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Richmond Community Healthcare in Partnership

'Richmond Community Health in Partnership' logo

Richmond Community Healthcare in Partnership (RCHiP) is a new ground-breaking new partnership between GPs from Richmond GP Alliance (RGPA) and Hounslow and Richmond Community Healthcare NHS Trust (HRCH). 

Richmond GP Alliance is a collaboration of every GP practice in the borough of Richmond, whilst HRCH provides the majority of NHS community services in the local area.

As part of this new initiative which launched in December 2016, Richmond GPs and community NHS clinicians are working together more closely than ever before to deliver better out-of-hospital community services for adult patients. 

Key to the success of the new partnership is achieving the "outcomes" that matter most to patients. Clinicians from the new partnership have been working with patients and local people to identify the health needs and outcomes that really matter to them. This work has been used to make improvements to "patient pathways" for the various community services involved. 

A "patient pathway" is the route that a patient will take from their first contact with the NHS (usually through a GP), through referral to other health services, to the completion of their treatment.

Areas of focus:

The new RCHiP partnership will initially focus on improving health services and patient pathways for the following community health services:

  • Cardiology

  • Diabetes

  • End of life / palliative care

  • Frail elderly care services

  • Respiratory care

  • Urgent care services


Latest updates:

 Improving cardiology care for Richmond patients 

Local cardiology specialists, including Richmond GPs, clinicians from HRCH, Kingston Hospital NHS Foundation Trust and Chelsea and Westminster NHS Foundation Trust – together with patient representatives, have been working together to understand how cardiology services for Richmond patients can be improved.  

As part of this work, the team has developed plans to ensure that Richmond patients who require cardiology care can receive more joined-up care and improved access to local services in the community.   

The objectives for improving local cardiology services are to:

  • Improve services for people living with cardiovascular disease (CVD) by joining up care and services between GPs (primary care), community care and hospitals – whilst improving links between providers

  • Improve the understanding and confidence of patients to self-manage their condition

  • Improve patient’s quality of life and satisfaction with the care they receive

  • Reduce unnecessary hospital admissions

  • Learn from, improve, and expand on what's already working well for cardiology services in Richmond

  • Improve the identification of patients with atrial fibrillation

  • Provide more and better cardiac rehabilitation services

The newly redesigned cardiology service in Richmond will provide all eligible patients with a person-centred service that improves their health and wellbeing - ensuring they get the right medications and treatment, whilst improving quality of life and minimising the risk of future cardiac problems. 

Changes to cardiology services in Richmond:

The first stage of the plans will see a Specialist Community Heart Failure Nurses working in the community to support heart failure patients to self-manage their condition more effectively, ensure they get the right medications, and provide access to other cardiology and cardiac rehab services.   The community cardiac rehabilitation service will also be improved to ensure patients are receiving care in line with best practice guidelines.   

 Convenient, local care & support for people with diabetes

Local diabetes experts - including GPs, diabetes specialist nurses and patient representatives – have developed a new “patient pathway” for diabetes patients in the London Borough of Richmond.

A "patient pathway" is the route that a patient will take from their first contact with the NHS - usually through their GP - through referral, to the completion of their treatment.

The new diabetes patient pathway for Richmond borough is helping local people with diabetes to get more convenient access to high quality diabetes care, closer to home – instead of having to travel to their nearest hospital. It means that patients receive improved diabetes care and access to local services, whilst achieving long term reductions in diabetes related hospital admissions.

Range of improvements

As part of the range of improvements introduced, diabetes care is now delivered through clinics held in local hubs within the areas where people live including Teddington Memorial Hospital, Parkshot Medical Centre and Sheen Lane Medical Centre. Patients can either receive their care from specialist community diabetes teams, locally - rather than in an acute hospital - or to access more of their care directly from their own GP.  

In addition, a telephone and email advice line is being introduced for Richmond patients and clinicians to support people with diabetes to manage the condition more effectively. 

Update on progress

It’s been almost a year since the new diabetes pathway was launched. There are lots of good news, as well as some challenges.

