Bucks Urgent Care (BUC) Out of Hours
Guide for GPRs
August 2013
Dr. Michael Ip
BUC Associate Medical Lead
& Dedicated OOH GP
© Harmoni 2011
Out of Hours Services
• Since the revised GP contract in 2004 OOH services are contracted by
the PCT
• Classically seen as NIGHT work, it covers evenings, nights, weekends
and bank holidays (e.g. 66% of the week).
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Examples of OOH Providers
MKdoc (Milton Keynes)
West Call (West Berkshire) & EBPC (East Berkshire)
Herts Urgent Care (HUC) Hertfordshire
Dalriada Urgent Care (DUC) Co. Antrim
Western Urgent Care (WUC) Londonderry
Page 2
The Origin of BUC
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HARrow Medics Out of hours Network Inc (Harmoni)
Started in 1996, physically based out of Northwick Park Hospital
Originally a co-operative of 104 Harrow GPs, to cover their collective patients outside of
normal surgery hours.
It replaced the previous Buck’s Co-ops: AYDOC & WYDOC in 2004 till 2009 as part of a
national strategy.
Harmoni Bucks then joined with the 2 local GP collaborative: Chiltern Health (South
Bucks) and Vale Health (North Bucks)
Forming Bucks Urgent Care (BUC) (Thankfully we are not located in Flintshire!)
BUC commissions Harmoni to provide the OOH service.
Harmoni was purchased by Care UK in November 2012.
Care UK also locally run the Cressex Diagnostics Centre and the MSK Service, along
with HMPs and a nursing home (Catherine court).
Page 3
Google Search: BUC
Google Search: Care
So what happened to Harmoni?
Page 6
How Many Patients do we cover?
(Bucks 2011 Census)
Total population
505,283
100.0%
Males
248,346
49.1%
Females
256,937
50.9%
0 to 4 yrs
31,832
6.3%
5 to 10 yrs
37,192
7.4%
11 to 19 yrs
57,467
11.4%
20 to 39 yrs
117,413
23.2%
40 to 59 yrs
145,986
28.9%
60 to 74 yrs
75,932
15.0%
75 to 84 yrs
28,249
5.6%
85 to 94 yrs
10,279
2.0%
933
0.2%
95 yrs +
•We now cover 505,000 people in 2011!
(previously 479,000 in 2001)
•17% are over the age of 65.
Page 7
How Many Patients do we cover?
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Resident institutions: Nursing & Residential (approx 150),
Community Hospitals (4)
Prisons (3)
RAF Bases
Every GP surgery (200)
• Bucks Stats June 2013
• 4956 (6799 in 2012) total contacts
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Advice: 723 (15%)
PCC: 2478 (50%)
Visits: 657 (13%)
A&E/999: 203 (4%)
Other: (18%)
Page 8
GP VTS OOH Training
(ST3 Start point)
• From August 2013
• GPRs (ST1,2,3 in General Practice) have to complete set
“Hours” not “Sessions”.
• 6hours per month in General Practice.
• E.g. 108 hours for 18months Training
(36hours/6months as ST2, 72hours/12months as ST3).
• Part Time GPRs/LTFT trainees need the same total OOH
experience but worked pro rata during the training (rather than
the calendar) year.
Page 9
GP VTS OOH Training –
Types of Clinical Sessions available (as listed on Rotamaster)
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Base/Triage (“Bu: Location Patient Clinic/Triage”)
4-6 hours, primarily Base patients, but when not seeing patients then helping triage
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Mobile/Base (“Bu: Location Home Assessment\Triage”)
5-8hours, primarily visiting, but when not visiting then helping base or triage
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GP Triage (“Bu: GP Speak to”)
4-6 hours mainly triage, but if needed for other resources, may be asked to see base patients or do home visits. Can
occur at any of our clinical locations and the Smeaton Close Call Centre in Aylesbury. Please note that this experience
has been re-introduced following the introduction of NHS 111.
