The Team Around the Patient

Question 1

The traditional Primary Health Care Team

Answer 1

Receptionists
Community nurses
Midwives
Health visitors
Nurse practitioners
GP partners
GP assistants and other salaried doctors
GP registrars
Practice nurses
Practice managers

Question 2

GP Partner

Answer 2

GPs provide a complete spectrum of care - physical, psychological and social problems. They work in teams with other professions, helping patients to take responsibility for their own health.

Question 3

Responsibilities of GP Partner

Answer 3

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 4

Practice nurse

Answer 4

General practice nurses work in GP surgeries as part ofthe primary healthcare team, which might include doctors, pharmacists and dietitians. In larger practices, they might be one of severalpractice nurses sharing duties and responsibilities while in others, they mightbe working on their own, taking on many roles. General practice nurses may also have direct supervision of healthcare assistants at the practice.

Question 5

Responsibilities of Practice Nurse

Answer 5

They might 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.

Question 6

District Nurse

Answer 6

• Visit people in their own homes or in residential care homes, providing increasingly complex care for patients and supporting family members.
• A teaching and support role, working with patients to enable them to care for themselves/ with family members teaching them how to give care to their relatives.
• Accountable for their own patient caseloads.
• Keep hospital admissions and readmissions to a minimum and ensure that patients can return to their own homes as soon as possible.
• 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 7

Midwife

Answer 7

• Midwives provide care during all stages of pregnancy, labour and the early postnatal period.
• Work in the community, providing services in women’s homes, local clinics, children’s centres and GP surgeries.
• Some hospital based, where there are opportunities for midwives to work on antenatal, labour and postnatal wards and neonatal units.

Question 8

Health Visitor

Answer 8

• 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

Question 9

Macmillan Nurse

Answer 9

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.

Macmillan nurses offer the following:

-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 10

Allied Health Professionals

Answer 10

Physiotherapy

Occupational Therapy

Dietetics

Podiatry

Pharmacy

Counselling

Question 11

Pharmacist

Answer 11

• An expert in medicines and their use.
• 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.
• 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 12

Dietetics

Answer 12

Dietetics is the interpretation and communication of nutrition scienceto enable people to make informed and practical choices about food and lifestyle in health and disease.

Question 13

Dietician

Answer 13

-A dietitian will be trained inhospital 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:
- working with people with special dietary needs
informing the general public about nutrition
offeringunbiased advice
evaluating and improving treatments
-educatingpatients/clients, other healthcare professionals andcommunity groups.

Question 14

Physiotherapist

Answer 14

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 15

Occupational Therapy

Answer 15

Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific activity to prevent disability and promote independentfunction in all aspects of daily life.

Question 16

Occupational Therapist

Answer 16

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 these areas:

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

Question 17

Care Manager

Answer 17

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 18

Other Professions in the Health Care Team

Answer 18

Complimentary therapists, for example:
Acupuncture
Homeopathy

Social services, for example:
Social workers
Social care workers

Health promotion, for example:
Gyms
Education

Question 19

Factors of change affecting the PHCT

Answer 19

• Economic factors
• Political Pressure
• The development of new and extended professional roles
• The growing number of ageing patients

Question 20

Economic factors affecting change on the PHCT

Answer 20

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 21

Political change affecting PHCT

Answer 21

There are political pressures to:

Reduce the cost of treatments.

Provide more treatments closer to where patients live.

Question 22

Examples of new and extended professional roles

Answer 22

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 23

Implications of the growing number of ageing patients on PHCT

Answer 23

More long term conditions (managed largely in primary care).

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

Question 24

The Principles of Good Team Work- governing board

Answer 24

The forum on teamwork in primary healthcare - an initiative between the Royal Pharmaceutical Society, the British Medical Association, the Royal College of Nursing, The National Pharmaceutical Association, The Royal College of General Practitioners

Question 25

A good team should

Answer 25

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 26

The new PHCT

Answer 26

Increasing involvement of wider professional groups beyond the traditional PHCT

Question 27

The PHCT is now referred to as

Answer 27

MDT, due to the integration of health and social care

Question 28

The aim of the integration of health and social care agenda

Answer 28

• To help reduce unnecessary admissions to hospital and delayed discharges
• Integration is seen as a way to make more effective use of limited resources
• Is central to improving outcomes

Question 29

The Public Bodies (Joint Working) (Scotland) (Act) 2014

Answer 29

-Integration of adult health and social care

Question 30

Aims of the Public Bodies Act

Answer 30

improve the quality and consistency of services for patients, carers, service users and their families; to provide seamless, joined up quality health and social care services in order to care for people in their homes or a homely setting where it is safe to do so; and to ensure resources are used effectively and efficiently to deliver services that meet the increasing number of people with longer term and often complex needs, many of whom are older.”

Question 31

Integrated services- Integrated Joint Board Model

Answer 31

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.

Question 32

Integrated Joint Boards

Answer 32

• Must nominate 3 members each at least
  IJB must also include a carer representative, a GP rep, a nurse rep, a secondary medical care practitioner, a service user rep, a staff-side rep, a third sector rep, an officer who is responsible for financial admin, the chief officer and the chief social worker