Sophie, Joanne and Tracey have busy and crucial roles, connecting patients with specialist clinicians for a home visit within hours of their call to their GP. Their team, called the Acute Visiting Service, now provides care for a population of 340,000 across Nottinghamshire following an initial pilot centred in Newark.
Sophie explains the benefits of the service: “We help our patients to stay at home where it is safe to do so, rather than go to the hospital. We’ve had a 107 year old patient who was living at home, so it was great to get them treated really quickly without the stress and risks of leaving their home. It’s also really important that our service helps out the surgeries so that they can see other patients with less acute, but perhaps more complex needs more quickly.”
Their work has been made no easier with the impact of the coronavirus, but has been even more important for the most vulnerable in our communities, particularly those shielding who were worried about going to hospital or into the health centre. They have continued providing the service throughout lockdown by enhancing the safety precautions – even down to the clinicians sanitising their cars between visits.
Sophie explains the way the team works in partnership with the GPs and Practice staff, “We get calls from GP practices in Newark, Sherwood, Mansfield and Ashfield, so we talk through the cases to ensure they meet our criteria for a visit, then create secure digital files and add them to our planning board. The clinicians are automatically alerted to the new case and go out to visit the patient. They can either treat them with advice and prescriptions, such as antibiotics, refer them back to the doctor for any more complex issues, or get them to hospital if necessary. The clinicians pick up new cases until 6pm, so patients are literally getting home visits close to an hour of them being rung through from their surgeries, with 5pm being the deadline for same-day referrals.”
The criteria is focused on a specific range of infections or symptoms including chest infections, urinary infections and potentially serious conditions that might need an urgent visit. Sophie adds, “That’s why we are so careful with the referrals – so that the patient gets the help they need as soon as possible and we’re sure our clinicians will be able to help them. It’s such an amazing team – we’re always listening to each other and we collaborate to make sure we get the visits right for the patients.”
An important element of the service is how it’s been co-designed between PICS, GPs and commissioners, and how it is integrated with the care the patient gets from their GP surgery. The clinical team can access full patient records remotely and securely by laptop, which improves the quality of care and safety for patients. The team are in regular contact with the surgeries throughout the day to pick up cases, talk through the pathway and referral file and they advise on capacity and flag up slots that are still available towards the end of the day. Sophie adds, “After the visit and after the treatment or onward referral is made, the clinicians will write up the file and it’s sent back to the practice. Sometimes they’ll pop back in a week or so to check that the patient is improving.”
The service has been running for three years and has been shortlisted for the national Health Service Journal Awards 2020, recognising excellent redesign of services in primary care, and been showcased within NHS England to encourage further adoption of the model. Since the service started, they’ve made over 24,000 visits, saving GPs over 15,000 hours (July 2020). They have supported patients to stay at home rather than go unnecessarily into hospital nearly 7,000 times, which has saved hospitals an estimated £8 million (July 2020). For the 631 referrals that were made to hospital during the pilot, each of those patients got into hospital earlier in the day which is a much better and less stressful outcome for them.
NHS Locality Director, David Ainsworth, described the impact of the service for commissioners, “This services provides real savings to commissioners. The service has fundamentally changed the demands on them: We no longer have 40 GP practices travelling out across a large geographic area. We now have a much more efficient model to manage urgent visits within a single team, which saves GP time and releases GPs to do other things.”
100 per cent of patients who feedback on the service are satisfied, with two sharing their experience:
“The clinician was very patient with me because I cannot hear very well. They took their time to find out what was wrong with me and arranged carers to come and assess me further. The level of care was excellent.”
“The clinician was brilliant with my dad. The visit was ideal. My Mother has dementia and a serious infection. Daughter is not coping well with the pressures of caring and felt that the time and empathy was brilliant and required. It is what is needed at this stressful time. They were every professional and helpful. An excellent service.”
There is 96 per cent of satisfaction among GPs. who have shared their feedback. Dr Cusack, Clinical Director of the Primary Care Network who commissioned the pilot, and practicing GP in Newark, said: “We have benefitted hugely from this service. It has had a big impact on GP workload and has had a huge benefit to patients. Patients that need to be seen urgently are seen in a more timely way, and this frees up GP time to see more complex patients. The staff are competent and helpful. Overall it has been a huge success. Long may it continue!”