Good news

  • Parkshot Medical Practice clinics are proving very popular with patients and referrers – we’ve increased the number of appointments and are planning to increase them again

  • GPs have successfully taken on many more instances of routine care, providing better holistic service

  • By having nurses and GPs working more closely together we’ve identified quite a few patients who really need more urgent support – for example, we’ve helped at least 25 patients avoid unnecessary admissions

  • There have been over 175 calls to our advice line

  • We’re holding joint clinics at seven practices in the borough

  • We’ve had 444 attendances at our diabetes education sessions and feedback has been overwhelmingly positive!

Some challenges

  • Not every GP practice is using the advice line yet, but we are building those relationships

  • We have not been able to bring patients out of the acute sector as fast as we would like

  • Nurses currently only have limited access to GPs’ patient records, which is frustrating on both sides. However, a new data sharing agreement is due to come into force which could help

GPs, community clinicians and hospital staff have been working to support patients and their families who are nearing the end of their lives in their preferred location; whilst reducing the number of emergency hospital admissions for patients with long-term conditions by providing more ‘out-of-hospital’ palliative care services.

The team identified a number of objectives for improving palliative and end of life care for patients and local people: 

  • Placing an increased focus on providing care and services for patients who are in their ‘last year of life’.

  • Joining up care services provided by GPs, hospitals and community health services - with shared ownership for providing end of life care services.

  • Coordinating and facilitating ‘open discussions’ between the patient, their families/carers - and the various health and care services providing end of life care.

  • Ensuring continuity of GP care across different care settings.

  • Strengthening communication with patients and carers.

  • Extending bereavement care services in community.

  • Reducing unwanted variation in care between different services or care providers.

  • Coordinating advance ‘care planning’ across GPs and hospitals.

Richmond GPs, local hospitals and community health clinicians have been working together with patient representatives to improve care for frail and elderly people in Richmond borough.

Following a review of the existing care on offer - a range of new services are being created to support local elderly people, including two types of Senior Health Clinics - to help local healthcare professionals to assess and plan elderly people’s health and social care needs, working closely alongside the individual. 

1.Senior health clinic in Teddington

At Teddington Memorial Hospital there is a clinic with a pharmacist, consultant, therapist and nurse to assess the patient.

  • This clinic may be best for complex patients who have multiple health needs - including lots of medications, difficulty with physical tasks and general ill health, leading them to being frail and at risk of hospital admission.

  •  The patient will attend the clinic for an afternoon to be seen by all the professionals.

  • This happens weekly on a Thursday afternoon currently and is a pilot until the end of May.

  • Download the senior health clinic referral form here.

 

2. Virtual clinic

A new 'virtual clinic' uses a web-based video conferencing tool that allows us to invite any health or social care professional, the patient and or carers - plus any voluntary sector colleagues (as appropriate), to participate in a review and planning meeting for the individual concerned.

  • The virtual clinic may be best for a moderately frail person having difficulty coping at home due to complex needs and would like a multi-disciplinary problem solving session to look at new solutions to managing their care -especially if they are starting to fail to cope at home and a hospital admission or residential care home placement is imminent.

  • If the person does not have an actual assessment at this point, the virtual clinic is discussion based between the various health professionals involved, with a care plan written and agreed at the end.

  • The virtual clinic is starting on 31 March and will happen three times a week, on Monday, Wednesday and Friday between 1-2pm.

  •  Download the virtual clinic referral form here.

Both these clinics are linking closely to other services such as the Falls Clinic so the individual gets the most comprehensive and appropriate service for their needs. 

If you would like any help or advice about these new frail elderly services, please contact our administrator, Nicole Boultbee on Nicole.boultbee@hrch.nhs.uk or Sasha Pearce, senior clinical transformation lead for Frail Elderly on sasha.pearce@hrch.nhs.uk or tel 0208 973 3109. 


Other initiatives being developed include: 

Red bag scheme

HRCH launch Red Bag Scheme for hospital transfer pathway                 

 

The red bag initiative focuses on elderly residents from care homes in Richmond who are transferred to A&E at Kingston Hospital and West Middlesex University Hospital by London Ambulance Services.

 

The initiative, which will launch early June, has been designed to support care homes, the London Ambulance Service, Kingston Hospital and West Middlesex University Hospital to meet the requirements of the NICE guidance on transition between inpatient hospital settings and care homes.

