Pre-hospital Flow: The role of Primary and Community Care Dr Gregor Smith

Areas for discussion Care Management in NHS Lanarkshire Anticipatory Care Planning Care Homes Local Enhanced Service Lanarkshire Eye Health Network Scheme (LENS) Other areas under evaluation

Care Management in Lanarkshire Provides structure for many other benefits –ACP, LCP, co-ordinated care Nurse led: extended training in clinical assessment Access to care packages Identification of cases

Care Management in Lanarkshire Initial pilot 2007 –Small reduction in admissions –Improved co-ordination care packages Full roll out across 32 LTC teams following community nursing review 366 patients Impact assessed at 6 months

Care Management in Lanarkshire 10% reduction in ED attendances 8% reduction in emergency admission 114 people died in preferred place of care at home 30% increase in LTC nurse visits 32% increase in GP home visits in OOH period 44% reduction in OOH advice calls

Anticipatory Care Plans Advance care planning – better communication and recording of decisions Care based on needs and preferences of patients and carers Anticipation of change in clinical condition with interventions agreed between individual and care provider Based on discussion, voluntary and not binding

Anticipatory Care Plans ACP Pilot – 9 care homes (129 patients) Emergency admissions fell 36% Length of stay fell 51% ED attendances – static But – 20 of the 47 attendances after introduction involved 1 individual with recurrent dislocation of jaw!

Care Homes Local Enhanced Service Context Growing complexity of needs 38% increase in number of patients in top 4 dependency groups GMS provision predominantly reactive 4256 care home beds; 100 practices delivering care, often across multiple homes

Care Homes Local Enhanced Service: Objectives Enhance GMS input to care home residents Increase proactive care Reduce levels of unscheduled GP visits Reduce levels of unscheduled admissions Increase provision and use of evidence based protocols Improved management of prescribing

Care Homes Local Enhanced Service Evaluation 6.2% reduction in ED attendances 9.1% reduction in admission to hospitals 81% of GPs believed clinical care had improved 80% care home managers rated new service as “very beneficial”

% difference in ED attendances from care homes by locality between to

Lanarkshire Eye Health Network Scheme LENS Launched Nov optometrists GPs and optometrists asked to refer to LENS rather than eye casualty 1240 patients requiring acute eye care 450 (35%) seen by LENS optometrist 396 (32%) treated solely in primary care

Newer Developments and Onward GP “Hybrid” roles DVT Pathway Atrial Fibrillation pathway Risk assessment and management in the community