British Association of Health Services in Higher Education Conference 6 th July 2005 The Minor Illness Nurse

Our Practice Wigmore Lane Health Centre Luton North east (near the Airport) Three full time doctors (many outside commitments) Two sessional doctors Two part-time practice nurses (50 hrs) One Nurse Specialist (30 hrs) 6,100 patients 10% under fives

The Problem Too many patients Too little time

Increasing GP Workload Increasing patient Demand Increased transfer from secondary care Care in the community PCTs

Decreasing GP Workforce Recruitment crisis Part-time working Few reliable locums

The Extras - Patients Requesting Same Day Appointments >Uncontrollable workload fluctuations >Major source of GP and receptionists stress

Who Were They? 33% Children under 5 19% Children 6-10 years 48% 10 years and over (72% female) 1,630 Extras per GP per year

Which Problems? Of the requests for same day appointments 57% URTI / ears/ cough 20% Eyes and skin 8% Abdominal / D&V / Cystitis

The Raw Deal Reluctantly squeezed into over-booked surgeries Long waits Harassed GP who has little time for explanation Maybe, unnecessary antibiotics

The Solution?

The experienced Practice Nurse

The Nurses Emergency Clinic

Protocol Regular, daily for 3.5 hours in the morning and some afternoons Book on the day Requires sensitive questioning by receptionists

15 minute appointments Doctor on hand for discussion or referral Prescriptions (if needed) written and signed by nurse (if clinical condition and drug on ENPF) or signed by GP

Responsibility Professionally accountable to the NMC GP employer is legally liable Indemnified by practice defence organisation MPS and RCN

Does it Work? YES!

Analysis of the clinic after 1 year (June1996-May 1997) 1,535 patients seen by Nurse Specialist 45% - received a prescription 7% - immediate referral to GP

Benefits to Patients Fixed appointment time so shorter wait Nurse spent more time with patient than GP initially but GPs now have 15 minute appointments Emphasis on self care supported by written material, not prescription drugs

Benefits for the practice Happier receptionists More satisfied patients Better health education Patient less likely to return next time? More job satisfaction for the nurse Reduced need for locums

Problems Training very time consuming Confusion over different practice nurses roles A few patients objected Holidays / Sickness

Nurse Specialist Minor Illness Course

Minor Illness Course Accredited by the University of Luton (45 credits level 3) One week full time seminars From September 1997 – March 2003, 6 months course with clinical sessions based at WLHC (no longer available)

Also available………….. Flexible training opportunities – 5 day Seminar week at based at WLHC or satellite locations around the country Open learning programme at Level 2 available through Radcliffe Publishers Combination of seminar week and open learning programme to attain accreditation

The Course - ingredients Consultation and Communication skills Clinical skills Examination techniques Infections Clinical Pharmacology Prescription writing Managing change Evidence based practice

………..The clinical sessions 8 weeks observation 12 weeks supervised 6 weeks solo

Extra ingredients Assignments: Pharmacology scenarios Case studies - 1 Adult & 1 Child Practice Administration Evidence Based Practice topic Skills Manual Video 4 consultations (not assessed) Own practice support

…………resulting in Competent, skilled, highly trained nurses able to manage patients requesting same day appointments. An understanding of the relevant theoretical background in the management of minor illness A holistic approach with insight into the possibility of a hidden agenda The knowledge when to seek appropriate medical assistance

Does it work for other practices? 63 nurses trained on the 6 month course A further 600 nurses attended seminar weeks Practice audits show very high patient satisfaction ( %) Similar prescribing patterns to GPs % referral rate to GP during clinic % re-consultation to GP with same complaint within 2 weeks

June 2005 Audit n=164 (over 2 weeks) F/M 2:1 URTI 39% Abdo/UTI gynae 13% Skin/rashes/eyes 35% Musculo/skeletal 10% Others 4%

References Chau S, Humphries A, Wheeler D, et al. Nurse management of patients with minor illness in general practice: multicentre, randomised controlled trial BMJ 2000; 320: Kinnersley P, Anderson E, et al. Randomised controlled trial of nurse practitioner versus general practitioner care for patients requesting same day consultations in primary care.BMJ 2000; 320:1043 Marsh G N, Dawes M L. Establishing a minor illness nurse in a busy general practice. BMJ March 1995; 310: Venning P, Durie A, Roland M, Roberts C, Leese B. Randomised controlled trial comparing cost effectiveness of general practitioners and nurse practitioners in primary care.BMJ 2000; 320:

Contact Sheila McLaughlin on For details and an application form