Developing the medical model
in community hospitals
– our experience
Overview
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Introduction to Torbay
Background to improvements in
older people’s services
Modernising community hospitals
Questions
Overview of Torbay
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Population of 140,000
High percentage of elderly people
Three population centres – Torquay,
Paignton, Brixham
Torbay Council – unitary authority with
co-terminous boundaries with PCT
Close working with South Devon Health
Care Trust, Teignbridge PCT and South
Hams/West Devon PCT
Recent developments in care of older
people
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Change Agent Team review of older people’s
services Dec 02 and subsequent action plan
One of 8 PCTs exploring new ways of
managing chronic disease
First wave site for accelerated development
programme in support workers for
intermediate care
Funding from DOH for specialist nurses to
improve elderly care in Torbay Hosptial in
line with standard 4 of the NSF
Decision to form Care Trust from Oct 05 for
all adult services across health and social
care
Older Peoples’ Services – the future
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Community services for older people
being developed as part of integration of
PCT / Social Services
Plan to group services around clusters of
GP practices serving approx 25,000
populations
Services to include social workers, dom
care, OT, physio, district nurses,
community hospitals managed by General
Manager
Paignton Hospital
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Paignton – 2 wards
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Coverdale – medical step up/down,
terminal care, rehab, treatments
(e.g.transfusions) – GPSI led
Fairweather Green – consultant led
rehabilitation
Outpatient clinics
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Medical, surgical, paediatrics,
dermatology…
MIU – Mon-Fri 9-5 (2,406 attendances
in 2003/04)
X-ray – Mon-Fri mornings
Brixham Hospital
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20 beds – medical step up/down,
terminal care, treatments (e.g.
transfusions)
Outpatients – e.g. medical, gynae,
orthopaedics, surgery, dermatology
MIU – 24 hours, 7 days a week (6651
attendances in 2003/4)
X-Ray Mon-Fri mornings
GP led – 12 doctors from 3 practices
Reviewing the medical model at
Paignton
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Coverdale was GP led with 31 local
GPs providing medical cover
Bed fund annual budget - £125K
Frustration of ward staff getting
medical input
Delays to patient discharge
Lack of coordinated care planning
Aims of review
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Improve quality of patient care
Provide focussed medical input to
ward
Support nursing staff whilst
retaining empowered ward team
Improve through-put of patients
Reduce delayed discharges
More effective use of funding
Process of review
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Proposal to terminate existing GP
arrangements and replace with
GPSI in Care of the Elderly
Discussed with local GP committee
and LMC
Redundancy payments made to
existing GPs
Request for applications for new
post made to GP community
Implementation of new arrangements
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One practice (3 GPs) applied along
with associate GP from another
practice
Appointed one GPSI for 0.5 WTE
3 GPSIs share remaining 0.5 WTE
GPSIs work Monday-Friday 9-5
WTE salary - £65k
Impact of changes
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Improved proactive patient care with
dedicated attention from GPSIs
Ward staff morale improved and they are
benefiting from on-site medical cover
(e.g.prescribing)
Medical input into multi-disciplinary team
meetings
Closer links with DGH geriatricians
Delayed discharges reducing
Improvement in discharge summaries
Through-put of patients improving
Learning experiences
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Challenge of planning contingency for
sickness/leave cover
Tendency for GPSIs to attempt to solve all
patient’s medical problems
Balancing hospital/practice commitments
Develop medical input across community
hospitals and intermediate care units
Encourage all staff to plan for discharge
as soon as possible
Other service improvements
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Modern Matron appointed across hospitals
Patient satisfaction questionnaires/follow up
phone calls
Education programme for nursing auxiliaries
on caring for older people
Improving MDT meetings and discharge
planning
Dedicated PCT/social services discharge team
working across acute/community hospitals
Future Plans for Community Hospitals
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Plans to develop other ward in Paignton as
nurse/therapist led intermediate care
Telemedicine links for MIUs
Co-locate the therapy/social work team
Implement ‘Essence of Care’ across the
hospitals
Independent skill mix review of ward staff
Review PCT medical cover across community
hospitals/intermediate care
Joint appointment of new COTE consultant
Questions ?