FPC2 Tutorial 4 The Team Around the Patient Flashcards
how are primary health care teams changing?
An even wider range of professionals are now being integrated into ever larger buildings with a wider range of services being offered within primary healthcare premises
This can include many community based services which have overlapping interests and responsibilities to those of the more traditional PHCT. The PHCT might therefore be considered to incorporate a much wider range of activities and professional groups
what makes up the traditional primary health care team (PHCT)?
GP partners
GP assistants and other salaried doctors
GP registrars
Practice nurses
Practice managers
Receptionists
Community nurses
Midwives
Health visitors
Nurse practitioners
who is the first point of contact of most patients?
GP
Where do most GP see their patients?
The bulk of the work is carried out during consultations in the surgery and during home visits. General practice allows individual doctors a wide choice of where to practice, with whom and how
What do GPs deal with?
GPs provide a complete spectrum of care within the local community: dealing with problems that often combine physical, psychological and social components. They increasingly work in teams with other professions, helping patients to take responsibility for their own health
How are most GPs employed?
Most GPs are independent contractors to the NHS. This independence means that in most cases, they are responsible for providing adequate premises from which to practise and for employing their own staff
what is a practice nurse?
General practice nurses work in GP surgeries as part of the primary healthcare team, which might include doctors, pharmacists and dietitians
In larger practices, they might be one of several practice nurses sharing duties and responsibilities while in others, they might be working on their own, taking on many roles
General practice nurses may also have direct supervision of healthcare assistants at the practice
practice nurses may be involved in most aspects of patient care including….
obtaining blood samples
ECGs
minor and complex wound management including leg ulcers
travel health advice and vaccinations
child immunisations and advice
family planning & women’s health including cervical smears
men’s health screening
sexual health services
smoking cessation
what is the role of a district nurse?
District nurses play a crucial role in the primary health care team. They visit people in their own homes or in residential care homes, providing increasingly complex care for patients and supporting family members
As well as providing direct patient care, district nurses also have a teaching and support role, working with patients to enable them to care for themselves or with family members teaching them how to give care to their relatives. They are also accountable for their own patient caseloads
What is a district nurses role in regard to hospital admissions?
District nurses play a role in keeping hospital admissions and readmissions to a minimum and ensuring that patients can return to their own homes as soon as possible
They assess the healthcare needs of patients and families, monitor the quality of care they’re receiving and are professionally accountable for delivery of care
what is the role of a midwife?
Midwives provide care during all stages of pregnancy, labour and the early postnatal period
There is the option to be hospital based, where there are opportunities for midwives to work on antenatal, labour and postnatal wards and neonatal units
Do midwifes work in the community?
Many midwives now work in the community, providing services in women’s homes, local clinics, children’s centres and GP surgeries.
what is a health visitor?
Lead and deliver child and family health services (pregnancy through to 5 years)
Provide ongoing additional services for vulnerable children and families
Contribute to multidisciplinary services in safeguarding and protecting children
(more info on each point on slide 14 in the notes section)
What is a Macmillan nurse?
Macmillan nurses specialise in cancer and palliative care, providing support and information to people with cancer, and their families, friends and carers, from the point of diagnosis onwards
Mcmillan nurses offer what
Specialised pain and symptom control
Emotional support both for the patient and their family or carer
Care in a variety of settings – in hospital (both inpatient and outpatient), at home or from a local clinic
Information about cancer treatments and side effects
Advice to other members of the caring team, for example district nurses and Marie Curie nurses
Co-ordinated care between hospital and the patient’s home
Advice on other forms of support, including financial help
what do Mcmillan nurses not do?
Macmillan nurses do not carry out routine nursing tasks, such as personal hygiene, changing dressings and giving medicines, and do not focus on non-cancer patients.
Though they may not directly give this care, they will coordinate a team of people who will and will provide cancer expertise and guidance to help them provide the most appropriate care
what are some allied health professionals?
Physiotherapy
Occupational Therapy
Dietetics
Podiatry
Pharmacy
Counselling
what is the role of a pharmacist?
A pharmacist is an expert in medicines and their use
They advise medical and nursing staff on the selection and appropriate use of medicines. They provide information to patients on how to manage their medicines to ensure optimal treatment
Pharmacists are able to undertake additional training in order to allow them to prescribe medicines for specific conditions
where do pharmacists work?
The majority of pharmacists practice in hospital pharmacy, community pharmacy or in primary care pharmacy, working to ensure that patients get the maximum benefit from their medicines
what is a dietician?
Dietetics is the interpretation and communication of nutrition science to enable people to make informed and practical choices about food and lifestyle in health and disease
A dietitian will be trained in hospital and community settings as part of their course. Most dietitians are employed in the NHS, but may also work in the food industry, education, research and on a freelance basis
Dietitians have a wide range of responsibilities including what?
working with people with special dietary needs
informing the general public about nutrition
offering unbiased advice
evaluating and improving treatments
educating patients/clients, other healthcare professionals and community groups
what is the role of a physiopherapist?
