Service Delivery Posters 3014 – 3020
3014 Service evaluation of a new urgent care facility
Objectives: To evaluate the urgent care provision in a unique standalone facility, adjacent to a large general practice.
Background: In 2011/12, the local CCG was within the worst 10% for A&E utilisation. An urgent care centre (UCC) was constructed to manage patients in the community more effectively, streamline services and improve cost-effectiveness. From its inception, the UCC employed GP-led triage to optimise early decision making. Point of care testing available includes troponin, D-dimer and blood gas analysis in addition to routine blood tests, ECGs and radiology, allowing rigorous assessment of complex conditions.
Methods: Data was collected by the UCC from October 2012 to March 2016 and analysed by SPSS v22.
Results: Attendance to the UCC has increased year-on-year, now seeing over 60,000 patients annually, and has similar attendance patterns to the local A&E. Increasing attendance from neighbouring towns is noted, including those travelling further than their local A&E. Over 25% of patients are paediatric, (majority aged 0-5 years), with a second peak in adults in their 20s. Over time, the proportion of patients requiring GP follow up has steadily decreased (now <20%). Approximately 10% of patients require further referral, with only 1% referred to A&E. Five triage categories are applied, with those triaged as urgent or very urgent (patients who would traditionally need A&E) avoiding A&E in 76% of cases. For paediatric patients the equivalent avoidance figure was over 80%. 99% of patients are seen within four hours.
Discussion: Initial data analysis from the UCC confirms patient demographics and demonstrates the effect that its particular approach (model, recruiting, training, pathways, standard operating procedures, near patient diagnostics etc) has had in minimising local A&E attendances.
3015 Interpreting services for General Practice in the NHS – service usage, costs and the GPs’ perspective
This poster presents a two part study conducted across a local health board area. The first part looks at the usage and costs for the provision of interpreting services in General Practice for non English speaking patients over a 6 month period. While the second part assesses the opinion of local GPs on the interpreting services available to them. T
he results itself reveal a stark disparity in the average costs between the telephone interpreting service (£9.25 per consult) and the face to face interpreting service (£88.11 per consult). The total overall cost for the provision of interpreting services over a 6 month period was £60,720.97. Furthermore a consult requiring a telephone interpreter lasted an average of 15.22 minutes (standard appointment length of course being 10 minutes).
A survey of 95 local GPs meanwhile revealed that 86% of them felt a consultation requiring an interpreter of any sort was less satisfying than a standard consult. 83% preferred the use of face to face interpreters. Only 9.5% had received any formal training on how best to utilise an interpreting service in a consult. 1 in 5 were never notified beforehand if a patient required an interpreter, while over 40% said they were not allocated a longer appointment for a consultation requiring an interpreter. The study has great relevance to the current diverse and multilingual British demographic. One could easily argue that the study, or its variants, should be reproduced nationally to help formulate a standardised interpreting model and policy best suited to General Practice.
3016 Pressures on the selection of novel oral anti-coagulants over warfarin amongst patients in a GP practice
Novel oral anti-coagulants (NOACs) have entered general use in both hospital and GP settings but an absence of selection guidance of NOAC or Warfarin allows freedom of choice that may reflect the pressures on the healthcare provision at the point of therapy initiation.
This study determines the healthcare setting and factors for initiation of NOACs over warfarin to identify pressures that may dictate the selection.126 patients on a GP register were started on NOACs since 2010, 70 patients (56%) by a hospital and 56 patients (44%) within primary care. Reasoning for NOAC choice over warfarin was provided in 105 cases (83%), with documentation in all GP initiations but only 70% of hospital initiations. Of those with a stated reason, most frequently by 25 patients (20%) warfarin was refused or a NOAC was selected in preference, 13 patients started NOAC (10%) for a potential DVT, and 12 patients (10%) were switched to a NOAC for compliance concerns on warfarin.
Differences between hospital and GP NOAC selection were mainly confined to differences in clinical event presentations but notably, patient choice as determinant of NOAC use was comparable in both the hospital and GP setting. While the debate continues as to whether NOACs are truly superior or cost-effective with respect to warfarin the current use is defined by patient choice, initial therapy duration and simplicity of use. Importance therefore must be made to give patients complete information about the benefits and limits of each therapy so they can make an informed decision.
3017 Public Health England’s (PHE) migrant health guide – development of an evidence-based resource for primary care
Aims and Objectives Europe is currently experiencing a humanitarian crisis, with large numbers of refugees moving between countries. These refugees and migrants have multiple and diverse health needs influenced by their experiences in the country-of-origin, their migration journey and socio-economic factors on arrival. The health needs of migrants and refugees need to be appropriately recognised and addressed and evidence based advice is needed for primary care professionals.
