Tutorial 4: The team around the patient

Question 1

List traditional primary healthcare team (PHCT).

Answer 1

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

Question 2

Outline role of GP partner.

Answer 2

• GP: first point of contact for most patients.
• Mostly work by surgery consultations & home visits
• Deal with combined physical, psychological and social problems so provide complete spectrum of care
• Most GPs = independent contractors to the NHS: so they have to provide adequate premises, and employ their own staff
• Work in teams with other professions

Question 3

Outline role of Practice Nurse.

Answer 3

• May work on their own or with other practice nurses
• May directly supervise healthcare assistants
• 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

Question 4

What role does district nurse play?

Answer 4

• Visit people in their homes or residential care homes
• Have a teaching and supporting role where they enable patient or family member to care independently
• Minimise hospital admissions or readmissions
• Assess healthcare needs of patients and family
• Monitor quality of care

Question 5

Outline role of a midwife.

Answer 5

• Provide care during all stages of pregnancy, labour, & early postnatal period.
• Work in the community, children’s centre, GP surgeries, local clinics, women’s own homes, hospitals

Question 6

Outline role of a health visitor.

Answer 6

• Lead and deliver child and family health services (pregnancy through to 5 years):
  >offering parenting support and advice on family health and minor illnesses
  >Advice on feeding, weaning and dental health
  >physical and developmental checks
  >provide specific support for post natal depression etc.
• Provide ongoing additional services for vulnerable children and families:
  >referring families to specialists, e.g speech and language therapists
  >arranging access to support groups,
  >organising practical support - e.g working with a nursery nurse on the importance of play.
• Contribute to multidisciplinary services in safeguarding and protecting children:
  >they are trained to recognise risk factors, triggers of concern, signs of abuse, & neglect in children so interventions can be made early.
  >May appear in court to explain action taken

Question 7

What roles does Macmillan nurse play?

Answer 7

Specialise in cancer and palliative care, provide support from the point of diagnosis onwards.
- Specialised pain and symptom control
- Emotional support for the patient/family/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, e.g. district nurses and Marie Curie nurses
- Co-ordinated care between hospital & patient’s home
- Advice on other forms of support, e.g. financial help.
Do not carry out routine nursing tasks e.g. personal hygiene, changing dressings, giving medicines etc.

Question 8

Name allied health professionals.

Answer 8

• Physiotherapy
• Occupational Therapy
• Dietetics
• Podiatry
• Pharmacy
• Counselling

Question 9

Outline role of pharmacist.

Answer 9

• Advise medical and nursing staff on the selection and appropriate use of medicines
• Provide info to patients on how to manage their medicines to ensure optimal treatment
• Work in hospital, community, or primary care pharmacy
• Can prescribe medication for certain conditions with additional training

Question 10

Define dietetics.

Answer 10

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 11

What role do dietitian play?

Answer 11

• 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.
• Work in the NHS, food industry, education, research and on a freelance basis

Question 12

Outline role of physiotherapist.

Answer 12

• Help and treat people with physical problems caused by illness, accident or ageing.
• identify and maximise movement through health promotion, preventive healthcare, treatment and rehabilitation.
• Appreciate psychological, cultural and social factors influencing their clients.
• Core skills: manual therapy, therapeutic exercise and the application of electro-physical modalities.

Question 13

Define occupational therapy.

Answer 13

Assessment and treatment of physical and psychiatric conditions using specific activity to prevent disability and promote independentfunction in all aspects of daily life.

Question 14

Outline role of occupational therapist.

Answer 14

Work with people of all ages to help them overcome the effects of disability caused by physical or psychological illness, ageing or accident.
Areas covered: 
-physical rehabilitation
-mental health services
-learning disability
-primary care
-paediatrics
-environmental adaptation
-care management
-equipment for daily living

Question 15

What role do care managers play?

Answer 15

Experts in working with individuals to identify their goals and locate the specific support services that enhance well-being.

Highly trained social workers who work with the patient to advise on social and financial support services.

Question 16

Name some complementary therapists.

Answer 16

Acupuncture

Homeopathy

Question 17

Name other professions (social services & health promotions) involved in the care of a patient.

Answer 17

Social services, for example:

• Social workers
• Social care workers

Health promotion, for example:

• Gyms
• Education

Question 18

How does economic factors affect the PHCT?

Answer 18

They have big impact on the development of healthcare premises. The development of healthcare premises affects the PHCT because:

• 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 19

How does political factors affect the PHCT?

Answer 19

There are political pressures to:

• Reduce the cost of treatments.
• Provide more treatments closer to where patients live

Question 20

What makes a good team?

Answer 20

A team that:

• 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.

Question 21

What should a team do?

Answer 21

• 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 22

What are the factors affecting PHCT?

Answer 22

● Correct composition
● Economy
● Political pressure
● Developing role of nurses and pharmacists
● More ageing population, increased demand of care and long term conditions

Question 23

Why integrate health and social care?

Answer 23

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 24

What is the purpose of Public Bodies (Joint Working) (Scotland) Act 2014?

Answer 24

● Gov’t plan to integrate adult health and social care
● Created Integration Authorities
● Requirement on NHS boards and local authorities to budget for integrating health and social care, as well as submit a scheme
● Set a framework: Integrated Joint Board Model (IJB); set up an IJB and delegate planning and resource provision for integrated care to IJB
- IJB must contain minimum 3 members from NHS and local authority each, as well as representative for various integrated parties and a board of executives