Diagnosis – in clear, readily understood terms. It should be clear from your
notes how you arrived at this conclusion. Include any uncertainties about
diagnosis, and steps taken to rule these out. Detail any further investigations
or referral arranged
Record-Keeping and Medical Notation
Information – what you have told the patient, including details of the risks and
benefits of particular treatments where relevant
Consent – details of any consent the patient has given e.g. for specific
examination, including whether a chaperone was offered and accepted and the
name of the chaperone
Treatment – detail the type and dosage of drugs, the total amount prescribed and
any further treatment organised
Follow up – include the arrangements for follow up and “safety netting” advice
given, being as specific as possible and not relying simply on a function key
entry for “GP follow up” when using electronic record
Recommended Reading: MPS: Guide to Medical Records and RCGP OOH audit
toolkit.
Care UK Policies
• All available online on at MyCareUK website
• Here are some of the most frequently used:
• Prescription Policy: OOH Formulary, FPS, 7days, no substances of misuse, coding, avoid faxing.
• Methadone e.g. this is not prescribed.
• Prescribing over the Telephone e.g. this is not allowed.
• No Reply Policy.
• CD policy: how to access.
• Palliative Care: Drugs held, Pink forms, Local prescribing guidance.
• Microbiology Samples: how to send them off.
• Local Antibiotic Guide.
• How to deal with abnormal blood results.
• Urinary Catheters: When to intervene.
• Prison patients: How to manage them.
• Public Health: Who to contact.
• EPU/PVB pregnancy: Strict plan (Updated).
• Confirmation of Death: Unexpected vs Expected.
Your local Team
Contacts Details
Dr Ehsan Ahmadi
Clinical Lead, Care UK Suffolk
Dr Chris Browning
Clinical Lead, Care UK Suffolk
Emma Doughty
Service Manager
Theresa Kelly
Nurse Lead
Zoe Pursglove
GP Relationship manager, point of contact for GPs and GP registrars
Sally White
Rota Manager
Email addresses: [email protected]
Telephone: 0118 990 2210
Operational Staff
Useful Numbers
Co-ordinator Line: 0118 990 2211
Operational Fax: 01473 713 698
Administration: 0118 990 2210 (office hours only)
Rota Team: 0118 990 2212 / 2213 (office hours only)
Questions Question ?