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MIIU 6hours, available only as a one off RED Session for a handful of GPRs
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Work Force Deployment
Weekday evenings:
2 Base GPs (2 Bases) 5 hours shift.
2 Visiting GPs (2 Cars) 4.5hours shift.
1 Triage GP 5 hours shift.
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Weekends:
4+Base GPs (4 Bases) 4/5/6 hours shift.
4+Visiting GPs (4+ Cars) 5/6 hours shift.
2+Triage GPs 4/5/6/hours shift.
Page 10
GP VTS OOH TrainingClinical Competency Classification of Progress
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Registrar Sessions are clinically labelled as:
Red
Sitting in with a BUC Supervisor/GP Trainer with
some observed consultations/learning Adastra.
Amber
Interacting with patients under direct/nearby
observation of BUC Supervisor/GP Trainer.
Green
Interacting with patients independently, with a BUC
supervisor/GP trainer being contactable for support.
Please note the BUC supervisor/GP Trainer is not to
be confused with your own Personal GP trainer in
surgery.
GPRs use the online booking process to book Red &
Amber Sessions. Green Sessions have to be booked
manually.
Page 11
GP VTS OOH TrainingGuide to allocating your hours across the Clinical Sessions,
Clinical Competencies, and ST2/ST3.
RED
Clinical Sessions
Base/PCC
ST2
GPR Status
ST3
36
OOH Hours to be Completed
72
AMBER
Length of
Clinical
Sessions
6
Clinical Compentency
AMBER
GREEN
2
2
2
2
2
2
Recommended Number of Sessions
1
Home Visit
6
1
GP Speak To/Triage
6
1
1-2 of any
of these 3
sessions
MIIU
6
1
n/a
n/a
n/a
Modules
6
1
n/a
n/a
n/a
24 to 30
6 to 12
36
36
Total Hours
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Red should be limited to 4-5 sessions (24hours) within ST2 period.
Approximately 7-9 Amber sessions (42-54hours across ST2 & ST3)
Approximately 6 Green sessions (36hours) at end of ST3 period.
Depending on your ability you may go from amber to green very quickly (see document).
Spread your sessions out across the 3 clinical session types e.g. PCC/Triage/Visits e.g. do not do
18 visiting sessions.
Page 12
GP VTS OOH TrainingShift Tips
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Depending on your ability you may go from amber to green very quickly (see document).
Some GPRs may need more Amber experience.
Spread your sessions out across the 3 clinical session types e.g. PCC/Triage/Visits e.g. do not do 18
visiting sessions.
The length of sessions vary, and you should ideally stay for the whole booked session.
On Occasion you may need to leave the session early either due to other commitments or for
example if you are nearing the end of your 36hour limit within your RED or AMBER sessions; if this is
the case, then our Rota Team must be notified of this at the time that you book the session and
cannot be accommodated at the last minute. This also cannot be promised on visiting shifts and
cannot be carried out on GREEN sessions.
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Do not book a whole load of sessions and then cancel them.
Ensure you do at least one amber or green session during a bank holiday!
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There should be a 20 minute protected time, debrief session at the end of every session with the BUC
Supervisor/GP Trainer.
You must complete your OOH training & Paperwork to be able to complete your VTS.
The last 2 Green Sessions should at least be booked in 2 months before you complete VTS.
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Page 13
GP VTS OOH TrainingShift Tips
• Bring your OOH Paperwork with you (Record and Evaluation Forms).
• Ensure you have your Windows and Adastra Username and
Passwords; ensure they work and note the Windows one Expires and
needs renewal.
Page 14
GP Registrar OOH Training: what do you need?
• 3 sets of Usernames & Passwords created by the Harmoni Rota Team
(via completed Rota From).
• Online booking service (Rotamaster) Username & password –this is to
book your shifts.
• Harmoni Windows Username & Password.
• Adastra Username & Password - without this you cannot see
patients!
