South Hampshire Vanguard Multi-specialty Community Provider Acute Frailty Intervention Team HEW Frailty Workforce Development Team Meeting 17 May 2017
Where are we now? Enhancing Patient care: Service is embedding well, with positive outcomes; from patient • experience and initial GP/SCAS feedback Supporting Staff: Considerable progress in demonstrating model but much more support • needed to improve delivery; including standardising outcomes/practice and further training on multiple GP IT systems There have been a number of unforeseen administrative challenges with a • service yet to be commissioned; HR process, contractual/clinical governance conflicts and organisational barriers (stretched resources) Financial Sustainability: Financial impact looking positive but need longer term to evaluate • outcomes
Project update - AFIT • Staff appointments • Training & Education • Milestones, objectives reached • Activity to date • Patient Feedback
Staff appointments - Challenges • Recruitment process for ‘Locum’ GP (employing GPs due to type of contract) • Associate Practitioner – Foundation Degree (requirement impacts on available pool of applicants) • Differences in Organisational recruitment style and processes (needs a values based recruitment)
Staff Appointments – The Team Geriatricians: Dr Gill Turner and Dr Marianne Plater; WNF Locality Frailty Lead: Dr Ed Reeves Associate Frailty Consultant Practitioner: Debbie Crewe; Associate Practitioner: Sarah Holloway Trainee Practitioner: Lucy Lewis Frailty GPs: Dr Iain Redmill, Dr Victoria Wright, Dr Sian Brett, Dr Jabir Merali SCAS Technicians: John Cross, Steve Gordon; ICT Support: Eleanor Corbett, Allison Collins, Trina Cooper
Training & Education • GPs & Practices: o Local Delivery Group & Clinical Locality Group: § Presentations on Scope & Criteria (exceptions/inclusions) § Challenges (technology & recruitment) SCAS: Crew training sessions: • o 4 x sessions in Feb 2017, 5 x sessions in Mar 2017, 3 x Sessions in April 2017: AFIT: • o Self supportive (clinician to clinician) o Mentoring o AFIT Away Day – 26 April 2017
Training & Education - SCAS Crew Training • Aimed to: o Introduce the AFIT project o Who it’s aimed at o How it will work • Focus on frailty and what may cause an episode of decompensation followed by the inclusion and exclusion criteria that the crews needed to follow • Focus on the process and how feedback from the crews was imperative to demonstrate how well the project works
Training & Education - AFIT Away Day 26 April 2017
Training & Education - AFIT Away Day Outcomes & Actions Enhancing Patient care: Improved assessments • Improved efficiencies • Improved processes • Long Term Management • Supporting Staff: Standardising record keeping • Lessons Learned and Shared Learning • Review/reflections • Financial Sustainability: Future expansion – WHCCG business case •
Training & Education - AFIT Away Day Shared Learning • Frailty Awareness • Role of CGA • Where AFIT fits within frailty process • Assessment of gait and mobility • Advanced Care Planning Discussions • Considering Cognition – using MOCA inc. MOCA for visually impaired (http://mocatest.org)
Milestones, objectives reached Project milestones and activities delivered: When achieved (Timescale): Task & Finish Groups (concept & development) 1 14 July 2016 – 8 December 2016 Proof of Concept 2 18 July – 12 August 2016 Frailty Workshop 3 19 October 2016 Recruitment of Consultant Practitioner in Frailty and SCAS Technician 4 October-December 2016 Delivery Group (to implementation of Pilot) 5 12 January – 9 March 2017 Recruitment of Frailty GPs 6 January-February 2017 Recruitment of Band 4 Associate Practitioner 7 February-March 2017 Process Criteria Brief & update to WNF Clinical Locality Group 8 25 January 2017 Memorandum of Understanding in place 9 3 February 2017 Update to Local Delivery Group (BLC Board) 10 14 February 2017 AFIT Pilot start 11 6 March 2017 AFIT Team Away Day (training and capture of lessons learned) 12 26 April 2017 Communications Campaign (BLC, Practices and Local Media) 13 28 April 2017
Milestones, objectives reached cont. Activity as at 10 May 2017
Patient Feedback
Patient Feedback “We were told of this new service at 10pm on a Wednesday night by ambulance service. AFIT were “The two medics that came to see with us by 10am next morning - my elderly neighbour were very That is ‘service’ excellent” friendly and very kind to her. They treated her with dignity and “The Frailty team were most respect. professional & very thorough at Fantastic service.” assessing my Mother’s needs at this time – thank you all.” “The two team members who came to see my “Everyone was so kind and husband were very polite explained to me. Thank you and efficient, and I much all.” appreciated this service.”
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