September 2007 Reforming community services in Wiltshire
Step by step
The NHS in Wiltshire is changing. Wiltshire Primary Care Trust is leading a series of reforms and improvements, which affect a number of NHS services in towns and villages across the county. This regular newsletter will keep you up-to-date with progress and plans.
Changes to Minor Injury Services
From 1 October 2007, there will be two minor injury units (MIUs) in Wiltshire: • Trowbridge, open 24-hours, seven days a week • Chippenham, open 7am – 1am, seven days a week. Minor injury services will also be available from the Clover Unit adjacent to the Great Western Hospital in Swindon, as well as at Andover MIU, at the Walk-in Centres in Bath and Swindon, and a range of other locations. Minor Injury Units currently located at Devizes, Savernake, Warminster and Melksham hospitals, and at Eastleigh Surgery in Westbury, will close on 30 September 2007. Managing Director of Wiltshire Community Health Services, Jenny Barker, said: “The new arrangements will ensure safe, high quality care consistently, as the public, patients and health staff will know what is available and when.” The PCT has produced leaflets and posters for the public. These have been distributed widely, including to GP surgeries, pharmacies, health centres and community hospitals, schools and colleges, libraries and leisure centres. They have been written to help people choose the most appropriate place to go for healthcare. NHS Direct also advises people about where to seek treatment and the PCT has been in touch with NHS Direct to ensure that their staff are able to advise and direct patients within Wiltshire to the appropriate place. We have also placed advertisements and information in the local press and on local radio.
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Where we are now – neighbourhood teams
There’s been a lot of talk in the media recently about Neighbourhood Teams and what happens next. Step by Step updates you on the current position and what is planned over the next few months as Neighbourhood Teams continue to develop.
Talking it through
One-to-one interviews with staff took place in July and August. 361 staff, more than 98% of staff affected by the introduction of Neighbourhood Teams, opted for an interview. It is clear that staff remain committed to the model of Neighbourhood Teams, and (with the exception of Malmesbury) there are sufficient nurses and therapists in every area to staff the teams, on paper. The consultation process identified a variety of issues and concerns, including the pace of bringing the Neighbourhood Team model into being; the number of staff and range of skills available in each team; the shift patterns, particularly in relation to working at night and working after 7.30pm; lone working; disposal of clinical waste and requests for further clarity in the job descriptions. Staffing levels in each area are being scrutinised further and recruitment advertisements have been placed for therapists where there are individual gaps in the daytime hours. In future the Neighbourhood Teams will operate from 7am to 6pm. Services from 6pm to 10pm will be provided in three locality areas across Wiltshire. A separate night duty service will operate from 10pm to 7am. Implementation of the night duty service will be phased across the county with the first phase in west Wiltshire to support the planned changes to inpatient services.
Individual Neighbourhood Teams will organise their own rotas to help ensure that staff’s home and family commitments are considered alongside the requirement to deliver the service which our patients need.
Working with GPs
Members of the PCT senior management team, and the Reforming Community Services in Wiltshire programme, have met with the Practice Based Commissioning consortia in the north, east and west of Wiltshire to hear about GPs’ experiences of the new teams and to answer questions. Neighbourhood Team coordinators are meeting with practices covered by their team to develop local working relationships. Details of the staff within Neighbourhood Teams and the link person for each practice will be circulated to all practices in early October.
Service Development
The Neighbourhood Team coordinators recently held an ‘awayday’ which gave them an opportunity to work together to clarify the scope of the teams’ role and to understand and improve the internal part of the referral process. Work is taking place on training needs analysis and developing ‘self-rostering’. Representatives from each team meet fortnightly with Jenny Barker, Managing Director, which gives an opportunity to voice any concerns and make suggestions. 2
Where we are now – inpatient services
There will always be some patients who need to be cared for in an inpatient bed, even if this is only for a day or two. Step by Step updates you on how inpatient services are changing to ensure the best arrangement of care for patients
Inpatient Development Manager
Madelyn Griffiths has been appointed to this role having previously worked with the Reforming Community Services in Wiltshire programme team. Madelyn is an experienced nurse and her role is to make the vision and strategy for the inpatients care a reality. Madelyn will work closely with the ward managers and matrons, and with other parts of Wiltshire Community Health Services – the neighbourhood teams, Minor Injuries Units and Access to Care. Madelyn’s role also includes working with the inpatient operational managers in the local acute hospitals to achieve improvements in delayed transfers and in reducing length of stay.
The timetable for changes to the provision of inpatient beds across Wiltshire is being reviewed to reflect the changes to the implementation of Neighbourhood Teams. The PCT is committed to continuing to provide sufficient beds for patients during the continued development of the Neighbourhood Teams.
New timetable
The reduction in the number of inpatient beds at Chippenham and Melksham hospitals has been delayed until the end of October 2007. This will allow us to continue to provide safe care to our patients and to allow staff to move into their new roles in the Neighbourhood Teams at the right times.
Keeping staff informed
A programme of meetings for inpatient staff will take place during October, giving staff the opportunity to hear more about the arrangements for transition, the workforce model and the future of inpatient services. Staff are encouraged to read and to post questions on the Question and Answer section of the PCT’s intranet, and to speak with their team leader or modern matron. 3
Spotlight on …
Access to Care
Access to Care is the ‘gateway’ for health and social care professionals in north, west and east Wiltshire to access the new Neighbourhood Teams and Community Hospital beds. Access to Care is provided by a partnership between Wiltshire Medical Services (WMS) and Wiltshire Community Health Services. WMS manages the dayto-day service. Shift times and patterns are under review to ensure the optimum number of staff on duty to meet the demands on the service.
How to refer
Health and social care professionals can refer to Access to Care by fax, phone or e-mail. Each referral is logged by administrative staff and, in all but the simplest of cases, the referral is passed to one of the Access to Care clinicians for further assessment in order to obtain an accurate clinical picture of the patient. The Access to Care clinician then decides the most appropriate pathway and refers the patient on to the relevant professional and service by phone, fax or e-mail.
Did you know...
In the first few weeks of operation Access to Care received approximately 100 GP referrals each week. By early September, this figure had increased to approximately 300 GP referrals per week.
Accessing the service
Access to Care has been in operation for three months and is still a new service. The volume of referrals at different times of day is still being assessed. Where possible health and social care professionals are asked to make non-urgent referrals by email or fax. This will leave more capacity for urgent telephone referrals.
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