Manchester Primary Care Partnership.
Manchester was successful in obtaining funding from the Prime Minister's Challenge Fund in order to set up and run a service that
offered evening and weekend appointments for patients, referred to as extended access, to meet the NHS' commitment to a seven day
This is a partnership project delivered by PCM and Central Manchester University Hospitals NHS Foundation Trust (CMFT). The service started in October 2014 with the aim of delivering patient centered, proactive and reactive care to residents in central Manchester care homes where they are registered with a central Manchester GP practice. A key aim of the service is to improve the care of patients in residential and nursing care homes by developing and maintaining good relationships and communication between professionals, care home staff, patients and their relatives. There are four integrated elements of the service.
Each of the 14 care homes covered by the service has been allocated to one of 8 lead GP practices. These practices were chosen as the practice looking after the majority of patients in each home already as they already had relationships with the care homes staff and the majority of residents and relatives. Patients were encouraged to migrate to the lead practice due to the more intensive care offered and through natural turnover in the residents of the homes. We have achieved complete or almost complete registration with the lead practice in 11 of the 14 homes and migration to the lead practices continues. Each lead practice provides a weekly review of patients in the homes at a set time. During this time proactive and some reactive care is delivered. Meetings with relatives can be set up, relationships with staff developed and working with the nursing and medicines management colleagues facilitated.
The PATCH service provides nursing and administration support designated the 'Care Homes Support Team' (CHST). This team is provided by CMFT. The CHST nurses provide planned reviews of nursing needs and respond as the first line to calls from the homes. They have particular skills in end of life care but also provide experience in catheter care, other nursing skills, prescribing and manage minor illness in the homes that is beyond the scope of the care homes staff. The CHST has significant experience managing end of life care and has facilitated improved care and avoided inappropriate admissions in this area. The CHST works closely with the district nursing team, IV team and other professionals to enhance patient care.
Medicines management staff from CMFT's community medicines management team provide medication optimization reviews for patient in care homes as part of the service. Costs have been reduced but also many risks identified and resolved and poor medication practices in homes corrected. The project has won a national medicines management award for innovation.
The clinical lead is a GP with an interest in care homes primary care. They facilitate a monthly meeting of everyone involved in the service, as well as encouraging learning through the review of patient cases and significant events. This activity has a powerful effect on attitudes and behaviors.