1. Portsmouth Primary Care Alliance Acute Visiting Service (AVS)
Dr Howard Smith
GP Partner
Trafalgar Medical Group Practice
PPCA Director
Mr Mark Stubbings
Managing Partner
Portsdown Group Practice
PPCA Director

2. Portsmouth Primary Care Alliance
GP Alliance – 31st March 2015
All Practices – Shareholder Members. 26 at time of formation, now 22 as a result of mergers.
Opportunity for Projects / Pilots / Work to be undertaken at scale and cooperatively.
Alliance aim has been to deliver projects providing better care for patients and improving the workload and capacity difficulties faced by primary care.
AVS our first project.
AVS – Output from Commissioning Evening May 2014 attended by all GP practices.

3. Why an AVS Service?
Feedback from practices that unscheduled home visits in Primary care having significant impact on workload and capacity.
SCAS report a cohort of 999 calls for those patients and/or their carers who perceive their problem to be too urgent to wait until a lunchtime GP visit.
Lunchtime visiting creates a surge in demand for patient transport over short period of the day 1- 3pm.
MAU report spike in GP admissions in late afternoon – AVS service will enable those patients needing admission to be referred earlier during the day.

4. Acute Visiting Services
Concept is well established and proven elsewhere. Earliest since 2008 St Helens CCG.
Other schemes in Nottingham, Leicester, Hertford. Stafford.
High Patient Satisfaction rates.
Approval of Concept by Kings Fund Review.
Offers in-Hours visiting on behalf of GP.

5. Portsmouth AVS Our Offer 3 Locality Service (Mon – Fri)
4 Hours each Morning.
7x 30 minute visits.
Practice Duty GPs are Gatekeepers and decide if referral is appropriate.
Referral criteria exclude children, acute mental health crisis, and End of Life.
Proforma and Medical Summary is faxed to AVS.
Visits allocated to 3 locality GPs who have mobile IT.
Engagement with GPs has been key to success.

6. Advantages of the AVS
Self Funding if one complex elderly admission avoided per area per week.
Visits more timely 43% 30 mins; 76% 60 mins.
Reduction in admissions and attendances at the acute trust.
Unavoidable admissions arrive earlier in the day at QAH avoiding afternoon activity spike at PHT.
Earlier arrival and treatment means possibility of day attendance rather than overnight stays.
Frees capacity for Duty GP in surgery.
Early success for the Alliance and stepping stone for our next big projects.
Ambulance service able to refer in directly to avoid conveyance (with GPs consent)

7. Potential Pitfalls
Will the AVS GP do a proper sort out? – AVS GP has access to the medical summary and we are keen that the visit is undertaken as if our own patient and with an appropriate amount of time.
What about complicated patients or patients where their own GP has plan? – with patients own GPs as gatekeeper particularly complex or difficult patients will not be referred.
Will the AVS reduce locum availability in the area?
Surely GPs would not choose to spend a session just doing visits! – I hate them – but only because they are crammed in my very busy duty day ‘lunch’ break.

8. Potential Pitfalls
When will we hear the outcome? Within 30 minutes of the visit completion.
Will a Paramedic / NP / Paramedic practitioner do a good enough sort out? – initially we felt that the service should be staffed by GPs.
What about Data sharing / IG etc? – patients give consent at the time of the visit request and recorded by their own surgery before forwarding the referral.
What if patient needs PRRT / support at home? – AVS have direct access to the PRRT and will make the referral.

9. AVS Year One 3010 home visits undertaken.
633 perceived saved admissions.
181 Referral to PHT
 Average response time is 66 minutes.
All practices but one using the service regularly.
Previous Kings Fund and St Helens AVS work estimates a typical admission to cost £ Clear saving to local health economy.
Met all the specified KPIs.
Several enquiries from other areas keen to implement their own AVS.

10. AVS Feedback - GPs
“A real team effort, resulting in patients being reassured and staying in their own homes’”
“A big thank you to all the team for seeing and admitting patient earlier in the week. Keep up the good work!”
“Just had a patient come into the practice to say a big thank you for the AVS visit, he is feeling better!
“Great service – has helped make my duty day bearable!”

11. AVS Feedback - Patients
“Very pleased with prompt visit about 1 hour after phoning practice”
“Phoned for Dr at 8.15am, 9am Dr arrived, 10.15am Paramedic arrived, 11am at hospital. Doctor was excellent.”
“A very sensible service’”
“Excellent service, couldn’t wish for anything better”
“Very happy with a good, quick, successful GP visit”

12. AVS Phase 2
Commissioners, GPs, Patients impressed with the service and keen to expand its impact.
Implementation of SystmOne Module for use by AVS
Referral will be made electronically within SystmOne.
Visiting Doctor will be review all medical notes / hospital Letters while mobile.
Electronic Prescribing.
Read code and QOF values will be entered.
Immediate information to own GP.

13. Portsmouth AVS Phase 2
Monday Mornings – identified as area of high demand for service – 4th GP approved and has gone live.
Afternoon service 1pm – 5pm – different referral criteria but aimed at avoiding / earlier referral of ‘evening’ visits.
Trial of Additional Paramedic Practitioners who are supported by the AVS GP rather than calling patients own GP.

14. Any Questions?

15. Contacts Jan Matthews Janice.matthews2@nhs.net Howard Smith
Mark Stubbings