Workforce Impact in Practice (WIP) Capture Template
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Keep brief and focussed, think about what others might find useful to know to help them.
Title of Workforce Impact in
Practice Title?
Name of Lead organisation
(and any partners)
Who was involved?
What was the workforce issue
you were trying to address?
Usually quite short –background
– set scene
eg
Why were you doing it?
What was the challenge you
were facing?
What was the WIP hoping to
achieve?
“Post-CCT (GP) Fellowship in
Emergency and Acute Care”
Leading: Health Education West Midlands.
Partners:
- West Midlands Ambulance Service;
- Worcester Acute Hospitals Trust;
- Worcester University;
- South Worcestershire CCG;
- Rother House GP Practice, Stratford;
- Pool Medical Centre, Warwickshire;
- Mount Pleasant Medical Centre;
- Corbett Medical Practice, Droitwich.
How do we keep patients from attending the A&E?
When patients do attend, how do we set a baseline for whether
they should be admitted?
The DoH identified a need to address pressures on A&E
services in the longer term – starting with care for vulnerable
older patients with complex health problems. The objective for
such change is a planned reduction of patients needing to be
conveyed repeatedly to A&E. The consequent freeing-up of
clinical staff would result in improved diagnosis, treatment and
discharge times, when patients do need to attend hospital. Frail
and elderly patients also represent some of the NHS’s most
vulnerable patients and those most at risk from failures to
provide seamless care.
To address such issues, we must introduce a branch of
clinicians with suitable skills and experience to make the “tough
decisions,” while also becoming a bridge between primary and
secondary care practice’ – a clinician who is able to operate in
both community and secondary care settings, with sufficient
knowledge of both pathways to decide whether a patient should
be admitted or not.
It was with this requirement in mind that the Post-CCT
Fellowship programme was born.
Why is this project required?
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A response to identified workforce shortages in
secondary care.
To reduce bed pressure by creating an effective path
for triage and flow-through of patients presenting with
complex co-morbidities.
To understand the root causes of hospital referrals from
primary care / community practice and develop
strategies to avoid such referrals.
To develop the role as a “safety net,” preventing
unnecessary hospital admissions and re-invigorating
community practice as first point of contact for patients.
To allow the graduating fellow to practice equally as
effectively in the Emergency Department, AMU,
ambulance service or community GP Practice.
To reduce costly Trust / Practice Locum spends and
improve continuity of care / joined-up practice, by
introducing a stable and consistent role.
To follow the 2013 Hunt Recommendations for
improving “joined up care, spanning GPs, social care,
and A&E departments - overseen by a named GP.”
The Fellowship will combine practical and didactic teaching
over a twelve month period. The aim will be to create a GP
practitioner who is confident in the diagnosis and treatment of
patients presenting with acute and urgent conditions; conditions
which would otherwise have been referred to hospital.
How did you address this
issue?
How did you go about it?
What was involved?
The HEWM project team recognised that a multi-organisation
team would be necessary to fully develop the model and
provide a robust business case. The Project Manager brought
together professionals from a range of potential user groups in
Primary and Secondary care, forming a focussed and proactive
project team. With input from all user groups, the Fellowship
program was developed to include five distinct areas:
1) A secondary care placement in an Emergency
Department (ED).
2) A secondary care placement in an Acute Medical Unit.
3) A placement period within the West Midlands
Ambulance Service.
4) A “base” within a nominated GP practice, where the
fellow will apply the experience gained in the secondary
care phases of the Fellowship, to community medicine.
5) Collaborative working with Worcester University, to
inform the development of a Post-Graduate
Certificate in Emergency and Acute Care.
A measure of success of this project will be that the
Accreditation, clinical structures and pilot Fellows are of a
standard fit for the purpose of training this first cohort.
The GP Fellow will spend time on Emergency and Acute
Medicine units, to gain experience in the providing of care for
step-down patients in the community. There will also be time
spent developing new and innovative processes for GPs to
practice within their regional Ambulance Service, as well as
other necessary aspects such as Paediatrics / care of acutely ill
patients / end-of-life care.
Optional question-Did you
use any products or services
to help you?
Please feel free to share what
you have used .If you have
used Skills for Health products
or services please explain.
We want to see what ideas you
have used
Not used Skills for Health products for this project, but would
consider using for future activities.