Physiotherapists help and treat people with physical problems caused by illness, accident or ageing
They see human movement as central to the health and well-being of individuals and identify and maximise movement through health promotion, preventive healthcare, treatment and rehabilitation
A physiotherapist’s core skills include manual therapy, therapeutic exercise and the application of electro-physical modalities. They also have an appreciation of psychological, cultural and social factors influencing their clients
what is the role of an occupational therapist?
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific activity to prevent disability and promote independent function in all aspects of daily life
Occupational therapists work with people of all ages to help them overcome the effects of disability caused by physical or psychological illness, ageing or accident
Occupational therapists work with young children, adolescents, adults and older people in what areas?
physical rehabilitation
mental health services
learning disability
primary care
paediatrics
environmental adaptation
care management
equipment for daily living
what is the role of a care manager?
Care managers are experts in working with individuals to identify their goals and locate the specific support services that enhance well-being
When faced with the array of choices and challenging decisions, care managers provide support to find the best solutions
They are highly trained social workers who work with the patient to advise on social and financial support services
what are some other proffesions may bethat are part of a patients team?
Complimentary therapists, for example: Acupuncture, Homeopathy
Social services, for example: Social workers, Social care workers
Health promotion, for example: Gyms, Education
There are many factors driving changes which affect the PHCT. These changes affect:
Which professional groups are part of the PHCT
Which professional groups work alongside the PHCT
The working relationship between these different professional groups
Economic factors will have a big impact on the development of healthcare premises. The development of healthcare premises affects the PHCT because:
About 60% of primary healthcare premises are still owned by GPs
Many existing premises are too small or unfit for purpose and growing numbers of new GPs need to be accommodated
There is a trend away from smaller traditional doctor-owned premises to much larger buildings owned and developed by private companies
There is a developing trend towards a much wider range of services within enlarged premises. The introduction of additional services is helping to fund new surgeries and this trend is likely to continue for both political and economic reasons
This presents a massive challenge to successful teamwork
There are political pressures to:
Reduce the cost of treatments
Provide more treatments closer to where patients live
What are examples of the development of new and extended professional roles?
The development of healthcare assistants (often from existing staff)
The extended role of pharmacists in medicines’ management and minor illness
The development of nurse prescribing and triage
what does the growing number of ageing patients cause?
More long term conditions (managed largely in primary care)
A greater demand for healthcare generally (managed largely in primary care)
what are the principles of good team work?
Recognise and include the patient, carer, or their representative, as an essential member of the primary healthcare team at individual patient-centred team level or at practice level
Establish a common agreed purpose (share understanding of teamworking)
Agree set objectives and monitor progress towards them
Agree teamworking conditions, including a process for resolving conflict
Ensure that each team member understands and acknowledges the skills and knowledge of team colleagues (and regularly reaffirms)
Pay particular attention to the importance of communication between its members, including the patient
Take active steps to ensure that the practice population understands and accepts the way in which the team works within the community
Select the leader of the team for his or her leadership skills (rather than on the basis of status, hierarchy or availability) and include in the membership of the team all the relevant professions serving a practice population
Promote teamwork across health and social care
Evaluate all its teamworking initiatives on the basis of sound evidence
Ensure that the sharing of patient information within the team is in accordance with current legal and professional requirements
Take active steps to facilitate inter-professional collaboration and understanding through joint conferences, education and training initiatives
Be aware of other measures involving national organisations, educational measures, research and general guidance which impact on teamworking
what is the new and evolving concept of a PHCT?
The PHCT is no longer a narrow list of professional titles and job descriptions
A broad list of professional groups are now encouraged to come together and define individual and common purpose. This should include patients and carers. The PHCT should define and agree the objectives and principles of teamworking
The development of new and larger practices poses a challenge to the members of the PHCT to initiate effective teamworking
The success of new and bigger practices depends on successful teamworking and is one of the emerging challenges for primary healthcare
There is now increasing involvement of wider professional groups and others beyond the traditional PCHT
Also there are structural changes to the services provided, such as the centralisation of District Nursing services which impact upon the way the PHCT has traditionally worked
what is the aim of itegration of health and social care?
An aim of the integration agenda is to help reduce unnecessary admissions to hospital and delayed discharges
Integration is seen as a way to make more efficient and effective use of limited resources and is believed to be central to the challenge of improving outcomes for patients and service users
What is the Integrated Joint Board (Body Corporate) Model?
Under this model an Integration Joint Board (IJB) is set up and the NHS board and local authorities delegate the responsibility for planning and resourcing service provision for delegated adult health and social care services to the IJB. NHS boards and local authorities delegate budgets to the IJB which then decides how to use the resources
The number of representatives on the IJB from the local authority and NHS board is specified in the integration scheme. They must nominate at least three members each, but may nominate more as long as the same number is nominated by each group. Local authorities will nominate councillors and the NHS board will nominate non-executive directors (or other members of the health board if necessary)
The IJB must also include a carer representative, a GP representative, a nurse representative, a secondary medical care practitioner, a service user representative, a staff-side representative, a third sector representative, an officer who is responsible for financial administration , the Chief Officer and the Chief Social Worker
Who delivers the care to the patient?
You will have seen how the care of a patient is not just delivered by their GP
The patient is at the centre of their care, with a wider health and social care team helping them
The team will communicate with the patient, but also with each other to deliver the needs of the patient
