A telemedicine service which saves time for GPs in East Lancashire and provides the most appropriate care for residents in care homes is being piloted by Airedale Hospital.
Nurses based in the hospital’s Telemedicine Hub take calls from staff in care homes which would normally go straight to GPs and assess the residents on screen using a secure video link.
The clinical team in the Hub, together with the care home staff, determine whether the patient needs to see a doctor or whether a visit from a district nurse or other community team would be more appropriate or if they need to visit the Emergency Department.
The GP triage service started at the beginning of the year as a pilot for three care homes and two practices in East Lancashire and has now developed across Pendle working with 20 care homes in Colne, Barnoldswick, Earby and Nelson.
The GP triage service runs between 8am and 6pm, Mondays to Fridays and out of hours, the care homes use 24- hour service provided by the Telemedicine Hub.
In some cases, the Hub nurses can get a prescription or give advice themselves without any need for the patient to see a doctor. In other cases, the nurses may ask the care home staff to do observations, such as taking their blood pressure, temperature or checking oxygen levels over a period of time, so they can make a more accurate assessment and the best decision for the patient.
Sheila Jackson, GP in Barnoldswick, said they had seen a dramatic drop in requests for visits from the care homes taking part in the pilot. She said that whereas previously care home staff often saved up less urgent visit requests over the weekend, now there is no need for this and GPs no longer have multiple visit requests on Monday mornings.
Dr Jackson added: “Now the weekend staff contact the Hub when a problem arises and all visit requests are appropriate. The staff in some care homes are now happier that they can have immediate access to medical advice”.
“Urgent visit requests which come in whilst you are in the middle of your surgery can also be reliably dealt with by the Hub nurses, who have no hesitation in requesting an ambulance if necessary.”
She added: “One of my colleagues remarked – of all the changes in the 15 years I have been working, this is the greatest change which has reduced workload that I can remember. I don’t mind the extra ‘late’ duty doctor visit as this is more than made up in the drop in other visits.”
Annette Ferrier, the clinical lead in the Hub at Airedale NHS Foundation Trust, said the nurses currently receive between 60 and 80 triage calls a week which would have previously been dealt with by the local GP practices. She said: “Our aim is to support the care home staff, who are often not registered practitioners, by providing clinical advice so they can give their residents the most appropriate care depending on their needs. Our nurses have access to each resident’s medical history using a system shared between GPs and hospital staff.”
Phil Parkinson, managing director of Immedicare – a partnership between Airedale NHS Foundation Trust and technical company Involve, who provide the telemedecine service to over 300 care homes across the country – said:
“The GP triage service helps busy doctors manage their workload more effectively and prioritise calls from care homes. We continue to innovate the Immedicare service and further improvements will be trialled amongst our existing customers.’’
“Doctors spend a high proportion of their time caring for this group of elderly and frail patients. In some cases a patient’s symptoms will settle down within a few hours with appropriate medication or care from a nurse – but if needed, the Hub staff can call an ambulance and get the resident to hospital very quickly.”
The GP triage service has been evaluated in the East Lancashire region and will be replicated in other areas where GP services are under pressure.
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