GPs caring for 200,000 people in Herefordshire are providing innovative services, including running a virtual ward with hospital doctors, through cross-organisational record-sharing.
Taurus Healthcare, an out-of-hours (OOH) provider and federation for all 19 GP practices in the county, has seamlessly joined forces with nurses and hospital specialists via EMIS Web for community care and cross-organisational tasks. It is part of the One Herefordshire Sustainability and Transformation Partnership, with local NHS trusts, CCGs, and Worcestershire County Council working as one.
Innovations to improve care during the pandemic include:
- a telephone/video service for patients with covid-19 where GPs and advanced nurse practitioners offer daily phone calls to provide medical care, advice and guidance for patients who are symptomatic or at risk of more severe illness – minimising the need for patients worried about their symptoms to go to their GP or A&E. The clinician can access the patient’s usual GP record
- face to face clinics and home visiting service for people with Covid-19 from all 19 practices, and a dedicated clinic for shielded patients, run by nurses who do not work in any other part of the primary care service.
- a trial with secondary care clinicians of a ‘virtual’ ward (for non-Covid patients) where GPs and hospital doctors treat patients together using EMIS Web and avoid a hospital admission where possible.
“Cross organisational record-sharing has helped us to improve access to care 24/7, as well as run COVID-19 clinics. We could not have done it without EMIS Web.
“The ability to view patients’ GP records round the clock means that OOH doctors can deal with the presenting problem in its entirety on the spot. If we need to make a referral on to secondary care or another service, we don’t need to send them back to their own GP first.
“In a mental health crisis, we can refer patients straight on to the mental health service, heading off an acute phase of illness.”
“The virtual ward will mean, for example, that rather than send a patient to A+E for investigations, a GP can speak with an acute medicine consultant and arrange a consultation virtually. Care is then managed among organisations – dissolving the boundary between primary, secondary and community care and making a truly integrated team. Cross organisational tasks enables safe communication, which is recorded in the patient’s record. Everyone in the patient care team - district nurses, occupational and physiotherapists, GPs and acute medical teams will be able to see the patient’s record in real time.”
Dr James Bartlett, acute medicine consultant with Wye Valley NHS Trust said: “This ability to hold risk clearly and transparently has already built trust among teams as well as capacity to deliver care to patients in their own homes. It is already showing results, and there is huge potential to develop this type of care. We can consider remote monitoring, point of care testing, workforce development and specialist virtual wards.”