GP Education Session

1
GP Education Session

• Successfully Promoting Intermediate Care
  Services
• in Ashford, Kent.

2
Format

• Move away from old style back back
  presentations.
• (Numerous presentations would be too intensive
  for a 3 hour slot may affect attendance).

• Interactive format chosen to include all members
  of general practice.

3
Format

• Key stakeholders invited to participate
• Community and Voluntary Services
• Local borough council
• Social Services
• Local District General Hospital staff (including
  Consultant in the Care of Older People).
• Primary and Community staff
• 16 manned display stands.
• Audience split into workgroups and each given a
  different case study (seven scenarios).

4
Case Studies

• The scenarios were designed to challenge current
  perceptions of what is available within
  intermediate care services and highlight how help
  can be given in various ways significantly non-
  medical interventions and preventative measures.
• It also highlighted service gaps for future
  development.

5
Case Study Themes

• The case studies presented a variety of common
  themes e.g. live alone, private / isolated
  individuals, carer crisis scenarios, chronic
  illness, pain/ medicines management, elderly
  carer, acute episodes of debilitation e.g. food
  poisoning, hospital discharge, early detection.
• Groups were challenged to identify care pathways
  and also explain why they had chosen as they had.

6
Case Studies

• After shopping for the appropriate
  interventions for their case studies and
  discussion, each group leader presented the
  scenario and devised care pathway to the general
  audience.
• As well as being able to ask individual providers
  about specific information whilst shopping ,
  this part allowed for general cross-pollination
  of ideas and information allowing a further
  opportunity for questions to be raised.

7
Devised Care Pathways (Case Study 1)

• Admit to recuperative setting for residential
  rehabilitation.
• ICS in-reach to residential setting (step
  up/down) - set monitor rehabilitation
  programme.
• Following discharge home, Community services
  (ICS- same team) provides seamless care pathway.
• Full assessment by ICS SS, Nursing, OT, Physio,
  GP, Medicines management, Comm. Mental health
  team older people.
• Discharge from ICS continue SS, day hospital
  (?)
• Community voluntary incl. day centre (wife
  break).
• Offer full assessment to wife.

8
Devised Care Pathways (Case Study 4)

• GP assessment and referral to Pain Management
  service.
• Occupational therapy assessment (incl.
  adaptations).
• Social Services care package.
• Intermediate care services full assessment
  (nursing, Rapid Response, OT, physiotherapy,
  Community Mental Health Team (older people)
  Medicines Management). Maintenance by Community
  Nursing.
• Assistive technology e.g. lifeline Telehealth
  Bottle in fridge (emergency information scheme).
• Community Voluntary Services befriending
  day-centre.

9
Devised Care Pathways (Case Study 7)

• Intermediate care services to achieve full
  function. Interventions OT, nursing, Rapid
  response team, physio including falls assessment.
• Community Voluntary befriending, bottle in
  fridge, day centre.
• Social Care package benefits / warmth
  assessment.
• Post RRT nurses (6/52) refer to district nurses,
  primary care team or ICS Mental health team.
• Assistive technologies and Telehealth.

10
Feedback

• General feedback was very positive, in particular
  the format of the afternoon was very popular.
• The integration of established general practice
  staff with the GPs was greatly appreciated.
• Even long-standing GPs reported that they had
  learnt a great deal (!) and likewise from Acute
  staff.
• The session had a real buzz to it!

11
GP Education Session

• Successfully Promoting Intermediate Care
  Services

Linda Smith, Project Manager Innovation Forum,
Ashford, Kent. Contact Linda.smith_at_ashfordpct.nhs
.uk