The Polyclinic Service Model Jennie Bostock, Senior Project Officer, Polyclinics Team, HfL

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The Polyclinic Service ModelJennie Bostock,
Senior Project Officer, Polyclinics Team, HfL
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Polyclinic services

• GP
• GP services
• - Consulting and procedure rooms
• - Dedicated child-friendly facilities
• - Core and extended GP services
• - Extended hours - 12 hours, 7 days
• Practice Nurse services

• Community services
• District Nursing
• Health visitors childrens services
• Midwifery
• Specialised therapies
• Outreach services (TB/HIV)
• End-of-life care
• Dieticians

• Diagnostics
• Phlebotomy
• ECG, Pulse Oximetry, Spirometry
• X-ray, U/S and Vascular Doppler
• CTG
• CT, MRI
• Colonoscopy
• Haematology, microbiology and pathology

• Pharmacy
• Medicines use review
• Medicines management services
• Anti-coagulation services
• Dispensing services

• Long-term conditions
• Detection of undiagnosed
• Screening early detection
• Community matrons
• Management of disease registers
• Access to
• - Expert patient programme
• - Information prescriptions
• - Managers of complex needs

• Outpatient services
• Management of chronic illness (e.g. COPD, asthma
  and diabetes)
• Community paediatrics
• Consultant or PwS
• Mental health
• Audiology
• Chemotherapy
• IV transfusions
• Access to pain management

• Other healthcare professionals
• Optician
• Dentist
• Other health professionals

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Scheduled care patient case
A
Patient characteristics
Name Gender Age Profession Registered
Reason to see doctor Existing
conditions Other circumstances Clinical
process Final diagnosis

• Gladys Moore
• Female
• 71
• Retired
• Spoke (within PCT area)
• Calls registered practice (Spoke) as worried
  about mole on her arm. Home GP notices flag for
  regular Warfarin check and suggests to visit Hub
  and have both checks done in one visit. GP books
  appointments at the Hub and orders transport to
  the Hub.
• Pre-existing COPD
• Previous small CVA x 2
• High blood pressure
• Emphysema
• Multiple drugs currently in use
• Due for regular Warfarin level measurement

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3
4
Scheduled care draft patient flow
A
I
II
III
IV
V
VI
Arrives at PC Hub
Dermatology Service in hub removes mole
Patient identified (Doctor)
13
21
Calls home GP practice to schedule visit
1
6
Sample sent for biopsy
22
GP practice books patient to the Hub
Patient identified at the reception
2
7
Doctor checks patient record
14
Doctor (Hub) calls patient to share test results
Referral to district nurse for redressing
23
26
Receptionist books with Hub for mole check
Clerk checks availability of record
3
8
Examines mole
15
Doctor writes drug prescription
27
Clerk confirms patients schedule
Receptionist books with Hub for Warfarin check
4
9
Refers to specialist for removal (Hub)
16
Patient identified (Warfarin check)
18
Pharmacy receives drug prescription
28
Receptionist books with Hub for transportation
Doctor notified
5
10
Doctor (Hub) reviews blood test results
24
Blood taken, tests done
19
Notifies social services
17
Phlebotomist notified
11
Discharge/ update of home (Spoke) GP
29
Results sent to Doctor (Hub)
Doctor updates patient record
20
25
4
4
5
Polyclinic Service Model

• What is your reaction to the pathways
• Surprises
• Challenges to implementation
• 10 minutes discussion at your tables and then
  plenary feedback

6
Unscheduled care patient case
B
Patient characteristics
Name Gender Age Profession Registered
Reason to see doctor Existing
conditions Other circumstances Clinical
process Final diagnosis

• Mike Davis
• Male
• 50
• Banker in London, commutes home for weekends
• Manchester (home GP)
• Severe pain in his right foot (thinks it is
  broken after an accident)
• Recent chest pain on exertion discovered through
  consultation
• Very high blood pressure
• Drugs for blood pressure currently in use

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6
7
Unscheduled care draft patient flow
B
I
II
III
IV
V
Arrival
Assess
Arrives at PC Hub
Doctor identifies patient
Doctor refers patient to rapid access chest pain
clinic (within 48 hours)
Patient identified
1
6
17
20
Doctor accesses patient record (creates new if
not available)
7
Identified at the reception
2
Patient identified
12
Diagnosis confirmed
18
Blood taken, ECG done
13
Clerk checks availability of patient record
3
Doctor writes drug prescription
Discharge/update to home GP
19
21
Examines, takes history , chest pain noted
8
Results sent to Doctor
14
Patient booked to next available unscheduled
Doctor slot
4
Records provisional diagnosis(Gout, angina)
9
Patient identified
15
Doctor notified
5
X-ray taken, results sent to Doctor
16
Request blood test
10
Request X-ray
11
7
7
8
Polyclinic Service Model

• What is your reaction to the pathways?
• Surprises
• Challenges to implementation
• 10 minutes discussion at your tables and then
  plenary feedback