 

The red bags contains personal effects such as dentures, glasses, hearing aid and toiletries, as well as a change of clothes and pair of slippers so the individual can function, get out of bed and be ready to go home as soon as they are able.  The red bag initiative will help people living in Richmond care homes to receive quick and effective treatment should they need to go into hospital in an emergency. 

 

The bags also contain standardised information about the resident's general health, any existing medical conditions they have, medication they are taking, as well as highlighting the current health concern and important personal details about the individual.  This means that ambulance and hospital staff can determine the treatment a resident needs more effectively.

 

This will save time during the transfer of the resident from care home to ambulance and from ambulance to A&E. It will also allow A&E staff to make more informed decisions about the patient, as they will always be aware that she/he is a care home resident.

 

HRCH developed the red bag initiative together with Richmond Community Health in Partnership, Richmond CCG, Kingston Hospital NHS Trust, Chelsea and Westminster Foundation NHS Trust – West Middlesex Hospital, London Ambulance Service and representatives of the Care Homes in Richmond.

Care homes – Improving care and quality of life.

  1. Hospital Transfer Pathway/Red Bag Scheme:  When a care home resident becomes unwell and needs to be taken to hospital, they will be transferred with a set of standardised paperwork which includes all necessary health and social care information about that person to support staff in providing the right care. This is contained in a “red bag” which also holds their medicines and personal belongings.  The red bags are currently being made and should be ready for use at the start of June. We are currently working with the Care Homes and Hospitals to make sure everyone knows about how to use it.
  2. Support Worker Training: This is to provide essential training to unqualified staff to help them recognise the early signs of disease or ill health, such as dehydration or infection so that early diagnosis and referral can be made before serious consequences occur such as a fall or confusion. This is in the early stages of planning.
  3. Care Home Support Team: In conjunction with the training, looking at having a dedicated team of clinicians to support the borough’s Care Homes, e.g. pharmacist, nurse, dietitian etc. This is in the early stages of planning.
  4. Standardising GP support at the Care Homes: Investigating how best GPs can support the Care Homes in a uniform way across the borough.
  5. Care Navigators in A&E:  A pilot study involving Care Navigators is looking at providing a free, impartial and confidential service to older people in Richmond. They will be based or in contact with local hospital A&E departments to work with people who have avoidable attendances at A&E, i.e. they are sent home without treatment as they could have been supported elsewhere and had no need for acute input.
  6. Care co-ordinators with medical knowledge will advise and support frail elderly people in accessing appropriate services, implementing care plans and being a single point of contact for individuals, carers and services.

 Joining-up respiratory care services

GPs and clinical specialists from HRCH, Richmond GP Alliance, Kingston Hospital and Chelsea and Westminster NHS Foundation Trust - have been working together with patient representatives to look at how respiratory care services in Richmond can be improved to achieve better outcomes for local people with respiratory conditions.

The team identified a number of priority areas to address:

  • Joining up patient care by strengthening links between the various respiratory care providers  - such as local hospitals, GPs, and the community service providers

  • Achieving earlier identification of patients with COPD to improve outcomes

  • Improving patient safety by delivering care in the most appropriate setting

  • Supporting patients to self-manage their conditions more effectively

  • Provide more consistent care for patients

  • Reducing the number of unnecessary hospital admissions

     

HRCH will work collaboratively with GPs and local hospitals to improve services for people with respiratory conditions, as well as strengthening links between those providing care. 

From 1 April 2017, as part of the re-designed service - patients with mild to moderate COPD will benefit from self-management educational sessions and more convenient, local care provided at their GP practice; whilst patients with severe COPD will be treated by HRCH’s community respiratory care team.

Urgent treatment centre at Teddington Memorial Hospital

On 2 July 2018 the urgent treatment centre replaced the former walk-in centre

  • New opening hours are 8am to 8pm, 7 days a week
  • After 8pm please call NHS 111 – you can call NHS 111 at any time to find the right care for you
  • The centre cares for adults and children who need urgent treatment, if that is the right place for you to go   
  • We are increasing the flexibility of the service, which will be run by nurses and other healthcare professionals, supported by a GP
  • They will offer advice and treatment for adults with minor injuries, illnesses or problems that may need further investigation – but not in a large hospital or A&E - as well as advice and treatment for children with minor illnesses
  • Patients registered with a Richmond GP may be able to book a GP appointment via your own practice or NHS 111 as part of the Richmond extended hours GP service, if your practice or NHS 111 say that is the right place for you to go      

 

What’s different for patients?