What did you achieve?
ie What happened?
The Role Description went live in December 2013, receiving
immediate support from the regional LETB, Health Education
England, the Royal College of GPs, “First 5” GP group and
AHSN.
Such was the commercial relevance and potential of the role,
that the three regional University Trusts have requested a
further eighteen fellows (six each), to start in late 2014.
To follow best practice, the project team elected to first use a
pilot study to manage risk, identify and address practical
“lessons” and “train the trainers,” in advance of a formal launch
in September 2014. The September intake will be staggered
into three, six-GP cohorts over a 12 month period.
The pilot study commenced in January 2014, with three GPs
recruited. The GPs are currently seconded to Redditch
Alexandra ED, Worcester Royal Hospital AMU and West
Midlands Ambulance Service (from March 3rd). The ED and
AMU-based GPs are already forming plans for admissionsfocussed research work and liaising successfully with their
nominated clinical supervisors, course director and GP
Mentors.
What was the WIPs impact?
(Clear demonstration of impact
of change .eg. the workforce,
service delivery on
patients/service users.
Cost/quantity/quality,
productivity, Return on
Investment, staffing/clinical time
saved, potential benefits.
Data and any measures will be
useful as will qualitative and
and quantitative outcomes.
A lack of qualified medical cover is identified as preventing
patients from being discharged to community hospitals; the
fellowship program will aim to address this by:
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Testing how the GP can effectively function within
Emergency and Acute Medicine teams.
Developing ways in which the GP can apply
Emergency and Acute skills to support alternative care
pathways in the community.
Raising GP interest in Emergency Medicine career
paths.
Supporting and following the Hunt recommendations for
improving “joined up care, spanning GPs, social care,
and A&E departments - overseen by a named GP.” 1
In addition to their personal learning and development,
Fellowship GPs will be expected to:
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Work with their host Practice and Health Education
West Midlands to encourage other areas (regionally
and nationally) to commission the fellowship.
Develop an enhanced service locally, post-pilot.
Develop ways in which a GP may respond to
Emergency and Acute cases.
Establish a working relationship with the ‘Virtual Ward’
model and explore models of care that offer viable
alternatives to A&E admission.
During practice attachments, offer direct contact by
A&E staff. When patients of the host practice present at
A&E with ambulatory or long-term care conditions, the
Fellow will provide an assessment and management
advice.
Learn and enhance practical skills and interventions
including: chest drains, reducing dislocations, suturing,
cannulation and ultrasound use, as well as advanced
life support courses and acute illness management in
resuscitation.
Learning outcomes for the GP Fellow will include:
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1
To better understand the needs of patients, why they
are attending A&E and how the GPs role could be
adapted to improve A&E avoidance.
To develop innovative ideas / share best practice of
meeting the EM agenda in Primary care.
https://www.gov.uk/government/news/hunt-nhs-must-fundamentally-change-to-solve-ae-problems
Learning outcomes will be developed between the GP and their
mentor, consistent with the operational requirements of their
host and the following RCGP Curriculum guidelines:
Hints and tips for others
Share some of the
things/insights that you think will
help others trying to do the
same sort of thing
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Care of acutely ill people.
Care of older adults.
Care of children and young people.
Care of people with Mental Health problems.
Cardiovascular health.
End of life care.
Healthy People: Promoting health and preventing
disease.
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Crucial to success is developing a multi-organisation
project team, representing the interests of all potential
users.
Recruiting fellows who share a desire to develop,
innovate and push beyond traditional boundaries.
Recognising that change starts with education of the
individual.
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What will you use the prize
for?
Please tell us how you would
use the prize in your
organisation
In completing this template
are you happy to share with
the members of My Health
Skills and Skills for Health
Networks?
Name and Contact details of
person completing template
To provide GP Fellows with a peer communication and
information sharing resource, enabling cross-region
sharing of best practice and innovation.
Yes
Name: Matt Aiello
Title: Project Manager
Organisation: Health Education West Midlands
Address: St Chads Court, 213 Hagley Road, Edgbaston,
Birmingham, B16 9RG
Tel no: 07903 403 630
Email: matthew.aiello@wm.hee.nhs.uk
Many thanks for completing this.
Please return via email to myhealthskills@skillsforhealth.org.uk