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Q&As with Paul Tilson, managing director clinical services for Derbyshire Health United which runs the acute home visiting service for Wellbeing Erewash. We ask Paul about how the service helps local people and any improvements he would like to see.

 

How does the service operate?

“The acute home visiting service in Erewash was set up around 18 months ago. The original plan was to support the GPs of Erewash about how we can improve clinical resources within the practice and provide an improved service for patients.

"We have two advanced nurse practitioners for the 12 GP practices - very senior experienced nurses who are educated to masters/advanced practice level and are qualified to prescribe. So if a patient requires a home visit within Erewash the patient will access the surgery in the normal way, they will be allocated a home visit, and one of our advanced nurse practitioners will go and visit the patient at home.”

What has been the impact of the service?

“Since being established as a pilot it has had various iterations. We have found it has had a very positive response from all involved. For the GPs of Erewash it’s been a change in the way of working. Historically the majority of home visits in Erewash were by GPs - the clinical leads have been very supportive venturing into this new model. GPs still do visits but now we also have the advanced nurse practitioners. It’s a shift of skill and incorporates different skilled professionals visiting patients. You don’t always need a senior GP or a partner of a practice to visit. In many cases a nurse has the skills to look after the patient.

“The main supporters of the original concept before we mobilised have continued to support its development. Very rarely do we receive any negative feedback – it is overwhelmingly positive. The advanced nurse practitioners see patients in their own homes but the patients still return to the individual practice if they need further support or guidance. The GPs communicate with the team and the nurses communicate with the receptionists in the practices. It’s going very well.”

How have patients responded?

“It’s been very positive. One of the main concepts relating to the pilot was that a patient who is unwell at 8am may not receive a visit from the GP until after they have carried out their morning surgery, or the practice may have had to dial 999 due to lack of other options. We’ve been able to prioritise patients according to their health needs and their clinical presentation and been able to visit them promptly to possibly prevent them having to go inappropriately to hospital.

“Over the last year 4,500 patients have been visited and about 90% of them have remained in their own home and not required onward referral to a hospital bed, A&E or to the ambulance service. I think further analysis of the information will be helpful but that quicker response and the availability of a senior clinician to be able to visit the patient at home to initiate treatment more promptly has got to have helped and some of the data is telling us that.”

Is there anything we can improve?

From the initial mobilisation of the service it was agreed that to ensure clinical safety for patients in their own home and to help prioritise the urgency of visiting patients that a GP or a nurse practitioner would speak to the patient over the phone who is requesting the home visit. They would then make a clinical judgement based on does the patient need a home visit, how soon do we need to see the patient and is it appropriate for an advanced nurse practitioner to see the patient with their skill base as opposed to a GP? All those questions are key to making sure that the service is safe and that patients are waiting appropriately for a visit. It’s working well for the majority of the time - I understand there are pressures in the practices but we must retain the quality of the service and we must prioritise clinical safety for our patients.”

How has the ‘vanguard’ helped support the service?

“It has helped primarily through the co-ordination of services, and the openness and teamwork of different organisations across Erewash coming together to focus on how we can improve the patients’ wellbeing, journey and healthcare. We have put aside the interests of the individual organisations that we work for and the financial constraints that we work within to look at what outcomes we are actually trying to achieve for patients. I think it’s been a really positive team approach.”

How should the service be taken forward?

“I would like to see a Derbyshire-wide home visiting service for patients that provides consistency for all practices, access-based and has a reliable team of skilled clinicians that can respond promptly to patients’ urgent care needs in primary care in their own home. The STP (sustainability and transformation partnership) may be a way forward on this. Over the last few years at DHU we’ve been supporting numerous home visiting iterations across the county and they’ve all got their own little quirks and ways that we deliver but they’re all actually very similar to the Erewash model. It would be nice to achieve a more uniform service and continually improve what we’re delivering.”

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RT @NHSEngland: If you need medical advice fast but it’s not an emergency call NHS111 to be directed to the best local medical care for you…

Wellbeing Erewash

by Wellbeing Erewash