• Given the gaps between sessions your Windows Password is likely to
expire or you may forget them, so ensure you have enough time at the
start of a shift to reactivate this and make sure you bring them along
(we do not always have access to the internet so don’t rely on looking
up your old emails)
Page 15
Rotamaster log in /Adastra log in
Page 16
Equipment
Stethoscope
• The GP clinics and the Cars are all
fully equipped
• If you wish to bring your own
equipment you are welcome to
• A stethoscope is always handy!
• Please ensure you know how to use
a nebuliser, AED, IM & S/C
injections.
BM Machine
BM Sticks for machine
Disposable Lancets
Thermometer
Ear pieces (clear)
BP device
Picolight/Opthalmoscope/fluoroscein strips
Ear Pieces (grey)
Tongue Depressors
Tendon Hammer
Urine Multistix/ Urine & Stool Pots/Swabs
Nebuliser
Adult Mask with tubing
Child Mask with tubing
Peak Flow Meter
Pulse Oximeter
Defibrillator
Spare batteries for picolight/thermometer
Page 17
GP Registrar OOH Training: End of Shift Paperwork
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At the end of each shift you must fill out a
“Record of OOH Session” form.
This is done in a debrief session lasting
approximately 20minutes.
Later on in Green Sessions this is done
remotely via phone calls/fax/email.
Scan into your E-portfolio and highlight any
learning needs or completed competencies.
It is useful to have your previous forms for
review, as you may have several supervisors;
You can review any outstanding learning
needs from previous sessions.
Identify aims and goals for current session
which could include a DOP (direct observation
of procedural skills) e.g. catheter, IM injection,
dealing with mental health; preparation for the
CSA (Clinical Skills Assessment exam as part
of MRCGP).
Supervisors can sign off your DOPs in your eportfolio
Record of OOH session
GPR NAME:
Type of session (e.g. base doctor,
visiting doctor, telephone triage) :
Location:
Date of session:
Time of session and length (hours):
GPR Status (circle relevant session):
RED
AMBER
GREEN
Type of cases seen and significant events
Competencies demonstrated
Learning areas and needs identified
Debriefing notes from Clinical Supervisor
Signature of Clinical Supervisor
Discuss this regularly with your Practice
trainer.
Signature of Trainer
Date
Date
NB This Form must be discussed with your own Trainer for signing off and then scanned into
your E-Portfolio.
Any Trainer queries should be directed to the BUC Clinical Lead
Michael.ip@bucksurgentcare.co.uk
Page 18
Evaluation Sheet (Evaluating your supervisor)
• This ensures we are providing you
with appropriate training.
• If there is a Supervision Problem,
you can anonymise your form, of
alternatively email or speak to me
directly.
• Please complete one for every
session completed
GPR OOH Supervision: Evaluation Sheet
GPR Name (optional):
OOH GP Supervisor Name:
Date:
Please indicate on the scale, by circling one number, your opinion of the value of this session.
I enjoyed my OOH Training with Harmoni
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Little Value
1
2
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Little Value
1
2
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Little Value
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10
Great Value
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10
Great Value
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10
Great Value
I fulfilled my learning needs in OOH Care
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5
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I received the clinical supervision I needed
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7
I now feel more confident in approaching future OOH work
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Little Value
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What, if anything, would you change about this training session?
Please, feel free to comment further if you wish:
Thank you for completing this evaluation form
Please Fax to Bucks Rota Team at 01296 393 906
or email to michael.ip@bucksurgentcare.co.uk
Page 19
9
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Great Value
Amber to Green Confirmation Form
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The trainer is signing off the GP
Registrar’s clinical competency based on
their experience in In Hours General
Practice
e.g. the Registrar can work
independently in clinics and on home
visits; maintaining good clinical notes
and prescribing habits; keep to 10
minute consultations and know when
they need to seek assistance and
support from their supervisors.
Should a GP registrar not be up to this
standard then they should under go
further additional amber shifts with
agreement with the BUC Clinical Lead.
