Like GP practices across the country, here in Thanet we’ve seen a huge increase in our workload brought on by one of the worst flu outbreaks in years.
It’s proving a tough challenge. We feel like hamsters in a wheel – the faster we run, the more we seem to end up in the same place. What is needed is smarter and radically different ways of working coupled with the hard work we already do.
A colleague of mine said: “We don’t have a cavalry around the corner – we have to manage with what we have.” This set the ball rolling to improve the system locally.
This winter, as a primary care home (PCH), we’ve worked with our local acute hospital, the Queen Elizabeth the Queen Mother in Margate, to set up an Enhanced Acute Response Team (ART) which involves a GP and paramedic based in A&E for 12 hours. They care for patients whose conditions vary from normal primary care type presentations to somewhat more challenging problems like chest pains or acute abdominal pains. The latter can be managed by primary care clinicians with access to basic investigations without necessarily needing the expertise of the A&E team and more complex diagnostics.
Over the last two and a half months, the team has seen 2,300 patients and, in the majority of cases, there’s been no need for admission. We see an average of 35 patients a day but only two or three end up being admitted.
This new enhanced service builds on the success of the Complex Acute Response Team (ART) set up in November 2016, which has been helping us cope with the current surge in demand. The team brings together professionals from primary, secondary and community care with the aim of breaking down silos and providing joined-up care, especially for frail, older patients and those with complex, multiple conditions. The team is made up of a GP, nurses, a health care assistant, occupational therapist, physiotherapists, volunteer care workers and care agency staff.
At the Queen Elizabeth the Queen Mother Hospital our team works with hospital colleagues in the acute medical assessment unit to assess patients so that frail, complex patients – who are deemed medically safe – can be given the option of “wrap-around” care either at home or in a residential home.
The community team, based in Margate, takes direct referrals from GPs and the ambulance service, especially for those patients who don’t need to go to hospital but would end up there without the wrap-around care. Teams share instant access to live patient data (provided of course that patients give their consent) via the EMIS clinical IT system.
We call this care, led by GPs, our safety net which might involve home visits from a doctor, nurse or therapist. Age UK volunteers are available to provide help with meals, housework, shopping or simply a listening ear. And we can call on a local care agency to help with things like washing, dressing and medication.
By providing this safety net, we are ensuring patients receive the care they need at home which is better for their recovery as they are in a familiar environment. It’s a win-win situation for patients, their families and the wider health care system
Over a trial period last winter, we cared for 155 patients in their own homes or residential homes with the support of the Complex ART team, with potential annual savings of £300,000. The team is currently managing up to 25 patients a week.
So what’s next? We’re currently working with the hospital to set up a “rapid integrated assessment hub” which will pool the skills of colleagues working in acute, primary and community care to manage medical patients at risk of avoidable admission.
We are also hoping to set up a joint acute frailty unit which will enable us to get our frail patients home within 48 hours. And there are plans for a six-bed step down unit in the hospital where patients will be looked after by the primary care team but with access to the hospital’s diagnostics and specialists if needed.
Thanet Health is at same time developing its PCH hubs. This will help us deliver sustainable care to our patients despite the challenges facing the GP workforce.
There’s not much new money out there so many people have asked us how we managed to pull this off. The answer is we were blessed by a forward-thinking CCG who supported us wholeheartedly. They helped pump-prime the projects which are now paying for themselves by the savings generated.
For me, as a clinician, the most important thing is the outcomes for my patients. These projects have resulted in both qualitative and quantitative improvements. Our rotas for the complex and enhanced acute response teams are full until March. This shows that if we do something innovative then people are willing to join and us to help develop the projects further.
The future lies in working across the boundaries, joined-up working and pooling resources for the sake of a larger, common goal. The challenge will lie in developing models which will enable money to be channelled into those areas where it’s most needed. In Thanet we are actively developing a clinical network which will channel resources, both human and financial, correctly, so enabling us to meet the challenges of the future.
Dr Ashwani Peshen, GP, Thanet Health PCH Lead