Care home residents are a challenging group for GP practices to manage. Studies highlight that this population have the most A&E visits and emergency admissions, a high proportion of which may have been avoided.
Our practice, Coldharbour Hill Surgeries in south east London, decided to introduce a new system in how GP services are delivered in the care home setting. The aim was to have a positive impact on health outcomes and patient experience, as well as reduce unplanned admissions and the use of emergency services.
The practice provides medical services for three care homes in the borough, which includes intermediate, nursing and dementia care as well as residential care homes.
Recognising the problems
Before making changes we looked at what the problems were. These included the barriers to providing care to this group of patients, inconsistency in documentation with regards to patient’s notes, issues around communicating with pharmacists, the need for more consistency in GP reviews and the importance of understanding the care home needs and requirements.
Through the use of 21st century technology and restructuring our processes we have successfully managed to achieve significant impact on addressing these issues. This has reduced trips to A&E from one home by 50% in a short period.
What did we do?
This has essentially been achieved by considering the care homes as our branch surgery. Using a mobile WiFi router and VPN technology, our clinicians can use a laptop (which has Gem Authenticate software for smartcard usage installed) to connect to N3 and access our clinical systems.
We learned how to configure printers in the homes to ‘speak to our clinical system’ in order to give us full functionality.
Each care home that we cover now has designated clinics, with a minimum of two sessions per week when one of our GPs visits the home. To ensure consistency and not detract from our core service provision we have employed more clinical and admin staff in the surgery to support this.
In these sessions the GP provides a full consultation and records all details on our clinical system. A copy of each consultation is printed out at the end and given to the care home, who then file this in the patient’s care plan.
This information is clear, detailed, and consistent with the surgery documentation. It also enables any of our clinicians to have full detailed medical history to refer to should a call come to the practice.
The headache of ‘chasing scrips’ between the care home, surgery and pharmacist, which was wasting time and risked missing medication, has also been addressed. The GP prints any acute scripts in the consultation, which are given to the care home staff immediately. Any ad-hoc scrips are issued, scanned and emailed to the pharmacist and copied to the care home, ensuring the pharmacy, care home and practice are all in sync.
Our GPs have also provided training, education and written guidelines for the carers in the home. These processes, have had a massive impact on the care for vulnerable by making best use of our IT systems and technology.
- Aseem Kumaar is management partner and Dr Vaishali Ashar is a GP at Coldharbour Hill Surgery in Eltham, south east London
Coldharbour Hill Surgery was one of the finalists in the Best Use of Media and Technology category of the 2014 GP Enterprise Awards. You can read more about the awards here