Innovation Posters 801 – 806
801 Silver city
Aim To improve the support, care and opportunities provided for older people particularly those with frailty and multimorbidity by integrated working at a local level.
Method In a GP practice we established fortnightly Multidisciplinary (MDT) Meetings, involving a wide range of professionals: Practice Nurse, Practitioner, Wellbeing Coordinator, Public Health Coordinator, GP Geriatrician Care Manager. The Nurse Practitioner liaises with the person being discussed. The MDT identifies opportunities to improve wellbeing (e.g. signposting activities, polypharmacy review). We held Community Tea Parties (‘Big Blethers’), to encourage social interaction for the most isolated, and improve engagement with available wellbeing opportunities.
Results 56 people have been discussed at MDT meetings in 9 months (10 discussed more than once). Meetings provide a forum where people with complex needs can be discussed, improving integration and management of their care, and allowing earlier intervention for people at risk of decline. Professionals from diverse backgrounds are able to produce innovative solutions. Communication and relationships also improved outwith the meeting. Particular strengths were the involvement of the Wellbeing and Public Health Coordinators.
‘Big Blethers’ were effective at engaging the most isolated, who could benefit most from accessing health and wellbeing opportunities.The Nurse Practitioner and the Wellbeing Coordinator have helped people to develop personalised goals, and enabled them to achieve these goals in a way which is tailored to their interests, preferences and individual circumstances.
Conclusion ‘Silver City’ has successfully developed an integrated, practice-based, person-centred response to the burgeoning numbers of older people with complex needs in the community.
802 Using risk tools to reduce GP workload
AIMS This is a summary of initial ﬁndings when looking at risk stratification tool – Electronic Frailty Index (EFI) – and GP appointment activity.
CONTENT The two appear to be related and further analysis may hold to the key to reducing GP workload. I have analysed 2,500 patient records.
RELEVANCE / IMPACT Identifies a cohort of patients which we would not usually target, but are responsible for high current and future workload.
OUTCOMES 166 patients with moderate EFI Scores (many are young and do not have chronic diseases) are resposible for approx 4,000 appointments over 12 months.
DISCUSSION Interestingly a lot of activity relates to patients with moderate EFI scores. Life events such a s bereavement an d unemployment also have a large impact. Remarkably, more than half with moderate EFIs are aged 50 or less. Matching local services to the needs of this cohort should result in better outcome for patients, improved use of local services and reduce GP workload. We are working on identifying small interventions to large number of patients in this cohort eg working with social services and voluntary sector to support patients so as to reduce current GP activity and promote preventative activity. Exploring how best to make bulk referrals.
803 Varicose ulcer curability; let’s look at those legs
Patients with leaking legs and painful varicose ulcers need exorbitant nursing care and antibiotics. They become dependent on frequent home visits; usual shoes cannot be worn and immobility, isolation and increased morbidity ensue. Leg Clinics have significantly improved psychosocial factors and motivation, but treatment with four-layer nurse-applied bandaging remains standard. NICE (2013) recognised the morbidity caused by varicose veins, and recommends that varicose ulcers are seen by vascular surgeons for correct diagnosis, but, even if veins are incompetent, treatment may still involve compression.
High-resolution colour duplex sonography is now being used to quantify the effect of localised compression, and has proven more rapid healing with prevention of long-term effects of skin thickening and damage (lymphostatic fibrosclerosis) using inlays in compression hosiery. However the patient has to get hosiery on, wear it and tolerate it indefinitely.Difficulties with the self-application of compression to the lower leg by the patient or carer are now being solved by the use of prescribable, self-applied and adjustable velco-stabilised appliances such as Juxta-CureTM.
As only the calf is bandaged, normal shoes can be worn and the ankle joint is freed for its vital role in pumping lymph upwards. Feasibility and comparison studies are being undertaken on Juxta-CureTM, as well as cleansing solutions impregnated in wipes which may prove more effective than washing. Both are certainly putting varicose ulcer treatment into hands of patients and carers. GPs can now radiate encouragement, enthusiasm and conviction of curability.
