British Association of Health Services in Higher Education Conference 6 th July 2005 The Minor Illness Nurse
Mar 26, 2015
British Association of Health Services in Higher Education Conference 6th July 2005
The
Minor IllnessNurse
Our PracticeWigmore Lane Health Centre
• Luton North east (near the Airport)• Three full time doctors (many outside commitments)• Two sessional doctors• Two part-time practice nurses (50 hrs)• One Nurse Specialist (30 hrs)• 6,100 patients• 10% under fives
The Problem
• Too many patients
• Too little time
Increasing GP Workload
•Increasing patient Demand
•Increased transfer from secondary care
•“Care in the community”
• PCT’s
Decreasing GP Workforce
•Recruitment crisis
•Part-time working
•Few reliable locums
The Extras - Patients Requesting Same Day Appointments
>Uncontrollable workload fluctuations
>Major source of GP and receptionist’s stress
Who Were They?
33% Children under 5
19% Children 6-10 years
48% 10 years and over (72% female)
1,630 “Extras” per GP per year
Which Problems?
Of the requests for same day appointments
• 57% URTI / ears/ cough
• 20% Eyes and skin
• 8% Abdominal / D&V / Cystitis
The Raw Deal
• Reluctantly squeezed into over-booked surgeries
• Long waits
• Harassed GP who has little time for explanation
• Maybe, unnecessary antibiotics
The
Solution?
The experienced
Practice Nurse
The Nurse’s
“Emergency”
Clinic
Protocol
• Regular, daily for 3.5 hours in the morning and some afternoons
• Book on the day
• Requires sensitive questioning
by receptionists
• 15 minute appointments
• Doctor on hand for discussion or referral
• Prescriptions (if needed) written and signed by nurse (if clinical condition and drug on ENPF) or signed by GP
Responsibility
• Professionally accountable to the NMC
• GP employer is legally liable
• Indemnified by practice defence organisation MPS and RCN
Does it Work?
YES!
Analysis of the clinic after 1 year (June1996-May 1997)
1,535 patients seen by Nurse Specialist
45% - received a prescription
7% - immediate referral to GP
Benefits to Patients
• Fixed appointment time so shorter wait
• Nurse spent more time with patient than GP initially but GPs now have 15 minute appointments
• Emphasis on self care supported by written material, not prescription drugs
Benefits for the practice
• Happier receptionists
• More satisfied patients
• Better health education
• Patient less likely to return next time?
• More job satisfaction for the nurse
• Reduced need for locums
Problems
• Training very time consuming
• Confusion over different practice nurses’ roles
• A few patients objected
• Holidays / Sickness
Nurse Specialist Minor Illness Course
Minor Illness Course
•Accredited by the University of
Luton (45 credits level 3)
•One week full time seminars
• From September 1997 – March 2003, 6 months course with clinical sessions based at WLHC (no longer available)
Also available…………..
Flexible training opportunities –
• 5 day Seminar week at based at WLHC or satellite locations around the country
• Open learning programme at Level 2 available through Radcliffe Publishers
• Combination of seminar week and open learning programme to attain accreditation
The Course - ingredients
• Consultation and Communication skills• Clinical skills• Examination techniques• Infections• Clinical Pharmacology• Prescription writing• Managing change• Evidence based practice
………..The clinical sessions
• 8 weeks observation
• 12 weeks supervised
• 6 weeks solo
Extra ingredients
Assignments:• Pharmacology scenarios• Case studies - 1 Adult & 1 Child• Practice Administration• Evidence Based Practice topic
Skills ManualVideo 4 consultations (not assessed)Own practice support
…………resulting in
• Competent, skilled, highly trained nurses able to manage patients requesting same day appointments.
• An understanding of the relevant theoretical background in the management of minor illness
• A holistic approach with insight into the possibility of a hidden agenda
• The knowledge when to seek appropriate medical assistance
Does it work for other practices?
• 63 nurses trained on the 6 month course • A further 600 nurses attended seminar weeks• Practice audits show very high patient satisfaction
(98 - 100%)• Similar prescribing patterns to GPs• 3.1 - 12.5% referral rate to GP during clinic• 1.2 - 10% re-consultation to GP with same
complaint within 2 weeks
June 2005 Auditn=164 (over 2 weeks)
F/M 2:1
• URTI 39%
•Abdo/UTI gynae 13%
•Skin/rashes/eyes 35%
•Musculo/skeletal 10%
•Others 4%
28%
30%
28%
3%
5%
3%
4%
Advice
ENPFRx
FP10
REF DRTMA DR,PN
Ref to Other
DW DR
0
5
10
15
20
25
30
35
40
0-10
11-20
21-30
31-40
41-50
51-60
61-70
71-on
Patients seen
n=164
References
Chau S, Humphries A, Wheeler D, et al. Nurse management of patients with minor illness in general practice: multicentre, randomised controlled trial
BMJ 2000; 320:1038-43
Kinnersley P, Anderson E, et al. Randomised controlled trial of nurse practitioner versus general practitioner care for patients requesting ‘same day’ consultations in primary care.BMJ 2000; 320:1043
Marsh G N, Dawes M L. Establishing a minor illness nurse in a busy general practice. BMJ March 1995; 310:778-780
Venning P, Durie A, Roland M, Roberts C, Leese B. Randomised controlled trial comparing cost effectiveness of general practitioners and nurse practitioners in primary care.BMJ 2000; 320:1048-53
www.minorillness.co.uk
Contact Sheila McLaughlin on
01582 481914
For details and an application form