Roger John and Gwen Kohler
Welsh Ambulance Service NHS Trust
Scope:
A joint initiative instigated by the Welsh Ambulance Service NHS Trust (WAST) in partnership with St Johns General Practice and Cwm Taf University Health Board (CTUHB). Exploring the potential to reduce conveyance, accident and emergency attendances, hospital admissions and to increase GP capacity. This is a 12-month pilot where paramedics are supporting the Multi-Disciplinary Team model.
Context:
We know that:
- Capacity is stretched within General Practice particularly home visits;
- There is pressure of increasing demand within accident and emergency departments;
- In line with national trends there is a high percentage and increasing number of elderly patients on the practice register, plus the patient demand from 8+ care homes; and,
- We need to work across organisational boundaries to deliver patient focused care, which is founded by the principles of prudent healthcare.
Planning and development:
Patients are referred to a ‘Virtual Ward’ with reference to their frailty, multiple complex health and social care needs. Individual care plans are developed and agreed through a multi-disciplinary team approach which include allied healthcare professionals, paramedics, social care and GPs.
Feedback:
“The paramedics have been a great help and support to the GPs in managing a large percentage of home visits”
Practice Manager St Johns Medical Practice
“It was nicer to be treated at home rather than the hustle and bustle of hours at A&E”
Extract from patient feedback
“Being Involved in this trial allows me to take multiple high quality health care skills to a patients front door, and if safe to do so treat them at home”
Community Paramedic
Paramedics undertake home visits to deliver care packages on behalf of the practice. There is a focus on providing care which will enable patients wherever possible to remain at home safely. Clinical Supervision is in place, with regular case reviews with both WAST, GP and CTUHB. This is a new way of working together to ensure patients see the “right clinician at the right time”.
Outcomes:
Initial outcomes suggest:
- Facilitation of advanced care planning and raised standards of care resulting in increased patient satisfaction and improved outcomes (through partnership & co-production);
- Reduction in the number of A&E attendances/unplanned admissions, for a number of individuals (do only what is needed);
- Increased GP capacity and improved access as a result of the reduction in disruption of home visits (most effective use of skills);
- Potential to improve response times for non-life threatening calls (amber) (reduce inappropriate variation).