Unit 3 Midshires Business Park
Smeaton Close
Aylesbury
Buckinghamshire HP19 8HL
T 01296 850007
F 01296 393906
Confirmation Form of
GP Registrar Training level Maturation
Amber to Green
Registrar Name:
I confirm that the above Registrar, who is currently working at: Amber Status
Is now competent to work at: Green Status*
Signed (GP Trainer):
Date:
GP Trainer Contact details (Email Address & Tel No.):
Scan & Email to any of the Rota Team
• debbie.parkes@harmoni.co.uk
• richard.bowden@harmoni.co.uk
• bev.brown@harmoni.co.uk
• kate.merridan@harmoni.co.uk
Or Fax to them via 01296 393 906
Page 20
GP Registrar (ST3) OOH Training: GREEN Sessions
• Green sessions means you are working independently.
• In PCCs you will be alongside your BUC Supervisor/GP Trainer
• On visits you will be able to access your BUC Supervisor/GP trainer by phone
only.
• Green sessions are usually in high demand towards the end of your year, so
get them out of the way sooner.
• You are the main clinician and have patients booked into your clinic, arrive on
time, and please do not cancel this session once booked.
• These sessions are booked in manually via a phone call to the Rota Team.
• You are responsible for getting your paperwork completed at the end of every
session (especially GREEN sessions); this is harder to do as your supervisor
will usually be at another site.
• I would recommend that you contact your supervisor at the start and end of
each green session for remote sessions.
• If you do not get the paperwork signed off; you haven’t completed the session.
Page 21
COGPED/RCGP Competencies to be assessed July 2010
• The six generic competencies, embedded within the RCGP Curriculum
Statement on ‘Care of acutely ill people’, are defined as the:
1. Ability to manage common medical, surgical and psychiatric
emergencies in the out-of-hours setting.
2. Understanding of the organisational aspects of NHS out of hours care.
3. Ability to make appropriate referrals to hospitals and other
professionals in the out-of-hours setting.
4. Demonstration of communication skills required for out-of-hours care.
5. Individual personal time and stress management.
6. Maintenance of personal security and awareness and management of
the security risks to others
Page 22
Actual Examples of competencies to be assessed
• Referring a patient as a medical or surgical emergency or to the
community services e.g. arranging Out of Hours district nursing.
Problems when Medical Reg refuses, or Obstetric Reg demands proof
of foetal heart beat.
• Dealing with a death, contrasting an expected death with a sudden
death and the personnel and services involved. E.g. dealing with a death
that requires immediate burial for cultural or religious reasons.
• Problems of terminal care managed by Out of Hours provider. E.g.
managing symptomatic patient and relatives.
• Psychiatric problem dealt with Out of Hours e.g. a risk assessment/
MHA section.
• Commentary on a management/organisational issue e.g. arrangements
for Out of Hours care for Christmas/ Bank holiday weekend, a local
flu/meningitis outbreak.
• Critical Event and complaints report (if relevant).
Page 23
Actual Examples of competencies & opportunities that occur in
OOH
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Clinical Exposure:
Palliative Care & End of Life
Acute Medical Emergencies
Acute Mental Health
Care of the Elderly and Safeguarding Issues
Child Protection
• Practical Exposure:
• IM injections, Catheters, PR examination.
• “Luxury of time” on home visits to carry out DOPs or COT
RCGP ePortfolio
• http://eportfolio.rcgp.org.uk/forms
• DOPs (Direct Observation of
Procedural Skills)
• COT (Consultation Observation
Tool)
• CBD (Case Based Discussion)
• MSF (Multi Source Feedback)
Harmoni Connect & Statutory/Mandatory E-training
• For all Harmoni GPs (including GPRs before they start green sessions)
• All Modules must be completed and passed
• Allow approximately 6hours of E Learning Time.
• These are all on line, across 2 websites requiring 3 separate Log Ins:
• Harmoni Connect under the Education and Training Areas (results of these
go to the BUC team)- use your Windows Username & Password to Access.
• BMJ Learning* (results of these go to the BMJ and then the Training Team).
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* You must use the Harmoni Connect Link to eBMJ and not the usual eBMJ web address.
You will need to obtain your eBMJ Voucher Code: you must sign a consent form and return it to Danielle Day who will
then email you with a login voucher code.
