Nurseled Clinics The South St Experience

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Nurse-led ClinicsThe South St Experience

• Deb Funnekotter
• Practice Manager
• South St Medical Centre

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South St Medical Centre

• Large bulk-billing practice
• 10 GPs, 6 FTE GPs, 2 FTE PNs
• Current pts 35 000
• Wave 2 of NPCC
• ZedMed clinical billing software
• Access was of major importance

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Diabetes

• 367 patients on diabetes register at baseline
• Baseline data
• HbA1c lt7 0
• Chol lt4 0
• BP lt130/80 11
• SIP 0
• Lots of work to be done!

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Developing Register

• 1st step change over pathology to HL7
• Problems
• ZedMed register includes deceased and inactive
  patients
• Register in ID order rather than alphabetic
• Pathology register vs NPCC register

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Diabetes Clinic

• Having joined Collaboratives we knew where we
  wanted to get to but we had nothing in place
• Had to start walking before running

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Diabetes Clinic

• Pre-collaboratives ran diabetes clinics with
  pharmaceutical nurses
• 30min nurse appt followed by 20min Dr appt
• Nurse filled in GPMP template electronically
  which Dr could then open
• GP Management Plan developed and billed on same
  day

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Diabetes clinic

• Negatives
• Slow process for nurse
• Difficult to look at patient notes with GPMP
  template open
• Positives
• All electronic no scanning
• Great with nurse appt followed directly by Dr
  appt on same day

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Asthma clinic

• Run by pharmaceutical nurse
• Used paper based forms with plan on top page
  followed by spirometry and then nurses
  suggestions
• Nurse 30min followed by 20min Dr appt
• Drs liked this system as could look at the
  patient notes at the same time
• Plan then scanned and filed
• Patient put on recall

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Back to Diabetes Clinic

• Copy Asthma clinic model
• Not too much of a problem to scan
• Agreed on nurse filling in her own paper template
• Scan
• Recall
• Alerts for Annual Cycle of Care
• Started billing SIPs

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Diabetes Clinics

• 14 clinics held
• 124 patients seen and put on GP Management Plans
• Drs liked this state of affairs
• All involved and not many problems encountered

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Asthma Clinics

• 4 clinics held
• 45 patients seen
• Initially a good response
• Battled to fill 3rd and 4th clinic
• 1 cancelled
• Drs to tell asthmatic patients to make clinic
  appt at reception
• Not sick dont need to come in

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CHD Clinic

• Approached by pharma. company to run CHD clinics
• Plan
• Give nurse list of names
• Nurse to address and post letters
• Pts to ring in and make appt
• Nurse to see patient and prepare plans
• Nurse to discuss plans with Dr (different day)
• Nurse to send plans electronically to practice
• Pts then make appt with Dr to discuss plans

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CHD Clinic

• All did not go according to plan!
• Receptions staff sent out letters
• Nurse ran very late
• Patient dissatisfaction with nurse
• Staff turnover at pharma company delays in
  compiling plans
• Patients had to be rescheduled 2-3 times as plans
  had not been done by nurse

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Clinics

• In the meantime
• Practice nurse completed diabetes course
• Practice nurse timetable rearranged so now have 3
  days where clinics can be run
• Upskilled PN on registers PDSAs
• Identified patients due for diabetes review
• Developed templates for clinic letter of
  invitation and annual cycle of care
• Sent pathology requests with letter of invitation
• Trial process with 3 patients initially

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NPCC Measures
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Future Plans

• Continue with diabetes clinics
• Start new clinics
• 75s
• 45 year old health check
• Mental health
• 2 step asthma
• Immunisations
• Modify templates make easier and encourage all
  Doctors to use

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Conclusions

• One year on, we have accomplished a lot
• Two steps forward, one back BUT in general going
  forward
• Improvements in measures still a long way to go
• Thanks to our CPM/Division for support
• Looking forward to the next 6 mths