The Team Around the Patient

Question 1

How have GP practices changed over time?

Answer 1

From the early years of the national health service, GP’s worked from their own homes

Other professionals were linked to hospitals rather than GP’s

Role of gatekeepers commenced

More professionals, larger buildings, wider range of services now being offered in the primary heath care premises

Structural changes to services provided (e.g centralisation of district nursing)

Question 2

What is the traditional 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

GPs increasingly work in teams with other professionals

Question 3

How are GPs related to the NHS and independent from the NHS?

Answer 3

Most GPs are independent contractors to the NHS

In most cases they are responsible for providing adequate premises from which to practice and for employing their own staff

Question 4

What aspects of patient care might practice nurses be involved in?

Answer 4

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 5

What is the role of a district nurse?

Answer 5

Visit patients in care homes or residential homes

Provide increasingly complex care for patients and supporting family members

Teaching and supporting role, instructing people how to care for themselves and others

Try to minimise admission and readmission rates

Question 6

What is the role of a midwife?

Answer 6

Midwives provide care during all stages of pregnancy, labour and the early postnatal period.

Question 7

Where do midwives work?

Answer 7

Community - in homes of patients, local clinics, children’s centres and GP’s surgeries

Can work in the hospital too (antenatal, labour and postnatal wards and neonatal units)

Question 8

What are the roles of the health visitor?

Answer 8

Lead and deliver child and family health services

(Offering parenting advice on family health and minor illnesses. New birth visits which include advice on feeding, weaning, and dental health. Physical and developmental checks. Specific support on subjects like post natal depression. Liase with other health professionals such as nursery nurses and keep an overview of the heath and well being of the families in your area)

Provide ongoing additional services for vulnerable children and families

(Good at assessing vulnerable families, can refer to specialists such as SALT, they can arrange access to support groups)

Contribute to multidisciplinary services in safeguarding and protecting children

(Recognise risk factors, triggers of concern and signs of abuse and neglect in children. Assess the risk of harm to a child. Involved in every stage of the child protection process.

Question 9

What is the role of a macmillan cancer nurse?

Answer 9

Specialise in cancer and palliative care

Specialised pain and symptoms control

Emotional support for both the patient and their family or carer

Care in a variety of settings (hospital, home, local clinic)

Information about cancer treatments and side effects

Advise other members of the caring team

Co-ordinated care between hospital and the patients home

Advice on other forms of support, including financial help.

Question 10

Can you name some allied health professionals?

Answer 10

Physiotherapy

Occupational therapy

Dietetics

Podiatry

Pharmacy

Counselling

Question 11

What is the role of a pharmacist?

Answer 11

Making sure that patients get the maximum benefit from their medicines

Advise medical and nursing staff on which drugs to use and how to sue them.

They help patients manage their medicines to ensure optimal treatment

Can prescribe medicines if they have had the relevant training

Question 12

Who do dietetics work for?

Answer 12

NHS

Food industry

Education

Research and freelance basis

Question 13

What are some of the responsibilities of dietetics?

Answer 13

Working with people that have 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 14

What is the role of a physiotherapist?

Answer 14

Treat people with physical problems

Try to identify and maximise movement through health promotion, preventative healthcare, treatment and rehabilitation

Manual therapy
Therapeutic exercise
Electrophysical modalities

Question 15

What is the role of occupational therapy?

Answer 15

Help people with physical and psychiatric conditions to live independently and without disability in all aspects of daily life

Question 16

What areas do occupational therapists work?

Answer 16

physical rehabilitation
mental health services
learning disability
primary care
paediatrics
environmental adaptation
care management
equipment for daily living

Question 17

What is the role of a care manager?

Answer 17

Identify patients goals

Locate specific support health services that enhance well being

Help with decision making

Question 18

How are GP premises changing?

Answer 18

Many existing premises are too small or unit for purpose and growing numbers of new GPs need to be accommodated

Traditional doctor-owned premises are being replaced by larger buildings owned and developed by private companies

Wider range of services in enlarged premises

Question 19

What is the political pressure for GPs?

Answer 19

Reduce the cost of treatments

Provide more treatments closer to where patients live

Question 20

Describe the development of new and extended professional roles

Answer 20

Development of healthcare assistants (often from existing staff)

Extended role of pharmacists in medicines’ management and minor illness

Development of nurse prescribing and trage

Question 21

List some of the forum on teamworking in primary healthcare

Answer 21

Patient, carer or their representative is to be recognised as an essential member of the primary healthcare team

A common agreed purpose is to be established

Decide a set of objectives and monitor progress towards them

Agree teamwork conditions including a process to resolve conflict

Each team member should acknowledge the skills and knowledge of team colleagues

Communication between its members including the patient

Select a leader based on their leadership skills - include all relevant professionals in the team

Promote teamwork across health and social care

Teamworking should be evaluated on the basis of sound evidence

Sharing of patient information should be in compliance with the law and professional requirements

Interprofessional collaboration and understanding to be established by use of conferences, education and training initiatives

Question 22

What is the main challenge associated with larger practices?

Answer 22

Initiating effective team work

Question 23

What is the purpose of integration of health and social care?

Answer 23

Reduce unnecessary admissions to hospital and delayed discharges (focus on anticipatory and preventative care)

More efficient use of limited resources

Improves outcomes for patient and service users

Putting patients and not services at the centre of decisions

Aims to provide support and care in other environments outside the hospital setting such as home and homely settings

Question 24

What is the name of the act that merges health and social care?

Answer 24

The public bodies (joint working) (Scotland) ACT 2014

They created integration authorities with a view of breaking down barriers to joint working between NHS boards and local authorities

Health and social care budgets were allgined

Nationally agreed outcomes were set

Adult hospital services, primary care and community health services were merged with adult social services in terms of governance, planning and resourcing.

NHS boards and local authorities jointly submit an integration scheme to the integration authority. The integration scheme contains functions that are to be delegated to the integration authority.

National Health and Wellbeing Outcomes are what the integration schemes are measured against to assess their impact

Question 25

What are the two ways NHS boards and Local authorities can integrate their services?

Answer 25

The joint board model or the lead agency model

Question 26

What is in the integrated joint board model?

Answer 26

There are areas of service from both health care and social care that are delegated to the integration authorities as set out by the integration scheme. The integrated joint board plans and resources service provisions with regard to the delegated areas of service.

NHS boards and local authorities delegate budgets to the IJB which then decide how to use the resources

Question 27

Who is on the integrated joint board?

Answer 27

Representatives from the NHS board and Local authorities

NHS board = non-executive directors

Local authorities = councillors

A carer representitive

GP representitive

Nurse representitive

Secondary medical care practitioner

Service user representitive

Staff side representitive

Third sector representative

Officer who is responsible for financial administration

Chief officer and chief social worker