ABUHB Urgent Primary Care (OOH) Service [30/11/15]

The Health Board has been reviewing the challenges that have been facing the Urgent Primary Care (OOH) Service in recent months. We are aware of the increasing pressures facing everyone working for the Service, both at the front line and in the management team and we are sincerely appreciative of your support and dedication to the care of your patients in the service through difficult times.

We are very pleased to announce that from the 1st December sessional GP pay will be rising to £80/hour for weekday shifts, and £90/hour for overnights and weekends. Christmas pay will be £120/hour for the weekends before and after Christmas and for the bank holidays, with £130/hour overnight during these periods. This will make OOHs work competitive with other services and with in-hours work. The issue of the long delays before pay is received is also being addressed and we hope to report progress in this area soon.

To raise pay in this way will cost the Health Board an extra million pounds a year, and understandably the Executive Team will need to see an improvement in our performance against the Welsh standards as a result. In order to support each other to achieve this, we have asked Sam Crane to work with the team at Vantage Point House for the next 3 months, to provide support, help introduce new ways of working. She will be supported in this role by Dr Rebecca Payne, Primary Care Clinical Director, particularly with the clinical remodelling that is necessary to make the service sustainable.

Feedback from GPs within the service, combined with a close look at when the calls actually come, in has shown that despite recent shift timing changes, we still haven’t correctly matched the calls coming into the service with shift timings. This means many patients are waiting a long period of time for call backs, and the work is being shifted into the evenings and overnight periods. Not only does it impact on patients, it makes life extremely stressful for staff working these shifts.

In order to address this, there will need to be changes to the timings of some of the shifts, with a greater emphasis on triage first thing on weekend mornings, with base and home visiting shifted later in the morning. We will be introducing new triage shifts, many of which can be done from home, and hope to deal better with the demand as it comes in. We are asking for your support as we make these changes – which we hope will result in a safer service and more pleasant working environment. Many Welsh services (ABM, Shropdoc and Cardiff) have already done similar work and have seen big improvements very quickly. We will also be introducing some “booked surgeries” at peak times for a set fee where GPs less familiar with OOHs can come and see a set number of base patients similar to doing a locum at a surgery,

Another area in which small changes can yield big improvements is triage – we currently have one of the lowest percentages of self care advice from triage in Wales, and one of the highest rates of home visiting. As our average time of a home visit, including travel is 1 hour, even a modest reduction in the numbers of calls being passed through for home visiting can have a big impact on the service. Dr Rebecca Payne will be sending some guidelines about home visiting through in the next week or so, and will also be creating a You Tube video on telephone triage. We’ve been wondering about whether there would be interest in an evening session on telephone triage and have pencilled in the 8th December at VPH – please let Sam or Lynne know if you’d like to attend.

Finally, we wish to remind everyone that the Urgent Primary Care (OOH) Service is only for urgent problems that can’t wait until the patient’s own GP practice is open, and you will be supported when redirecting appropriate patients to wait until their GP practice is open.

We are also grateful to the Local Medical Committee for their ideas and support.

Finally, now that we have agreed the new enhanced rates we will be expected to have firmed up the rotas well in advance . Consequently, we won’t be able to escalate the rates at weekends so we would implore you to confirm you preferred shifts as far in advance as possible.

Thanks again for your continuing commitment and support to the service. If you have further queries , please can you direct them to Lynne and the operational management team in the first instance. We are also happy to hear from you directly if you have ideas or concerns in relation to the service

Yours sincerely

Sian Millar-Divisional Director
Dr Liam Taylor- Deputy Medical Director

 

GP OOH Update

OOH update article has been written By Dr Rebecca Payne - Newly appointed Primary Care Clinical Director, with a responsibility for Out of Hours in Gwent to inform of some exciting developments that will be occurring in OOH in the next few months and to invite you to join in with a consultation on the future clinical leadership of the service.

1. Hot topics course

2. Recruitment

3. OOH Clinical leadership

4. 111 update

 

Hot topics course

A FREE fantastic OOH course that will be run at the Caerleon campus on the 7th November – a flyer with link to book is attached. ABUHB has bought in the course which has capacity for 250 attendees.

Extremely helpful and relevant both to OOH and to Urgent inhours care.

The course is FREE to all doctors on the AB performers list or who work in the AB healthboard area, all local practice nurses and ANPs, Gwent GPOOH clinical staff and anyone else who commits to work for Gwent GPOOH within 3 months of the course.

If you are working that day and will not be able to attend please email This email address is being protected from spambots. You need JavaScript enabled to view it. who can arrange for you to be given access to a webinar of the course.

The link to book is http://www.nbmedical.com/gp-course-access and using access code ABHBF-79880

Any problems with booking please contact NB Medical (details on the flyer)

 

 

Recruitment

I have also met with Debbie Waters, LMC chair to discuss the LMCs concerns about OOH and to hear their suggestions to take things forward. The Healthboard is going to implement several of the LMCs recommendations including developing training videos for adastra and looking at how the OOH set up can be made more appealing to Inhours Gps. On the 15th October we are planning to run an OOH open evening at VPH including CPR and anaphylaxis updates, more information will be coming soon on this and your help promoting it to colleagues would be gratefully appreciated.

 

Clinical leadership

OOH has been transferred from the Unscheduled Care to Primary Care division of AB, bringing it under the remit of the team headed up by Dr Liam Taylor, with me as the lead Primary Care CD. Having worked in Gwent GPOOH for many years I know many of you already, but I’ve been working in BCU for the last 12 months and took up the CD post here last week.

The Primary Care team recognise the impact that rota gaps have had, as well as the reasons why many colleagues have been put off working for the service and is submitting a business case to the execs in mid September. A couple of things included in this are the proposal to raise GP pay rates on a long term basis and to encourage more participation in OOH from other clinicians such as ANPs and APPs.

Pete Thomas has moved on from his CD role in OOH to provide medical leadership to the 111 team, but will be supporting the OOH Management team and providing occasional clinical sessions for the service. The years of service Pete has given to the organisation are very much appreciated, and he will be sorely missed, however this change gives the opportunity to examine other models of providing clinical leadership to the OOH service. The health board will be formally consulting on the proposal to have a clinical leadership board with different GPs taking responsibility for different parts of the service eg datix, complaints, clinical guidelines etc.

If you would like to be involved in this consultation or are interested in leadership opportunities within OOH please contact me.

 

111

Attached to this article is a briefing from the 111 team bringing you up to speed on the latest developments and how this will affect the OOH service.

 

Many thanks again for all your support for the service.

 

Dr Rebecca Payne, MBBch DRCOG FRCGP

Primary Care Clinical Director

Division of Primary Care & Networks

Llanarth House

Unit 1, Newbridge Gateway

Newbridge

NP11 5GH