Enhancing Community Healthcare Services at Frimley Park Hospital: Collins Report Implementation

1. Implementing Collins at Frimley Mrs. Geeta Menon Director of Medical Education Frimley Park Hospital NHS Foundation Trust

2. Collins report

3. Stakeholder Discussion Groups • Chief Executive Officer and Medical Director • Clinical Directors, Heads of service, FTPDs and Consultants in charge of rota • Trainees

4. Initial response • Changing the mind set of colleagues • Discussion around training and service provision

5. Key themes and challenges • Options of integrating community placements • Service delivery and effects on rota • Links within the community • Opportunities

6. Trauma & Orthopaedics • Fracture neck of femur pathway • Working with physiotherapist and occupational therapist

7. Surgeons • Upper GI and Breast surgery • Phyllis Tuckwell Hospice

8. Urology • Community urology clinic with specialist nurse • Incontinence clinic

9. Obstetrics &Gynaecology • Community midwife

10. Paediatrics • Community paediatrics

11. Ophthalmology • Diabetic screening programme

12. Pilot • Urology • Trauma and Orthopaedics • Surgery

13. Results of Pilot • Pilot in T&O and Urology • Trainees views

14. NOF Fracture Pathway Dr. Serjevan Kalsi, Dr. Leila Mohamed, Dr. Thorrmela Vijayaseelan F1 Doctors Orthopaedics, Frimley Park Hospital

15. Pathway Outcomes • Reduce variation in length of stay, reduce mortality and re-admissions • Surgery within 24 hours at FPH • Early mobilisation • Multi disciplinary team • Discharge • Farnham/Fleet • Home +/- Care package

16. Farnham/Fleet • Rehabilitation Centres • Small Wards • Consultant Led Beds • F1 Review Daily • 1-1 Consultant Contact • Daily Physio/OT input • Experienced Nursing Staff

17. Home • No Orthopaedic follow up • No further OT input • Extra facilities in place • Physiotherapy Outpatients

18. Intermediate Care Team • ‘Promotion of independence & Safety first’ • Aims to build confidence in the home • Initial Interview • Mobility • Transfers • Domestic activities and Activity tolerance

19. Advantages of Project • Realistic process of discharge • Highlighted gaps in holistic care • Not just a simple social history • Are patients coping? • Recognising potential follow up

20. Disadvantages of Project • Difficult to get time off • Trauma, Post Trauma, Oncall Dedications • Difficult to co-ordinate visits

21. Recommendations • Incorporated into Rota/Taster Weeks • MDT Attendance • Presentation at Trauma Meetings

22. Thank you

23. Community Experience Dr Emma Humphreys FY2 Urology Frimley Park Hospital

24. 1 day at Fleet Community Hospital • Bladder Cancer CNS • Haematuria Clinic • Flexible Cystoscopy • Intravesical BCG • Consultant OP clinic

25. Advantages • Off-site so free from ward jobs • Enthusiastic nurse willing to teach • More time for learning • Able to carry out procedures • Observation of other OP Ix • OP clerking new pts • 1 to 1 with Consultant • DOPS/CEX

26. Difficulties • Rota challenges • Liaising with DNs • Incontinence clinic proved impossible • Relevance to job • Mostly observation

27. Recommendations • Build into rota • 5 days in 4 month placement sufficient • Placements to be organised • Utilise experience of Nurse Specialists

28. Thank you

29. Results of Pilot • Trainers and service provision • Community • Roll out to all posts in August 2012

30. Take home message • No easy answers • Engagement from - Leadership i.e CEO Medical Director - Middle management i.e Clinical Directors, Heads of Service, FTPDs, Consultants in charge of rotas - Trainees • Feedback