804 Get exercise confident: an educational resource on exercise for patients and health professionals
Get Exercise Confident is an online educational resource, inspired by my passion for preventative exercise medicine. Get Exercise Confident has two mains aims. The first is to increase the number of people exercising in the UK, due to the fact that nearly 80% of men and women do not reach the NHS’s recommendation for weekly physical activity, and as a result are at an increased risk of morbidity and mortality.
One of the key reasons given for not exercising is a lack of knowledge and confidence, which this resource aims to address with step-by-step exercise programmes supported by video tutorials, taught by myself – a medical student and qualified strength and conditioning coach, and a physiotherapist.
The second aim is to provide a safe and effective resource that patients can be signposted to. Patients are often encouraged to increase their physical activity levels. However, doctors and medical students receive little to no training on exercise medicine and there are very few high-quality objective resources accessible to patients. Get Exercise Confident aims to provide the latest evidence-based information on exercise, which has been evaluated by doctors, so that patients can learn how to exercise as effectively and safely as possible.
Get Exercise Confident is being used by my University’s GP Service, which looks after 20,000 students. Doctors and nurses will give leaflets to patients who they think would benefit from increased exercise. The resource has been viewed over 4,000 times, and we are currently expanding the resource to other General Practices.
805 What does integrated renal care look like? Building a community service for east London
Aims Improving the identification and management of chronic kidney disease (CKD) in east London is an important objective. High rates of hypertension and diabetes in London’s ethnic minority population are risk factors for above average rates of end stage renal failure. Many patients (35%) present at the point of requiring dialysis, associated with a worse prognosis and care experience. Progressive renal impairment is modifiable with early diagnosis and intervention to maintain renal function using renoprotective drugs.
Content This project redesigns a traditional hospital renal service to include a) virtual community clinics with shared access to patient records in EMIS Web, b) population oversight including database searches to identify uncoded CKD, dashboards to identify practice variation and incentivise coding and blood pressure control, and monthly trigger tools to alert GPs to patients with a falling eGFR. Patient education supports self-management.
Impact The virtual community clinic pilot period demonstrated that 50% of referrals could be managed without attendance at OPD. Waiting times for a nephrology opinion fell from 64 to 5 days. Planned evaluation will examine changes to hospital costs and activity, changes in dashboard indicators for primary care management and the impact of trigger tools on referral behaviour.
Discussion The successful introduction of a community CKD service across east London provides cost and activity data for others planning similar changes. Integrating system change across primary and secondary care enables a rapid response to patients requiring specialist advice, while providing resource and personalised support to manage more cases in primary care.
806 Recruitment to General Practice – an innovative approach
AIMS The aim of this project was to develop a competition which resulted in the production of a video, of no longer than three minutes duration, which depicts why Wales or a community in Wales is such a great place to live and work as a GP.
CONTENT The rules of the competition stipulated that anyone in Wales over the age of 16 could enter, with potential participants being identified through discussion within RCGP Wales. Target groups were sent individualised and adapted information outlining the aims and rules of the competition, along with appropriate poster material. Judges were recruited from a wide group which included overseas doctors . school students and patients.
RELEVANCE/IMPACT This work is relevant in terms of promotion of GP recruitment within Welsh communities and also has impact outside of Wales by recruitment of an international judging panel and bringing to the fore the attempts by RCGP in trying to address recruitment issues.
OUTCOME A total of five videos were submitted and a clear winner emerged – a GP and RCGP member from North Wales. The submitted videos are available publicly and the winner’s video has had over 1400 views and received national and medical press publicity.
DISCUSSION This project shows that the college can engage in innovative approaches to the recruitment crisis in Wales. It is our intention to keep the momentum up by launching a further competition this year but specifically targeting schools and colleges only.