You will need to create a BMJ username and password or use your current one.
Page 26
Harmoni Connect – How to access Connect
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Once you have obtained your
username and password, go to
the Harmoni Connect website:
https://connect.harmoni.co.uk
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The other way to access
Harmoni Connect is via
Adastra. There is a link down
the left column once you have
logged into Adastra (to right).
Page 27
E-Modules required to be completed by all GPRs
Modules
Location
How Often
Taken
Test
Fire Awareness
Statutory and Mandatory Booklet
2 Yearly
Read
Only
Health and Safety
Statutory and Mandatory Booklet
2 Yearly
Read
Only
Manual Handling
Statutory and Mandatory Booklet
2 Yearly
Read
Only
Information Governance
Statutory and Mandatory Booklet
Annually
Read
Only
Infection Control
Statutory and Mandatory Booklet
Annually
Read
Only
Safeguarding Vulnerable Groups
eLearning on Connect
Annually
Read
Only
Treating Patients as Family
eLearning on Connect
Just Once
Read
Only
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Find Enclosed the Stat & Mand booklet and GPR Guide- please note that due to the CARE UK
transition, some of the contact details are incorrect and have not been updated yet.
Page 28
E-Modules required to be completed by all GPRs
Modules
Location
How Often
Taken
Test
BMJ - NQR (National Quality Requirements)
eLearning on BMJ
Annually
MCQ Test
BMJ - Palliative Care
eLearning on BMJ
Annually
MCQ Test
BMJ Safeguarding Children (in association with
Harmoni)
eLearning on BMJ
Annually
MCQ Test
BMJ - Anaphylaxis (an update on management)
eLearning on BMJ
Annually
MCQ Test
BMJ – Chest Pain (do I need to exclude a cardiac
cause)
eLearning on BMJ
Annually
MCQ Test
BMJ - Feverish Illness in Young Children (in Association
with NICE)
eLearning on BMJ
Annually
MCQ Test
BMJ - Stroke / TIA
eLearning on BMJ
Annually
MCQ Test
Page 29
Children & Young Persons Urgent Care Board:
New Local Guidance: Fever.
Double click Image to enlarge
Page 30
Children & Young Persons Urgent Care Board:
New Local Guidance: Bronchiolitis (draft).
Double click Image to enlarge
Children & Young Persons Urgent Care Board:
New Local Guidance: Gastroenteritis (Draft).
Double click Image to enlarge
Performance Management
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1% Clinical Notes Audit
Medicines/Prescribing Audit & Pact Data
Voice Recordings Audit
Feedbacks, Concerns
Compliments & Complaints
Performance Management Tool- Dashboard
Page 33
Problems Experienced by previous GPRs
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Delays in Progressing
Forgetting to bring along username/passwords and not being able to see patients independently.
Accessing the e-Learning Modules and completing them all in time to be able to start Green Sessions
Trainers feeling under confident in signing off the Amber to Green Forms (please contact me and your
VTS Programme director if this occurs)
Left their OOH sessions to the end, and found it difficult to complete all of them on time.
Clinical Problems
Lack of global knowledge, despite topics being discussed and taught with recommendations for
further reading.
Incorrect Prescribing
Poor Time Management
Poor documentation.
Asking for guidance from a supervisor, but then doing something completely different and incorrectly
documenting this.
Inability to keep to time e.g. on visits/PCCs spending longer than 30mins per patient due to problems
with knowing when to refer etc. Failure to develop throughout the year leading to dismissal.
Page 34
Significant Events, Incidents, Concerns Examples
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Prescribing Incidents
Chlorphenamine Syrup prescribed as 4mg QDS for 4days for a 2.5yr old child.
It should be 1mg QDS and PRN.(Feb 10)
Note OTC Piriton Branded Syrup is not licensed for children under the age of 1 (but generic oral solution is)
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Ciproxin 250mg tds (Oct 2009)
It Should be 250mg/500mg bd.
