Case study summary
The Wokingham General Practice (GP) Alliance has delivered a primary-care led integrated paramedic home visiting model. This model sees patients, who urgently need a home visit, being seen by a paramedic, rather than their GP. The paramedic provides holistic one-stop care. They seek to solve the immediate problem, and take steps to ensure it is rectified and does not recur, working closely with integrated health, social and voluntary services. The service has delivered exceptionally positive outcomes. As well as reducing demand on GP workload, it has improved patient experience, and led to better management of pressures on other parts of the local health and care system.
Wokingham GP Alliance is a primary care network formed as a Limited Liability Company, with the shareholders being partners of 13 member practices in Wokingham, Berkshire. The Alliance provides an organisational framework and infrastructure to enable and support joint working across its practices. It aims to improve patient centred care through supporting practice resilience and sustainability.
Increasing workload in surgery, including home visits, and greater co-morbidities amongst the elderly population prompted Woodley Centre Surgery to audit its home visits. They found that over half of visits could have been seen by a paramedic.
The Alliance secured GP 5 Year Forward View funding to pilot a Paramedic Home Visiting Service across a cluster of 5 practices with a combined patient population of 62,000. The Service was integrated into the primary care teams across the cluster through:
- Collaborative working discussions held with practices to design the service, including processes, operational procedures pathways, and IT systems
- Meetings with the local ambulance trust to keep them abreast of developments
- A week set aside for training
- Monthly cluster meetings to monitor and develop the service
Patient requests are triaged by a GP. End of life and more complex patients are still visited by the GP. Paramedics undertake visits throughout the day, reporting back to the GP as the senior clinician accountable for the overall care of the patient.
Prompt home visits led by paramedics have increased the number of patients that can be managed at home and encouraged closer working and earlier involvement of social services, earlier intervention and community teams.
Communication between the Rapid Response teams and paramedics and between GPs and paramedics is done via SKYPE messenger and telephone calls . Where hospital admission is indicated these communications can take place sooner, allowing for a more even spread of admissions throughout the working day, , and reducing surges in demand on ambulance transport and admission and assessment services in hospitals. Rapid response to triaged home visits has also prevented patients from deteriorating further, which usually leads to longer stays in hospital and increased costs to the system.
Between 9th August 2017 and 31 March 2018 there were 599 patient contacts over a total of 106 worked days. In this time there were:
- 96 hospital attendances avoided
- 68 hospital attendances expedited, 11 with sepsis
- 177 111 calls saved, 28 999 calls saved,
- 58 successful pathway referrals
- 0 adverse outcomes on seven day follow up data
- 75 sessions of GP time saved (if allowing 30 minutes per visit)
Patient and carer feedback has included:
“I don’t think I would have coped. For you to have done so many tests and got my mum directly on to a ward is amazing, we can never thank you enough.”
“I was happy to be seen so quickly and the paramedic assured me there was no concern.”
The introduction of paramedics has improved the working lives of GPs. GPs have more time with patients, a greater ability to undertake essential practice administration, and an improved work-life balance.
“At Parkside we are delighted to have the paramedics helping us. It has made a real difference to our working lives. They offer a prompt and professional service. We have no complaints or anxieties. They see our patients earlier in the day than we would be able to manage. They undertake a thorough examination and email us photographs if appropriate. We wouldn’t be without them!”
Watch this video to learn more about how health and social care services are working together, in a more integrated way, to improve care for people living in Wokingham.