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