Felixstowe OTD Training Session - Agenda Arrival 1.30pm Overview – for all participants 1.45pm Case for Change Triage / Booking Process Walk-In Policy Rota Questions Break into 2 groups SystmOne training – for all Haven staff 2.15pm EMIS training – for Howard and Walton clinicians 2.15pm Doctors leave for Trinity Park 3.30pm

Case for Change Practices cannot recruit partners/salaried doctors as GPs retire or leave Practices without partners has an uncertain future for patients and staff – it could be taken over by the hospital or a corporation, or closed and the list passed to other surviving practices Practices are looking for ways to reduce workload on GPs The only option is to look at ways of doing things differently Any new money will be available only to practices working at scale, so it’s good to get together now Larger groups of GPs/practices will have more of a voice with the powers that be OTD is a really good start to relieving pressure on GPs right now

Felixstowe OTD Reference Guide November 2016

Triage/Booking Process

Triage Protocol - process   Patients continue to call their own surgery as usual but all calls after 3.30pm are filtered and triaged by reception staff using this OTD reception protocol. Filtering: there is a “banned list”- see Table 1.These cases are filtered and reception staff inform patients how their request can be met the following working day, or transfer the call appropriately. The remaining calls are placed on the OTD telephone list for the OTD team to triage. If it’s immediately apparent that the patient must be seen, the receptionist can book an appointment for the patient to be seen at FGH. Therefore there are two lists - one for OTD team triage, the second for patients who the receptionist has assessed as needing a face to face appointment at FGH. All entries on either appointment list should have the reason given by the patient for their call and it should be noted which practice the patient is from; Howard, Haven or Walton. Visit requests continue to be triaged by the doctor via a telephone call. Clinical work likely to come to OTD team:- On the day minors patients, face to face & phone, walk ins (refer policy) Triage visit requests after 15.30 Carry out any required visits Sink for tasks without other destination Some calls passed to the OTD team should be treated as urgent – see Table 2. This can be recorded on the OTD list and the OTD team would be contacted by telephone to let the GP know an urgent call has been added. Staff should err on the side of caution if unsure.

Triage Protocol - script   When patients are to be seen or called by the OTD team, reception staff can advise: The three surgeries are working together, so you may be seen by a doctor or nurse from another Felixstowe practice If the receptionist has triaged the call to be seen by GP or Nurse, advise they will be seen at FGH If patient requires further information about the service, a leaflet and poster is available at FGH waiting room If patient doesn’t wish to be seen by this service, alternate options are: Phone own surgery again next morning Call NHS111 Reception can offer Felixstowe GP+ appointment which can be booked (if available) all week

Triage Protocol – banned list (not for OTD)   Request Preferred call disposal Repeat medication requests Request on line Call next working day after 10am If on repeats, community pharmacy (at their discretion) can dispense a short supply whilst awaiting a new script Staff who would see their own employer working as a doctor in OTD team Receptionist negotiates alternative Med3 Call next day Routine follow ups With own GP next available day Dental issues Patient to ring own dentist Or ring 111 Medication issues except acute reactions e.g.; rash All script enquiries With own GP next day   Results Letters On-going problems that do not require urgent advice End of Life Pass call to own GP Methadone related enquiries, patients with substance misuse problems Social care background enquiries – usually a fax

Triage Protocol – for OTD but treat as urgent   Request Results faxed or phoned to the surgery from hospital or other organisations Visit requests Medical emergencies Shortness of breath Severe persistent chest pain Fitting Constantly crying infant Children floppy, rash or parental concern Uncontrollable haemorrhage Collapse or loss of consciousness New or worse confusion Severe allergic reaction Extensive burns or scalds Vomiting diabetic patient Stroke signs - FAST: weakness of face or arm, disturbance of speech. Time is of the essence Anything reception teams consider to be urgent Anything caller considers urgent or if caller insistent even if it appears on the banned list Err on the side of caution

Booking / Clinic Lists

Walk-In Policy - page 1. The Felixstowe ‘On the Day’ (OTD) service is a collaboration between Walton Surgery (managed by Suffolk GP Federation), Haven Health and Howard House GP practices. The collaboration does not currently include The Grove Medical Centre. Whilst OTD is not a walk in service it is recognised that there may be occasions where patients will present at the clinic without a pre-booked appointment. As OTD is not designed to be a walk in service it is under no obligation to see walk-ins, however, it is may be appropriate for the OTD GP to assess the patient.   1. Patient pathways 1.1 Walk-in patients registered at The Grove Medical Centre Patients registered with The Grove Medical Centre will automatically be re-directed at the point of walk-in to MIU at Felixstowe General Hospital. 1.2 Walk-in patients registered at Walton Surgery, Haven Health or Howard House As OTD is not designed to be a walk in service it is under no obligation to see walk-ins, however, it may be appropriate for the OTD GP to assess the patient. For those registered with Walton Surgery, Haven Health or Howard House the receptionist will:- advise the patient that OTD is not a walk in service there is no guarantee that an appointment can be made the receptionist will inform the OTD GP who will assess their suitability to be seen

Walk-In Policy - page 2. 1.3 Walk-in patients who are temporary residents (‘out of towners’) If Walton Surgery, Haven Health, Howard House are on duty that day for temporary residents arriving at MIU, it may be easier for the OTD doctor to deal with the patient at FGH rather than asking MIU to call the GP surgery as they usually would. The OTD GP will assess their suitability to be seen at FGH. Out of town patients attending MIU when medical cover is being provided by The Grove Medical Centre should not been seen by the OTD service and will be dealt with as they are now by MIU reception informing The Grove Medical Centre.   1.4 Clinical emergencies Patients may present with a medical emergency including: Shortness of breath Severe persistent chest pain Fitting Constantly crying infant Children floppy, rash or parental concern Uncontrollable haemorrhage Collapse or loss of consciousness New or worse confusion Severe allergic reaction Extensive burns or scalds Vomiting diabetic patient Stroke signs - FAST: weakness of face or arm, disturbance of speech. Time is of the essence. Doctors have an ethical duty, set out by the GMC, to help in a clinical emergency. Such patients will be treated irrespective of their place of registration.

Walk-In Policy – page 3. 2.0 Record keeping & signposting    2.0 Record keeping & signposting   The walk-in will be registered/recorded on SystmOne in order that the volumes can be captured for reporting/audit purposes and so that there is a record of the assessment undertaken by the OTD GP. If the OTD GP decides to see the patient, the receptionist will book an appointment and update the clinical system of the registered GP practice as per the usual process. The receptionist will advise the patient if they are not going to be seen and provide advice and signposting to other appropriate sources of help. The OTD GP may be involved if necessary. SystmOne will then be updated to reflect that the walk-in was rejected as either not appropriate, lack of capacity or advice & support given.

Rota – for first 3 months Haven Health – Monday & Thursday Howard House – Tuesday & Friday Walton Surgery - Wednesday

Questions?