Energising Primary Care Posters 643 – 645

Energising Primary Care Posters 643 – 645

643 Reduced antibiotic prescribing and unscheduled re-attendance by implementation of CRP point of care testing for acute LRTI in a nurse-led clinic

Liz Cross


Objectives: Determine impact on antibiotic prescribing, workflow and unscheduled re-attendance by implementing C-reactive protein point of care testing (CRP POCT) in patients with uncomplicated lower respiratory tract infection (LRTI) in an Advanced Nurse Practioner (ANP) minor illness GP clinic.

Content of presentation: CRP scores, antibiotic prescribing rates, unscheduled re-attendance in 67 patients (18-65 years) who visited their GP practice with LRTI symptoms, and underwent CRP POCT in line with NICE guidelines. Data collected in 2015/2016 were compared with the same period in 2014/2015.Relevance/impact: CRP POCT helps guide antibiotic decision making. Antibiotic prescribing was significantly reduced, and patients were reassured, when not prescribed an antibiotic after they had been tested. The reduced unscheduled re-attendance in this group infers significant cost savings to GPs and wider urgent care services, during peak winter months.

Outcomes: CRP POCT was easily incorporated into the consultation with no increase in workload. CRP levels of <20mg/L, 20-100mg/L and >100mg/L were observed in 70%, 25% and 5% of patients, respectively. Immediate antibiotic prescribing reduced from 31% (2014/2015) to 8% (2015/2016) with CRP POCT implementation. Unscheduled follow-up within 28 days for patients who were not prescribed antibiotics was reduced by >50%.

Discussion: Implementing CRP POCT can reduce antibiotic prescribing, increase patient reassurance, reduce unscheduled re-attendance, and lead to cost savings. ANP clinics are well placed to drive this innovation forward and improve patient care.

644 Clinical Apprenticeship Placement Scheme (CAPS) for refugee doctors in the UK. An evaluation to look at potential for GP recruitment

Emily Gowland


Aims/Objectives We undertook a questionnaire based study with qualitative interviews of the 66 refugee doctors who had completed the programme between 2011 and 2016. Questions focused on the value of the scheme in influencing career choices.

Outcomes Results are being analysed and will be presented at the RCGP primary care conference.Content of PresentationInternational medical graduates (IMGs) have made an invaluable contribution to the NHS, particularly general practice. One important group are the refugee doctors, many of whom are from healthcare systems without a primary care service yet their experiences would make them excellent GPs.

London provides support for refugee doctors through the Building Bridges programme and Clinical Apprenticeship Scheme (CAPS). Building Bridges provides specific support for GMC assessments and registration as well as enabling clinical attachments. CAPS offers a supernumerary 6 month placement at F2 level, providing refugee doctors with foundation competencies and eligibility to apply for training. It includes targeted support to ensure safe transition into the NHS.

This would seem particularly important for a career in general practice which requires expertise in culturally appropriate communication. But how many refugee doctors have gone on to be GPs? Relevance/ImpactWe have a recruitment crisis in general practice. Refugee doctors are a diverse and highly motivated group who with appropriate support could go on to be excellent GPs. We hope this evidence will provide support for a new national scheme to support refugee doctors not only back to clinical practice but into GP training and ensure this significant resource of medical workforce is not overlooked.

645 Triumvirate Leadership Programme

Martin Wilkinson


Aims/Objectives Primary care is undergoing transformation by “scaling up” in response to increased demands and inadequate workforce supply and resources. The Five Year Forward View relies on developing system leadership within the NHS to move the NHS forward working closer to home with new models of care. Based on a ‘triumvirate model’ a leadership programme was developed to support GP practices in responding to this new NHS agenda. The aim was to provide a leadership approach adopted by three key roles within general practice; GP, Practice Nurse and Practice Manager. The programme was designed to allow the practices to optimise their success in challenging times, build sustainability and unlocking their own potential.

Content of Presentation 63 participants from 23 GP practices participated over 9 months meeting on a monthly basis forming 5 action learning sets. The programme was based on the Kozners and Posners exemplary leadership model. Themes included: Service Redesign, Business Development, Patient Experience, Improving Patient Access, Change Readiness, Leadership in Primary Care, Succession Planning and Programme/Project Methodology. Internal and external evaluation will be presented.Relevance/ImpactLeadership in primary care has traditionally been GP led, nurses in primary care rarely supported into strategic roles. A new model of leadership is required for scaled up organisations.

Outcomes Practices described improvements in networking, understanding the NHS agenda, leadership skills, communication, culture and Friends and Family tests. Compared to pre-course score improvements were demonstrated in all parameters including shared leadership (+15.6%), communication (+23.8%),organisational culture (+28%), and strategic vision.