Bristol Team - BAAEC Conference 131015

Ambulatory Care – Bristol Royal Infirmary
UHB in Partnership with BrisDoc
- The Primary – Secondary Care Interface
Emma Kinnaird – Lead Nurse, Ambulatory Care, UHB
Paul Davies – Clinical Lead, GP Support Unit
Ambulatory Care History - Bristol
UHBristol
BrisDoc
• 2003 BrisDoc Formed
Thrombosis Service
• 2008 GPSU Created
TIA clinic
• 2013 Joint contract (with
Pathology Day Unit
UHB) awarded
Multiple initiatives across
site eg ‘Hot Clinics’
• ACU 2012
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Ambulatory Care Unit 2012-
Partnership
• Brisdoc awarded the contract for GPSU at BRI through
strategic alliance with UHB – 8am to 8pm M-F
• Provide medical advice to Health Care Professionals
24/7 (via OOH + GPSU using ‘Professional Line’)
• Interface between the local community Bristol GPs and
medical admissions team at BRI
• Based on delivering a local and personal service,
innovation, flexibility, team working, trust and
communication
• Contract includes Funding for Hospital Physician input to
‘Primary Care’ (GPSU) patients
Ambulatory Care Model for UHBristol Incorporating GPSU
Totality of
Ambulatory
Care in
UHBristol
GPSU Primary
Care Call
Handling
GPSU in
Hospital
TIA
Hot
Clinic
Ambulatory
Care Unit
Other
STAU
Informal
Consultations
MAU
Obs
Unit
DVT
PDU
Where we are now
• Physical location within Bristol Royal Infirmary
• Open 8am-8pm Monday to Friday
• Co-location of GPSU / Thrombosis / medical take teams
and PDU all working in partnership in ACU
• Established cross-organisational multi-professional team
• 21 pathways on trust intranet
• Executive support
• Performance measurement and ACU data report
• Patient satisfaction feedback is positive
GPSU Performance
• In addition to trust developments simultaneously GPSU
impact growing in alternatives to admission
• In 2014/15 GPSU took 7648 calls from Community
Healthcare Professionals (5566 GP calls) and passed
2615 of these patients to the AMU (and admitted 296 to
other inpatient areas)
• GPSU saw 3167 patients face to face, admitting 406
(13%) of these.
• Information flow from secondary to primary care (eg
cellulitis pathway, hot clinics)
• Similar unit being developed in North Bristol 2015
Next steps
• New 7 day service supported by 7 day nursing and
medical model (from October 2014)
• Continue pathway development based on data analysis
• Develop Joint Governance Framework for GPSU and
UHB in Ambulatory Care
• Review Performance data, feedback and audit to support
service development
• ?Acute Physician Model from early 2016 – likely to
influence model
• ?Opportunities for Training posts in Ambulatory
Care
Challenges
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Greater integration (core training and competences)
Commissioner agenda & financial implications
Role recognition, recruitment, indemnity & governance
Primary care delegation of responsibility?
Managing Frailty in ambulatory care
Politics and geography (CCGs)
Maintaining consistency in clinical management
2 tier system (ED vs GP admissions)
Information Technology
Ambulance and ED interface
Any Questions?