PRIMARY CARE CONTRACT NURSING & RESIDENTIAL CARE HOMES Right place, Right time, by the Right...
date post
13-Jan-2016Category
Documents
view
213download
0
Embed Size (px)
Transcript of PRIMARY CARE CONTRACT NURSING & RESIDENTIAL CARE HOMES Right place, Right time, by the Right...
PRIMARY CARE CONTRACT NURSING & RESIDENTIAL CARE HOMES
Right place, Right time, by the Right person
Shivaun Aveston, Transformation Lead
NHS OUTCOMES FRAMEWORKRight place, Right time, Right person
Domain 1Preventing people from dying prematurelyDomain 2Enhancing quality of life for people with long-term conditionsDomain 3Helping people to recover from episodes of ill-health or following injuryDomain 4Ensuring people have a positive experience of careDomain 5Treating and caring for people in safe environment and protecting them from avoidable harm
The CCGs 5 year Clinical Strategy& Joint Health & Wellbeing Board
To improve care for frail elderly individuals
To allow patients to die with dignity and compassion and in their place of choosing
Older people in Suffolk have a good quality of life.
Investigation into provision of GP services to care homes has shown that most care homes allow residents to choose a GP. This can result in different GPs visiting a single care home to see different patients This is an inefficient use of GP time and resources, but can also cause problems with communications as nursing homes have to deal simultaneously with several different systems for visits
Chronic disease management and prescription requests many homes would prefer their residents to be registered with just one GP surgery and have a weekly clinic to deal with minor problems and chronic illness.RCGP Report Preparing for the Future (2012) states:
HEADLINE COSTS 2011/2012Emergency Admissions 6m
A&E 2m
Ambulance Call outs 2m
Care homes represent 25% Ambulance call outs
25% of falls originate from Care homes
TOP 10 REASONS FOR ADMISSION TO HOSPITALHip Fractures
UTIs
Pneumonia
Disorientation
Femur FracturesHeart failure
Respiratory infection
Falls
Cerebral infarction
Senility
KEY ISSUES FOR CARE HOMESHigh level of different GPs
Key time for admission are within OOH
Time waiting for clinical support
Advance Care plans overridden
Untrained staff
Staff competencies
Lack of specialist provision Physio,OT
THE STORY SO FAR
Small Pilot in East Suffolk 36 Care HomesNurse practitioner/GP/Nurse offering additional supportInequalities in the provision of care across the patchCCG want to spread good care and equity to this marginalised group and provide a better patient experience for them
OUTCOMES
Improved clinical care Reduced admissions to hospitalReduced call outs to OOHReduced ambulance call outs
KEY COMPONENTS OF THE CONTRACTOctober March initially29 practices aligned to Care homesWeekly ward rounds- proactive management ProtocolScreening- Dementia & FallsCare Planning, Advance Care Planning (Yellow Folders)Medication ReviewFollow up after admission/OOH Multi- Disciplinary approachSupport Care homes through training
NOT IN SCOPEEMI Units
Sheltered Housing
Private Retirement Schemes
Learning Disability
IMPACT EVALUATIONQuestionnaire- Pre & Post
Activity Report (GPs)
Clinical Audit
Care Homes Dashboard
CONTACT DETAILSShivaun AvestonTransformation Lead, Redesign TeamRushbrook House Ipswich
[email protected] 770131Mobile: 07944212642
*
