Establishing a GP in A/E Service Dr Laura Ryan Unscheduled Care Clinical Lead (Primary Care) Dr Sheena MacDonald Associate Medical Director Primary Care NHS Borders

Outline  Introduction  Background  Milestones  Challenges  Things to think about/planning

Introduction  Other existing models-one size doesn’t fit all  Generic lessons can be learned  National Drivers eg T10  ‘blurring of lines between secondary and primary care’

Background  NHS Borders 113,000 population  Semi rural and rural with remote areas  Cross Border coverage  DGH approx 300 beds  Community Hospitals 135 beds

Background  OOH GP service Borders Emergency Care Service (BECS)  wte GP  Salaried Service (77% as of 8/2010)  One GP overnight with two OOH Nurses  PCEC daily in three Community Hospitals with MIU  GPs provide medical cover in MIU

Milestone 1 – New GMS 2004  Referral pathways from A/E to BECS .e.g. Gynaecology patients  Nurse Triage – When BECS doctor on duty  A woman presenting with a gynaecological condition should be referred to the BECS doctor.  Exception:  Any woman presenting with a gynaecological condition that is likely to require in-patient care or resuscitation should be referred directly to the SHO on-call for Gynaecology.

Milestone 2 - Unscheduled Care Collaborative  Local PDSA to look at Flow 1  50 % breaches in Flow 1 group  Orthopaedic junior/GP/Associate Specialist Orthopaedics /ENP  GP most effective at reducing waiting times

Milestone 3- First GP A/E Feb 2007  –  Subsequent capacity analysis  Shift better moved to –  Flow 1 100% compliant within months

Milestone 4 - Clarity regarding patient groups  RCGP Curriculum Competencies  Placed in Triage  Consultant appointment November 2008

Results 7 days a week – Total attendances at times when GP available Percentage seen by GPs (ED or BECS) Percentage seen in ED by GP Percentage seen by OOH service %13.89 %4.50%

Three Saturdays in May between Total attendanc es at times when GP available % seen by GP (ED or BECS) % seen in ED by GP % seen by OOH service 11225% %24.10 %1%

Three Saturdays in May from – Total attendances at times when GP available Percentage seen by GP (ED or BECS) Percentage seen in ED by GP Percentage seen by OOH service %1.92%17.30%

Challenges  Accountability/professional management  Personality and change management  Training and development  Appraisal Revalidation-for those GPs who work only in this role

What sort of Doctor?  Dedicated pool of ‘speciality doctors’ or  Interaction with OOH GP service or  Ad hoc sessional doctors

Reflections for the future  Planning event  Stakeholders  Managers  Funding  Appraisal  Potential workload implications for OOH services