Content Public Health England’s (PHE) Migrant Health Guide is an online tool for healthcare professionals. It was launched in 2011 and was widely used in both the UK and internationally. The guide has been transitioned to the gov.uk site and the updated guide will be re-launched in autumn 2016. Multi-disciplinary case-studies have been produced to supplement the information in the guide.
Relevance The guide has four main sections: 1) Migrants and the NHS provides information on entitlements to access the NHS; 2) The Countries section includes advice on infectious diseases, women’s health and nutritional and metabolic concerns for an extensive number of countries-of-origin; 3) Health Topics provides information about communicable and non-communicable diseases; 4) Assessing Patients includes a checklist for initial healthcare assessments and advice for patients travelling abroad to visit friends and relatives. The case-studies accompanying the guide provide a holistic narrative of the patient’s perspective and signpost on to further resources.
Outcomes and Discussion PHE’s Migrant Health Guide raises awareness for primary care professionals, of key issues and provides evidence-based advice, in order to improve the health of migrants and refugees both internationally and in the UK.
3018 Lessons Learned: Providing healthcare to resettled refugees in Leeds
In September 2015 the UK Prime Minister announced a commitment to resettle 20,000 Syrian refugees over 5 years. As a result, resettlement to our area of the UK has been offered to refugees from Syria and Afghanistan since December 2015. Our practice provides primary care to people who are homeless, vulnerably housed or seeking asylum. We were identified as the practice best placed to provide initial registration and healthcare to the families arriving as part of this programme. Innovative approaches were required to meet the complex needs of these newly arrived refugees, whilst continuing to provide care for our existing service users.
In this presentation, the authors will explore the challenges and lessons learned from developing this work. Key Themes explored: Integrated working with healthcare, local authority and third sector partners; Whole team engagement and commitment to providing a welcome to resettled refugees; Planning for service delivery to existing patients and new arrivals, including anticipation of complex health needs; Development of Standard Operating Procedures to ensure a consistent approach and maximising the impact of each contact; Seeking feedback from patients and partners involved.Impact of reflective practice sessions to support team-members involved.
Relevance: With the expansion of the Gateway Protection Programme, more areas will be providing resettlement for the first time. Sharing lessons learned helps health services develop their approach.
Outcomes and Discussion: Developing our service was an iterative process demanding critical appraisal and reflection after each cohort of new arrivals. Supportive team working and reflective practice underpinned our approach.
3019 The Impact of using pre-consultation questions
Does giving pre consultation questions help to make primary care consultations more efficient and focused? The aim was to design, then explore both the impact and practicality of using pre consultation questions? The poster outlines the pre consultation questions, examples of responses and an overview of their impact and practicality. Workload is an increasing problem in general practice with more being fitted into each consultation. Both patients and GPs want consultations to be focused and efficient to fit into the seven minutes of face to face contact within a ten minute appointment.
Out of a hundred pre-consultation questions, half were judged to be helpful by the GP. Examples of information raised before starting the consultation were cancer concern, past medicines used, drug allergies, beliefs about antibiotics, a clearer focus on a key issue, a clearer order of focus on multiple issues, and a key unexpected psychological issue. Positive messages of support for the doctor were added to several sheets by patients.
The pre-consultation questionnaire were less helpful for parents with children who had a simple minor illness and those with mild cognitive impairment, usually in older patients. Application of pre-consultation questions was practical, all patients were positive and GPs reported consultations felt easier. This was a qualitative observational study and further research in a larger cohort is required to determine the impact on the consultation length and workload.
3020 Uptake of online services by older people: how many silver surfers are there?
For patients, ordering and collecting repeat prescriptions from their general practice can be convoluted, inconvenient and frustrating. For the practice, traditional re-ordering systems, such as telephone services, are labour-intensive and stressful. Online systems could help to overcome this burden. In 2016, 10% of patients in England are using such a service, whilst in Wales it is offered by 70% of practices. However, there are concerns that online services could exacerbate health inequalities by reducing the access of non-internet users.
Many older people would fall into this group: whilst internet use is increasing for those aged 65 and over, still two thirds of women over the age of 75 have never used the internet. In this study, the database of one large sub-urban general practice in South Wales was examined, to determine whether the uptake of online services was affected by age.
Of 6435 patients with repeat prescriptions, 806 had registered for online re-ordering. This included 18% of 41-65 year olds and 14% of 66-70 year olds who have repeat prescriptions. In contrast only 8% of patients 71-80, 7% of patients 81-90 and 3% of >91 year olds have registered for online re-ordering. Uptake was also low in patients under 30 (<9%), perhaps reflecting a confounding of less frequent reordering.
When introducing online services care must be taken to retain the same level of service for all groups, whilst simultaneously aiming for efficiency. Whilst encouraging patients to try additional new services, maintaining accessible alternatives is essential.