FPC2 Tutorial 4 The Team Around the Patient

Question 1

how are primary health care teams changing?

Answer 1

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

Question 2

what makes up the traditional primary health care team (PHCT)?

Answer 2

GP partners

GP assistants and other salaried doctors

GP registrars

Practice nurses

Practice managers

Receptionists

Community nurses

Midwives

Health visitors

Nurse practitioners

Question 3

who is the first point of contact of most patients?

Answer 3

GP

Question 4

Where do most GP see their patients?

Answer 4

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

Question 5

What do GPs deal with?

Answer 5

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

Question 6

How are most GPs employed?

Answer 6

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

Question 7

what is a practice nurse?

Answer 7

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

Question 8

practice nurses may be involved in most aspects of patient care including….

Answer 8

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

Question 9

what is the role of a district nurse?

Answer 9

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

Question 10

What is a district nurses role in regard to hospital admissions?

Answer 10

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

Question 11

what is the role of a midwife?

Answer 11

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

Question 12

Do midwifes work in the community?

Answer 12

Many midwives now work in the community, providing services in women’s homes, local clinics, children’s centres and GP surgeries.

Question 13

what is a health visitor?

Answer 13

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)

Question 14

What is a Macmillan nurse?

Answer 14

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

Question 15

Mcmillan nurses offer what

Answer 15

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

Question 16

what do Mcmillan nurses not do?

Answer 16

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

Question 17

what are some allied health professionals?

Answer 17

Physiotherapy

Occupational Therapy

Dietetics

Podiatry

Pharmacy

Counselling

Question 18

what is the role of a pharmacist?

Answer 18

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

Question 19

where do pharmacists work?

Answer 19

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

Question 20

what is a dietician?

Answer 20

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

Question 21

Dietitians have a wide range of responsibilities including what?

Answer 21

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

Question 22

what is the role of a physiopherapist?

Answer 22

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

Question 23

what is the role of an occupational therapist?

Answer 23

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

Question 24

Occupational therapists work with young children, adolescents, adults and older people in what areas?

Answer 24

physical rehabilitation

mental health services

learning disability

primary care

paediatrics

environmental adaptation

care management

equipment for daily living

Question 25

what is the role of a care manager?

Answer 25

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

Question 26

what are some other proffesions may bethat are part of a patients team?

Answer 26

Complimentary therapists, for example: Acupuncture, Homeopathy

Social services, for example: Social workers, Social care workers

Health promotion, for example: Gyms, Education

Question 27

There are many factors driving changes which affect the PHCT. These changes affect:

Answer 27

Which professional groups are part of the PHCT

Which professional groups work alongside the PHCT

The working relationship between these different professional groups

Question 28

Economic factors will have a big impact on the development of healthcare premises. The development of healthcare premises affects the PHCT because:

Answer 28

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

Question 29

There are political pressures to:

Answer 29

Reduce the cost of treatments

Provide more treatments closer to where patients live

Question 30

What are examples of the development of new and extended professional roles?

Answer 30

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

Question 31

what does the growing number of ageing patients cause?

Answer 31

More long term conditions (managed largely in primary care)

A greater demand for healthcare generally (managed largely in primary care)

Question 32

what are the principles of good team work?

Answer 32

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

Question 33

what is the new and evolving concept of a PHCT?

Answer 33

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

Question 34

what is the aim of itegration of health and social care?

Answer 34

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

Question 35

What is the Integrated Joint Board (Body Corporate) Model?

Answer 35

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

Question 36

Who delivers the care to the patient?

Answer 36

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