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Doxycycline 100mg twice a day for 14days x 50 (Jan 10)
Ensure you alter the amount to be issued.
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Prescribing over the phone for a cellulitis in a 9 year old (Apr 2010)
Harmoni Policy is not to prescribe over the phone
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Prescribing the MAP over the phone with a pharmacist request (May 2010)
Some pharmacists have an PGD and can prescribe MAP; it may also be available for free if the pt is aged 15-17.
Harmoni policy is not to prescribe over the phone even if a pharmacist is requesting this.
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Prescribing 50mg midazolam in a syringe driver and removing analgesic patches (Apr 2010)
Do not remove analgesic patches
Do not use the BNF for syringe driver doses in palliative care; it is incorrect
Use the Harmoni Palliative Care Protocol.
Midazolam dose is 5-10mg!
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Zopiclone 3.75mg take 1 at night x 28 (Apr 10) &co-codamol tablets 30mg + 500mg tablet(s) take two four times a day x100 (Dec 10)
Do not prescribe more than 7 days of any Rx especially for medications that can be abused e.g.
DHC, Benzos etc.
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Ordering Oxygen on HOOF but not completing the process. Pt did not receive their Oxygen in 4.hours
Follow the Harmoni HOOF Guide. You must complete the HOOF form, get pt’s signed consent and then phone and fax the request to Dolby
Vivisol, following it up with a phone call.
Page 35
1% Medical Notes Audit
• July2011 Call No.12825 Audit Summary:
• No examination carried out on a 47yr old with a UTI and autoimmune
encephalitis.
• Learning Points:
• A full and appropriate examination is required even if it just appears to be a
simple “UTI”. E.g. and abdominal examination and basic observations.
• We have had cases before where E. Coli Sepsis and an appendicitis have all
been missed.
• September 2011 Call No.62798 Audit Summary:
• Did not use prescribing module - this must be done even for hand written
prescriptions
• Learning Points:
• Any Medication prescribed must be documented in the Adastra prescribe
module, even for handwritten prescriptions. If you are unsure of how to code
this then please refer to the Adastra Guide on connect.
• There is no way of finding out the regime of the antibiotic prescribed, so should
any problems arise we will not have this information for reference.
Page 36
VR Audit
• Mar 2011 Call No. 15448 Audit Summary:
• Needs to check patient details
• Learning Points:
• Although this may seem trivial it is very important at the beginning of
any consultation to confirm the identity of the patient or their
representative. We have had incidents where patient details have been
entered into the wrong medical notes and this therefore leads to 2
patients not receiving appropriate management.
Page 37
Complaint B3511 March 2012: Second Hand Histories
• 21yr old girl with headache, vomiting, photophobia, prev brain surgery
for epilepsy- call from pt’s mother.
• 999 called initially for pt
• Paramedic in attendance called BUC back (with some prompting from
pt’s mother) and spoke to BUC GPR.
• GPR Triage notes:
• “Last 24 hrs has a bad migraine.Pain over the forehead and temple,
both sides of the head.
• Temp.37.8 .Has photophobia and sickness.
• sats 98,pr 86/min,BM -5.8,obs-normal.
• Paramedic wondered whether she could have a home visit to discuss
about pain relief for migraine and sickness.”
• WHAT WOULD
YOU DO?
Page 38
Complaint B3511 March 2012: Second Hand Histories
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GPR outcome
“Diagnosis:headache?migraine
Treatment:Adv paramedic that Mum can buy OTC meds with anti sickness
(paramax,migraine relieve etc).can try these
tablets.Reassured migraine will get better.call back if not better or if symptoms change”
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Patient outcome:
Mom then asked for ambulance to take pt to hospital
Diagnosed with viral meningitis after an LP.
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Learning Issues:
Speak to the pt or mother and get a first hand history
Be objective with presented findings
Follow the clinical clues
Complete the Harmoni Connect Meningitis Module
Page 39
Coroner’s Case Feb 2011
•
Home Visit on a 40yr old alcoholic man with confusion & Vomiting.
