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First-contact care success

Training 'first-contact' practitioners can bring an extra dimension to the practice.

The First Contact Care programme is a scheme to train other health professionals, such as pharmacists and nurse practitioners to carry out assessment, diagnosis and treatment and to take on some of the work usually carried out by GPs. The scheme's aims were designed to help meet 24- and 48-hour access targets in primary care and to expand patient choice.

The programme was piloted and launched by the NHS University (now the NHS Institute for Innovation and Improvement) in 2003 and was rolled out a year later.

Mohammed Ahmed, a primary care pharmacist in Doncaster, South Yorkshire was one of the first people to undertake the training programme.

'When I enrolled on the course, I was already a supplementary prescriber,' explains Mr Ahmed. 'I joined the course at Sheffield Hallam University in January 2004 and began my training immediately.'

This month, Mr Ahmed started working as a first-contact practitioner at Bilton Medical Practice in Bradford.

He previously worked at Petersgate Medical Centre in Doncaster where he was the practice pharmacist before taking a twice-weekly first-contact session.

'I saw patients when they came to the surgery and saw 15-20 patients in a session, which is the same as the GPs,' he explains. 'The receptionist told patients they could see me as a first-contact practitioner and gave them a choice.

'They came into my clinic and I diagnosed or referred them, or I had a chat with the GP. But most of the time I could diagnose and treat them there and then.'

Needs dictate training

The training that a first-contact practitioner receives depends on their needs, says Mr Ahmed.

'I already had a background as a pharmacist, so I concentrated on examination and consultation skills during my training,' he says.

While training, Mr Ahmed had a GP mentor and tutor, Dr Stephan Weller, from the Petersgate Medical Centre, who supported him in his practice work.

Dr Weller says that the First Contact Care programme worked well at his practice.

'I had very few teaching qualifications prior to starting the scheme here, but Mohammed was dynamic and keen to go on the course,' says Dr Weller.

'He was one of the first in the country to finish the course, so it was all new territory for us. I wasn't familiar with it and so Mohammed organised much of the training.'

Mr Ahmed sat in with Dr Weller consultations to build up clinical experience.

'When the training finished, we made use of him for locum-type purposes,' says Dr Weller. 'When partners were off, we made use of Mohammed to boost our appointments. He certainly helped us and reduced our workload.

'He doesn't practice independently, like a GP. He is a first-contact practitioner, so he would come into the room and ask us about certain things.

'In our surgery, he would not consult without a doctor available.'

There have also been personal benefits for Dr Weller.

'I have enjoyed training and I am now in the process of becoming a GP trainer,' he says. 'It has confirmed to me that it is something I enjoy.'

Patients' Views

The patients' views of having a first-contact practitioner in the practice have been mixed, as any patient view would be, says Dr Weller.

'Patients sometimes want to see a doctor and nobody else because they are unfamiliar with the concept of the first-contact practitioner. But I think that it has been received well.'

Now that Mr Ahmed has a new job, he has further aspirations for the future.

'I would like to incorporate supplementary prescribing, first-contact practitioner work and perhaps some work for the PCT in these five sessions,' he says.

Dr Weller says that, once the whole concept of the programme is better known in the practice, they will formally evaluate it to determine its success, but for now, he says 'So far, so good'.

CASE STUDY - DR AJAY MISTRY

Kelvin Grove Surgery, Barnsley, South Yorkshire

Dr Mistry and partners at the Kelvin Grove Surgery have supervised three first-contact practitioners for over a year. They are all nurses and are at various stages of a training programme for First Contact Care at Sheffield Hallam University.

'The First Contact Care programme is working very well here now,' remarks Dr Mistry. 'It was new to us and everyone had to settle into it and determine what their roles would be. But they have settled down now and it's going well.'

The first-contact practitioners have similar roles to the GPs at the practice.

'They take consultations, triage calls, visit patients and so on,' says Dr Mistry. 'Their roles also expand into other areas such as chronic disease management, but we do have other nurses here that do that area of work.'

In terms of the advantages of having a first-contact practitioner in the practice, they help to reduce the GPs' workload, says Dr Mistry: 'In addition, because they are going through different phases of training, in terms of education it helps both them and us. The experience and support they provide from a different perspective gives us a new way of working together and it is cost-effective. Overall, it adds a different dimension to our way of working.'

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