© the practice plc 2008 “An innovative integrated care pathway delivered to the care home community" Company confidential

Background Clinical support to Care Home is variable and inconsistent with  Multiple GPs  Poor chronic disease management due to a lack of regular routine visits  Slow response to urgent calls with a default to calling an ambulance  OOH services do not always consider the patients best interests due to the pressures of service delivery and the lack of knowledge of the patient EoL delivery is erratic dependent on the knowledge and level of engage of individual GPs and nurses. There is no accountability Excess Anti Psychotic prescribing and to many medication errors Inappropriate Hospital Admissions. A&E is over burdened with patients who don’t want to be and shouldn’t be there Drug wastage. 8% of medicines are returned Minimal Specialist Care Home related Training Due to the sheer number of GPs delivering the service it very difficult to develop and facilitate integrated working with LASs, Secondary Care, Community Services Mental Health and Palliative Care services Company Confidential

Objective of Service Provide a patient focused service Provide GP services to patients in a primary care setting Work with a wide range of care providers to deliver an integrated care pathway Reduce Inappropriate Admissions into secondary care setting Reduce medication costs Reduce medication errors Disseminate knowledge to other interested and relevant parties Company Confidential

Summary of Service The Service provides: innovative integrated care pathway delivered to care home residents innovative technology and processes Integrating multiple teams, drawing on their specific expertise from:  private sector  primary care  secondary care  acute trusts delivering a patient focused service Identifying and incorporating the patients' wishes, ensuring the patient is:  cared for  receives emergency care  ends their days in the comfort of their home Company Confidential

Summary of Service contd. Capitalising on work that has already been done and building on what has been achieved in the areas of:  End of Life  Medicines Management  Admissions Avoidance  Dementia Care  Chronic Disease Management By following best practice and utilising lessons learned from initiatives that have taken place on a smaller scale with reduced scope, a service is being delivered that is:  Benchmarked  Monitored  Regularly reviewed and tweaked  100% compliant care pathway Company Confidential

The Integrated Service 24/7/365 Clinical Support  Regular routine on-site GP surgeries which will include: o Urgent Needs o Regular Health Checks o Managing Repeat Prescriptions o Resident / Relatives consultations  Telephone Triage / Urgent visits from the clinical team within surgery open hours  OOH Telephone Support from GP outside of core working hours End of life contract and management Full GP access to patient record and End of Life contract Clinical Reviews Online access to reports, prescriptions and drug information Efficient prescription ordering process to save significant time Active reduction in the use of antipsychotic drugs Training Company Confidential

Who we are working with Integrated working with:  Care Homes  Pharmacy Team  EoL Team  Palliative Team  Acute Trust  LAS  Geriatricians  Diabetes Team  Community Team  Nutritionist  Alzheimers Society Company Confidential

Support and Endorsement for the Service Support and Endorsements for the service has been received from: National English Community Care Association Care Home Groups Alzheimers Society NHS Diabetes Age UK NHS End of Life NICE Local South Central SHA TV HIEC Bucks Hospital Trust NHS Bucks NHS Milton Keynes South Central Ambulance Service Florence Nightingale Hospice Care Home Associations Care Home Groups Company Confidential

Current Status Homes signed up  Milton Court, with 110 residents, started service 3 rd May  Hampden Hall, with 140 residents, starting service July  Rock House, with 50 residents, starting service July  Burford House Nursing Home, 50 residents, starting in August  Fremantle Trust is rolling out service in 6 of their homes, which have approx. 450 residents, between July and Sept  On going discussions with : o Caring Homes o Four Seasons o Barchester Healthcare Company Confidential

Current Status contd. Resourcing - recruitment  Medical Coordinator  GPs Lessons Learned include:  Initial Assessment of patients conducted by Nurse rather than GPs  Integrated working with Nutritionists / Dietician  Engagement with PCTs Pharmacist Stand alone unit agreed with NHS Buckinghamshire, which includes  Setting up own “K” code  Own clinical system  Funding  Registering patients across boundaries within SHA Company Confidential

Savings £33,253 saved within 1 st month of service on medication review patients from Milton Court  21 med changes to more cost-effective items (many liquid med conversions to tablet form)  50 meds discontinued During episodes generating 519 spells at a cost of £1.27m. Only 149 were elective the rest were emergency. The top 6 admissions and spends are; 1.Chronic Renal Failure 2.Good of Fracture neck of Femur 3.Urinary Tract Infections 4.Influenza and pneumonia 5.Acute Renal failure 6.Lower respiratory If we manage to save a quarter of these costs during 2011, we will save the NHS £317,500 Company Confidential