We are listening - Out of Hours

Tom

The Out of Hours Service receives referrals from NHS24 for people who require urgent medical care when their GP surgery is closed. All referrals to the Out of Hours Services are co-ordinated through the “HUB”. This is a central administrative area that arranges patient appointments, manages the clinical and non-clinical staff and is the first point of contact for professional staff (NHS24, Emergency Departments, Ambulance Service and District Nurses) that may need to contact the service.

NHS Lanarkshire was visited by the National Peer Review Group as a follow-up to the National Review of Out of Hours services by Sir Lewis Ritchie. The visit recognised the actions taken in Lanarkshire in support of the National Review, to deliver safe, effective, person-centred care.

Some of the changes and improvements that we have made have been aligned to a different professional skill mix within the Out of Hours Service, namely:

Specialist nursing support for Paediatric patients (Children)

Paediatric nurses worked with the Out of Hours team based within Douglas Street Clinic in Hamilton over a three month period. Children were monitored and reviewed in the clinic rather than being sent directly to the Paediatric ward at Wishaw General Hospital. This new way of working hasreduced the number of children being referred to hospital unnecessarily; previously, 83% of children referred to Wishaw were discharged within a couple of hours of review. During our test period 96 children were referred to Wishaw General Hospital with 85% of them needing to be admitted to the Paediatric ward for further medical treatment, whilst 387 were monitored, treated and discharged from the clinic.

Specialist nursing support for patients with Mental Health symptoms

A similar test was undertaken with mental health colleagues. The plan was to have a sustained mental health model within the Out of Hours setting to respond to patients with mental ill health; 596 patients have been seen, with 12 of these having face to face consultations within the Primary Care Centre.  This means patients receive both physical and mental health care and support when attending the Out of Hours Service. 

Additional Advanced Nurse Practitioners

NHS Lanarkshire has recruited nine Advanced Nurse Practitioners, four of them will work within the Out of Hours setting, providing advanced support and care for adult services.  This will enhance the current nursing workforce as they will be able to see, treat and discharge a wider range of patients, undertake home visits and be involved in reviewing, developing and auditing service needs.

The Out of Hours Team – Left to Right: Clinical Support Worker, HUB team leader, Receptionist, Paediatric Nurse, Driver, HUB team leader, Nurse Practitioner and Mental Health Nurse

Pharmacy

We are also in discussion with Pharmacy colleagues to expand the availability and provision of non-medical prescribing pharmacist in the urgent care setting.

e-Health

Video conferencing facilities are being considered to enhance Out of Hours services. This will enable site-to-site case discussions and reduce the waiting and/or travel times for patients who have access to video conferencing facilities (such as local council care homes). It will also support and optimise learning opportunities for staff.

If you have an experience of Out of Hours Service you would like to share, please speak to a member of staff, respond on Care Opinion, or visit the “Your Feedback” Section of the NHS Lanarkshire website to see the other ways to get in touch www.nhslanarkshire.org.uk