The Practice and its Team Flashcards
Members of traditional primary healthcare team
GP partners GP assistants and salaried doctors GP registrars Practice nurses Practice managers Receptionists Community nurses Midwives Health visitors Nurse practitioners
GP partner role
First point of patient contact
Consultations and home visits
Provide complete spectrum of community care - physical, psychological and social components of problems
Work with other professions in teams to help patients take responsibility for health
Responsible for providing adequate premises from which to practice and employing own staff
Practice nurse role
Work in GP surgeries and as part of PHCT Direct supervision of practice health care assistants Blood samples ECG Minor and complex wound management Travel health advice and vaccinations Child immunisations and advice Family planning and women's health Men's health screening Sexual health services Smoking cessation
District nurse role
Visit patients in own homes or residential care homes
Provide increasingly complex care for patients and supporting family members
Teaching and support role
Accountable for own caseloads
Keep hospital admissions and readmissions to a minimum and ensure patient return to own home ASAP
Assess healthcare needs of patients and families
Monitor quality of care receiving
Professionally accountable for delivery of care
Midwife role
Provide care during all stages of pregnancy, labour and early postnatal period
Work in community providing services in women’s homes, local clinics, children’s centres and GP surgeries
Work in hospital in antenatal, labour, postnatal and neonatal units
Health visitor role
Lead and deliver child and family health services
Work with parents to assess support needs ad develop appropriate programs to give child best start to life
Support and educate families from pregnancy to 5th birthday
Work closely with other professionals and retain overview of health and well-being
Provide ongoing additional services for vulnerable children and families
Contribute to multidisciplinary team services in safeguarding and protecting children
MacMillan nurse role
Specialise in cancer and palliative care, provide support and information to people with cancer and family, friends and carers from point of diagnosis onwards
Offer specialised pain and symptoms control, emotional support, care in variety of settings, information about treatments and side effects, advice on members of care team, co-ordinated care, advice on other forms e.g. financial support
Pharmacist role
Expert in medicines and their use
Work in hospital, community or primary care pharmacies to ensure patients get maximum benefit of medicines
Advise medical and nursing staff
Provide information to patients
Undertake additional training to prescribe for specific conditions
Dietician role
Interpretation and communication of nutrition science to enable informed and practical choices about food and lifestyle in health and disease
Work with people with special dietary needs
Inform public about nutrition
Offer unbiased advice
Evaluate and improve treatments
Patient/client education
Physiotherapist role
Help and treat people with physical problems caused by illness, accident or raging
Manual therapy
Therapeutic exercise
Application of electro-physical modalities
Appreciation of psychological, cultural and social factors influencing clients
Occupational therapist role
Assessment and treatment of physical and psychiatric conditions using specific activity to prevent disability and promote independent function Work with patients to help overcome effects of disability caused by physical or psychological illness, accident or ageing Physical rehabilitation Mental health services Learning disability Primary care Paediatrics Environmental adaptation Care engagement Equipment for family living
Selected secondary care services
Hospital consultants
Diagnostic imaging
Operating services
Factors affecting primary health care team
Economic
Politcal
Development of new and extended professional roles
Growing number of ageing patients
Principles of good team work
Recognise and include patient/carer/representative as essential member of PHCT at patient-centred team or practice level
Agree team working conditions
Ensure each member understands and acknowledges skills and knowledge of team members
Pay particular importance to communication between members
Select leader of team
Promote teamwork
Evaluate team working initiatives on basis of sound evidence
Ensure sharing of patient info is in accordance with current legal and professional requirements
Take active steps to facilitate inter-professional collaboration and understanding
Be aware of other measures involving national organisations, education, research and general guidance which impact on team working
Who leads chronic disease management?
Practice nurse
How can the patient care for themselves?
Stopping smoking
Attend reviews and screening
Take medication and notify is side-effects
Hospital if e.g. hypoglycaemic episode or HKK
Recognition of blood glucose being out of control and how to manage this
Exercise ad eat well
Management of patient with MRSA
Oral or IV antibiotics
Ward staff follow protocol for screening and management
Staff induction in infection control
National and SHA monitoring of hospital infection rates and holding hospital accountable by NHS, media and public
7 stages of significant event analysis
Awareness and prioritisation of significant event Information gathering Facilitated team-based meeting Analysis of significant event Agree, implement and monitor change Write it up Report, share and review
What is appraisal?
Development and support process where the doctor reflects on their performance with one of their own peer group
What is revalidation?
Process is more robust, doctors required to do this to maintain their license
Patient satisfaction mainly focuses on
Doctor-patient relationship
Communication skills
Empathy received
Service e.g. time to wait, time taken to get an appointment
Types of discrimination as defined by 2010 Equality Act
Direct discrimination Associative discrimination Indirect discrimination Harassment Harassment by a third party Victimisation Discrimination by perception
What does ADL measure?
Person’s ability to perform self-care or mobility activities
Advantages of self-reported ADL
Allows assessment of wide range of activities in home and elsewhere at all times of day and night and over days, weeks and months
Individual can report on important activities to them
Advantage of observational ADL
More objective
Disadvantage of observational ADL
Restrictive to what can be carried out in hospital or on brief home visit
Items measuring daily function used in Barthel Index of ADL
Feeding Moving from wheelchair to bed and return Grooming Transferring to and from a toilet Bathing Walking on a level surface Going up and down stairs Dressing Continence of bladder and bowel
Performance is influenced by
Actual loss of function
Restriction on function
Premature termination of activity and suboptimal performance
Factors included in health-related quality of life
Includes physical, emotional, functional and social wellbeing. Based on the gap between real and ideal, hope vs reality
Health related quality of life assessment allows comparison of
functional health over time and between patients
Effects of developing illness
Distressing symptoms Diminished functionality Social isolation Dependence on family members Feel as though they are burdening loved ones Depression, anxiety and grief
What is the compression of morbidity principle?
Objective of increasing lifespan should be associated at the same time with an increasing quality of life or a reduction in disability - no point in increasing lifespan if disability is high and quality of life is low
Quality adjusted life years gives an idea of
extra months or years of life in reasonable quality that a person might gain from treatment
Disadvantages of QUALYs
Patients QUALYs assessed and decisions made on how well treatment went for them, so treatment with most acceptance can be applied exclusively but patients are unique and have individual responses to treatments
Tend to be value-laden and subjective
Resources are finite
Interventions for disability prevention
Public health e.g. folic acid in early pregnancy
Disease prevention interventions e.g. immunisation, smoking cessation
Disease modifying drugs
Physiotherapy and occupational therapy
Splints and aids
Rehabilitation
Occupational and environmental medicine
Factors of primary prevention
Prevention of disease onset in health individuals to reduce risk, severity and duration of disease/illness/injury
Secondary prevention
Early detection of pre symptomatic disease
Screening programmes
Occupational screening
National screening
Tertiary prevention
Reduce consequences of disease and disability and prevent deterioration
Limit disability and enhance quality of life
Prevent spread of disease
Primordial prevention
Broader social and environmental circumstances that predispose society to disease
Addresses social and environmental circumstances
