1. Felixstowe OTD Training Session - Agenda
Arrival pm
Overview – for all participants pm
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 pm

2. 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

3. Felixstowe OTD
Reference Guide
November 2016

4. Triage/Booking Process

5. 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.

6. 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

7. 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

8. 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

9. Booking / Clinic Lists

10. 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

11. 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.

12. 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.

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

14. Questions?