Following the success of a pilot acute home visiting scheme in a Derbyshire primary care network, the service is being expanded this year. A primary care network (or PCN) is where a group of GP practices work together to provide a service.
The service pilot ran in Arch PCN in September and October 2021 and saw a total of 84 people visited by a PCN team member rather than the individual GP practice sending a clinician out. Arch PCN covers Alfreton, Ripley, Crich and Heanor and has nine GP practices working in three neighbourhood areas. The PCN is based at Church Farm Primary Care Centre in Ripley.
An acute home visiting service is where a range of different professionals, working together as a team, provide person-centred, timely, responsive care for vulnerable individuals. The service is part of the Ageing Well and Team Up Derbyshire approach to improving care for the housebound population.
The pilot service ran one-day-a-week for 10am to 4pm, overseen by clinical lead Dr Natalie Craven. Eight pilot days were completed achieving an average of 10.5 visits per day and an average visit length between 15 and 30 minutes. Only two referrals were rejected as being inappropriate. A number of lessons were learnt from the pilot including the need to improve IT systems and boost staff recruitment.
With additional staff now in place (two community GPs, three advanced care practitioners and two admin support roles), the PCN plans to run a five-days-a-week service from spring 2022. The service would run 8am to 6.30pm on those days, increasing to a 12-hour day to 8pm when staffing allows.
A small multi-disciplinary team (MDT) was launched during the pilot, including a community GP, care coordinator, community matron and social prescriber. This was found to be beneficial for onward referrals and discussion of complex patients with frequent contact of multiple health and care agencies. The MDT is due to re-start in line with the expanded service.
Future plans for Arch PCN include taking on responsibility for the care of residents in care homes from the individual GP practices.
Becky Tomlinson, Operations Manager, Arch PCN, said: “GP practice staff have said they are grateful for the extra support that we can provide and the informal feedback has all been very positive; staff have been asking when we are going to run the acute home visiting service again.
“Patients have also appreciated the extra time and attention we can give them, not only addressing their immediate needs but being able to look at their situation holistically, liaising with services such as pharmacy, social care and housing. We have spoken to patient participation groups (PPGs) at the GP practices and the feedback has been very supportive.”
Alongside this scheme and other activities, Arch PCN is committed to being a training and educational environment for staff in both formal academic settings and day-to-day learning opportunities. This includes drop-in and shadowing days for trainees to gain exposure to acute visiting and community geriatrics. One member of staff is to be supported through a three-year MSc programme for advanced nursing while working within Team Up Derbyshire. Both Dr Natalie Craven and Becky Tomlinson are also undertaking Affina professional coaching qualifications.
For further information about Arch PCN, please contact Becky Tomlinson, Operations Manager, via email r.tomlinson2@nhs.net