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Wellbeing Erewash is bringing services closer together so that care is provided in a more joined up way.

A patient-facing pharmacist role has been created, pushing the boundaries of the traditional pharmacist role. The work involves direct patient contact, either in face-to-face consultations within the GP practice or offering advice over the phone. Support and advice includes minor ailments clinics, medication review clinics for people with long-term conditions, hypertension review appointments, anticoagulant advice or advice on hormonal contraception.

The patient-facing pharmacist has the potential to make a significant impact on the safe and appropriate use of medicines across Erewash with the aim of keeping patients healthy in their own homes and reducing the number of medicines-related hospital admissions.

We have established a nurse-led home visiting service to support GPs in providing care close to home at the right time during practice hours. There are six advanced nurse practitioners working in the team covering all 12 GP practices in Erewash.

Referrals into the service are made by patients who ring their GP practice with symptoms that require a home visit or have requested a home visit. A team member visits the patient in their home on the same day, thereby avoiding an unnecessary referral to hospital if the patient’s GP could not have seen the patient due to other practice commitments.

Patient benefits are that they are seen earlier in the day, start their treatment sooner and through this support may prevent hospital admissions. Advanced nurse practitioners are able to prescribe medication meaning patients get the treatment they need much earlier than they might otherwise. The team is enabled with mobile working and full access to the primary care patient records. This enables the record to be accessed and written while the nurse is with the patient.

We have two primary care hubs - one in Ilkeston and one in Long Eaton – which have enabled GP surgeries to offer additional appointments when busy or closed, seven days a week. The hubs provide 15-minute appointments with an advanced nurse practitioner. In the first 12 months, 5,760 patients were seen in these hubs.

We are working to understand the size and shape of our current workforce against future needs. Using the SWIPE (strategic workforce integrated planning and evaluation) approach, we have looked at local demographic projections for increases in need and considered how services can best respond. To date, we have completed planning work and considered workforce implications for the frail elderly population and children’s services.

A community GP is developing new ways of working with community teams, providing advice over the phone or making same-day visits. The role aims to enhance the quality of care provided, reduce inappropriate hospital admissions and reduce contacts with surgeries for requests of advice or home visits. The community GP also has a focus on care home residents and the frail elderly at home.

The community GP role is being carried out by Dr Anna Percival who links in with a number of community services including single point of access, care homes service, acute home visiting service and community matrons. The advice provided, for example medication reviews or care package discussions, builds confidence in the local teams and eliminates any need to take the patient’s GP out of surgery. The guidance and support provided by the community GP often enables a patient to be seen and treated at home rather than in hospital.

An innovative on day service has been launched in Erewash improving access to primary care. Patients who call their GP for an appointment that day may be directed to the on day service where they will be seen by a GP or advanced nurse practitioner as appropriate.  The service was initially launched in Long Eaton and in March 2017 was extended to include practices in Ilkeston.

The on day service is available from 8am to 6.30pm on weekdays excluding bank holidays. Patients just call their normal GP number.

The service is increasing same day access for patients and freeing up time for the GP practices to better meet the needs of their patients with complex and long-term conditions. In the first four weeks the service saw 1,300 people.

Expected benefits include reduced waiting times for patients and a reduction in accident and emergency department attendances.

Integrated Care Teams bring health and social care professional together to focus on the needs of individual patients, without being hampered by organisational boundaries. They work closely with GPs and make sure that people are seen by the right person in the right place at the right time.

We are also looking out how GP practices might work together differently, as we know that the demand on GPs continues to increase.

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