•
NHSD Notes: Incoherent/disorientated/falling around/groaning for ongoing situation.
Ambulance out on Thursday. And alcohol dependent and mental health issues. Not
having any alcohol for several days. Mum with him at the moment. Please consider a
home visit as unable to get out.
•
TAS Triage: Vomiting for the last week and own GP has prescribed buccastem.not able
to have a conversation. Blotchy rash which comes and goes and does not blanch. Not
hot but feels hot and puts himself in a cold bath. No headache, no photophobia. Not
eating for the last week. now very weak. only taking water and his medication.
Past Medical History: Collapsed lungx3, mental health history. Alcohol dependent not
taken any for 1 week. Never been sectioned or admitted to hospital
Medications: Dolmatil 400mg bd (sulpiride), baclofen, lansoprazole, serenace
(haloperidol).
parents are carers.
Plan: Urgent Home visit ?psychotic disorder with underlying physical problems. If worse
parents to phone 999.
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Page 40
Coroner’s Case Feb 2011
• History: Ongoing mental problems, under the care of the mental
health team and his regular GP care. 2 weekly periods of excessive
vomiting and ?confusion with refusal of medication. This episode
building over last 5-7days. Today refused medication and fluids. Most
of the history obtained from mother. Normally has haloperidol 500mcg
for acute episodes, but unable to take one this morning due to
vomiting.
• Examination: PERLA, responsive to questions and commands.
Naked in cold bedroom, cooperative, slow movements. Mumbling
speech.
• Diagnosis: Exacerbation of psychotic condition.
• Treatment: Haloperidol 2.5mg IM (with patient's consent) Advised
mother to give medication again in 30min. Called back if worried.
Page 41
Coroner’s Case Feb 2011
• Pt Died 6hrs later.
• Cause of Death was “Alcoholic Ketoacidosis and Sulpiride
Toxicity”
Page 42
Coroner’s Case Feb 2011
• Medical History omits presence of GP Supervisor
• Finer details of symptoms are absent, e.g. quantify the level of vomiting (is he
dehydrated), given the alcohol history, need to ensure no blood (risk of
varices).
• Clues from triage not addressed e.g. rash, feeling hot and other symptomatic
questions - diarrhoea, abdominal pain (to rule out pancreatitis, infection), no
alcohol for 1week (could this have been delirium?)
• Examination details are brief. Confusion could be quantified with Mini Mental
State Basic observations not recorded and could possibly highlight underlying
medical issue e.g. fever.
• Location of Injection not stated. (The GPR confirms in her formal report that it
was the right gluteal area).
• Injection not coded in the prescribing module.
• Overall History and examination have not sufficiently ruled out an organic
cause e.g. metabolic problem, neurological event etc.
• Inaction (inability to rule out other causes) may not have been in patient's best
interest.
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Opportunities within BUC
Opportunity for new GPs, and established GPs
•Portfolio Career
•Opportunity to learn new skills – fine tune your acute medicine
•Work closely with a variety of people (Hospital/non-medical)
•Clinical Supervisor role
•Salary comparative to a partnered GP
•Provision of training
•Monthly teaching sessions, case discussion, audit, appraisal.
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Induction Paperwork
•
•
•
•
•
For Induction Session: Please complete all these now.
Sign In Sheet
Honorary Contract
Rota Form
Evaluation Form
• For OOH Sessions: (Further Copies are also downloadable from
Connect)
• OOH Worksheet
• Evaluation Sheet
• Amber to Green Form
Any Questions?
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Contact Details
• BUC Offices
• 01296 850 007/ Fax 01296 393 906
• For enquiries and updating us if you are having difficulty finding/getting to a
session.
•
•
•
•
•
•
Rota Team
Emma.bowden@harmoni.co.uk (GPR Rota Organiser)
debbie.parkes@harmoni.co.uk
richard.bowden@harmoni.co.uk
bev.brown@harmoni.co.uk
Kate.merridan@harmoni.co.uk
• Clinical Lead
• Michael.ip@bucksurgentcare.co.uk
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