1. Implementing Collins at Frimley Mrs. Geeta Menon Director of Medical Education Frimley Park Hospital NHS Foundation Trust

2. Collins report

3. Stakeholder Discussion Groups Chief Executive Officer and Medical Director Clinical Directors, Heads of service, FTPDs and Consultants in charge of rota Trainees

4. Initial response Changing the mind set of colleagues Discussion around training and service provision

5. Key themes and challenges Options of integrating community placements Service delivery and effects on rota Links within the community Opportunities

6. Trauma & Orthopaedics Fracture neck of femur pathway Working with physiotherapist and occupational therapist

7. Surgeons Upper GI and Breast surgery Phyllis Tuckwell Hospice

8. Urology Community urology clinic with specialist nurse Incontinence clinic

9. Obstetrics &Gynaecology Community midwife

10. Paediatrics Community paediatrics

11. Ophthalmology Diabetic screening programme

12. Pilot Urology Trauma and Orthopaedics Surgery

13. Results of Pilot Pilot in T&O and Urology Trainees views

14. NOF Fracture Pathway Dr. Serjevan Kalsi, Dr. Leila Mohamed, Dr. Thorrmela Vijayaseelan F1 Doctors Orthopaedics, Frimley Park Hospital

15. Pathway Outcomes Reduce variation in length of stay, reduce mortality and re-admissions Surgery within 24 hours at FPH Early mobilisation Multi disciplinary team Discharge – Farnham/Fleet – Home +/- Care package

16. Farnham/Fleet Rehabilitation Centres Small Wards Consultant Led Beds F1 Review Daily 1-1 Consultant Contact Daily Physio/OT input Experienced Nursing Staff

17. Home No Orthopaedic follow up No further OT input – Extra facilities in place Physiotherapy Outpatients

18. Intermediate Care Team ‘Promotion of independence & Safety first’ Aims to build confidence in the home – Initial Interview – Mobility – Transfers – Domestic activities and Activity tolerance

19. Advantages of Project Realistic process of discharge Highlighted gaps in holistic care Not just a simple social history Are patients coping? Recognising potential follow up

20. Disadvantages of Project Difficult to get time off – Trauma, Post Trauma, Oncall Dedications Difficult to co-ordinate visits

21. Recommendations Incorporated into Rota/Taster Weeks MDT Attendance Presentation at Trauma Meetings

22. Thank you

23. Community Experience Dr Emma Humphreys FY2 Urology Frimley Park Hospital

24. 1 day at Fleet Community Hospital Bladder Cancer CNS Haematuria Clinic Flexible Cystoscopy Intravesical BCG Consultant OP clinic

25. Advantages Off-site so free from ward jobs Enthusiastic nurse willing to teach More time for learning Able to carry out procedures Observation of other OP Ix OP clerking new pts 1 to 1 with Consultant DOPS/CEX

26. Difficulties Rota challenges Liaising with DNs Incontinence clinic proved impossible Relevance to job Mostly observation

27. Recommendations Build into rota 5 days in 4 month placement sufficient Placements to be organised Utilise experience of Nurse Specialists

28. Thank you

29. Results of Pilot Trainers and service provision Community Roll out to all posts in August 2012

30. Take home message No easy answers Engagement from - Leadership i.e CEO Medical Director - Middle management i.e Clinical Directors, Heads of Service, FTPDs, Consultants in charge of rotas - Trainees Feedback