The main differences for patients are that bookable appointments are available and the opening hours changed.

Appointments

  • When you call NHS 111, they may add you to a list for the UTC to call you back, if that is the right place for you to be treated
  • You may be given a booked GP appointment by your GP practice or NHS 111 if you are registered with a Richmond borough GP
  • You can still walk in and be given a booked appointment (you can then choose to sit and wait or come back at the appointment time) - a survey recently established that 59.5% of people who attended the previous walk-in centre would accept an appointment rather than stay and wait to be seen

Opening hours

  • The new service is open until 8pm, rather than 10pm as previously, in line with other urgent treatment centres – call NHS 111 after 8pm


Richmond CCG, Hounslow and Richmond Community Healthcare NHS Trust and the Richmond GP Alliance, have worked on developing the service together, with input from stakeholders.

If you have any queries about this please email pals.hrch@nhs.net or call 0800 953 0363 – the phone is answered between 9am and 5pm, but you can leave a message at any time. For more information, please click here https://www.england.nhs.uk/wp-content/uploads/2017/07/urgent-treatment-centres%E2%80%93principles-standards.pdf


What is an urgent treatment centre (UTC)?

This is where you go if you need urgent medical attention, but A&E isn’t the appropriate place. It is usually open for 12 hours every day of the week, every week of the year – including bank holidays. The Teddington service is run by nurses and other healthcare professionals, supported by a GP.


Why has the service been renamed as an urgent treatment centre?

The NHS is working to standardise the services available for urgent care. Feedback from the public suggests the range of services currently on offer is confusing, from minor injury units, to urgent care centres, urgent treatment centres and walk-in centres – all of which provide similar services. This is about standardising the services, so they are all open from 8am-8pm, with appointments available through NHS 111, to give help the public understand where the best place is for their care.


How does it differ from a walk-in centre?

The main difference is that the service is open until 8pm (rather than 10pm) and booked appointments are available. Walk in appointments are also available.

What are the opening hours?

In line with the national model for Urgent Treatment Centres, the service will be open 7 days a week, including bank holidays, from 8am to 8pm. 

Do many patients attend from 8-10pm?

In Teddington the number of patients who attend each day between 8-10pm is small at about eight people on average. The NHS has a responsibility to spend taxpayers’ money in the most effective, fair and sustainable way, so staffing and running a treatment centre for two hours when demand is so low is not a good use of finite local NHS resources.

When should I go to an urgent treatment centre?

An urgent treatment centre is appropriate for conditions such as injuries, fevers, eye problems or suspected broken limbs. If life is in danger, patients should call 999 or go to A&E.

Examples of conditions treated at an urgent treatment centre are:
• minor injuries to limbs, with possible fractures
• urinary tract infections
• rashes
• superficial burns and scalds
• wounds requiring stitching/closure
• bites and stings
• minor head injuries, such as large bumps, bruises, or cuts
• tetanus injections if you need one following burns, cuts, or wounds
• minor skin and tissue infections
• removal of foreign bodies, including from eyes, ears and noses
• emergency contraception

 

Urgent Treatment Centres have access to simple diagnostics such as pregnancy tests or x-rays, as well as a range of other services.

Prescriptions can be issued, but you will need to go to a pharmacy to get the medication. To find a pharmacy near you, please check online at https://beta.nhs.uk/find-a-pharmacy/

Are children seen in the Urgent Treatment Centre?

Yes

Can patients contact the urgent treatment centre directly to book an appointment?

No.

How are you going to manage the move towards predominately booked appointments?

The transition to booked appointments will be gradual. NHS 111 will help us manage the transition as they gradually book more people into the service. Walk in appointments will continue to be available.

Will the urgent treatment centre be able to cope with bookable appointments as well as people just walking in?

Yes, there will be one system for booking appointments and another system for people who walk in. The systems will work alongside each other.

For more information about urgent treatment centres, visit: https://www.england.nhs.uk/wp-content/uploads/2017/07/urgent-treatment-centres%E2%80%93principles-standards.pdf