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SRG 6 Part 2 - Cross System Approach to Care

The second presentation was by Pamela Vaughn, an Advanced Respiratory Physiotherapist working who spoke about the role of allied health professionals and how they could provide a key role in working across boundaries from hospital into communities. She provided and overview of her experience and professional development to become a highly specialised practitioner in respiratory disease. One of the diseases being chronic obstructive pulmonary disease (COPD) that affects a 133,000 people across Scotland, which is predicted to rise by a third over the next 20 years, and results in a large number of bed days (admitted to hospital) and this is increasing.

Pamela explained that when people with COPD are admitted to hospital it results in a downward spiral as certain factors such as loss of conditioning and body weight due to inactivity and nutrition can actually lead to an overall decline in health. This means that when discharged the person is not as able they were before and their condition is worsened as is their ability to cope e.g. more breathless carrying out everyday activities and they are now more likely  to be admitted to hospital again and this is repeated. However, if inpatient rehabilitation can happen earlier this can break this cycle and the person can discharged in better condition breaking the cycle.

She also spoke about the how in the North East of Glasgow a pilot approach had been taken where a team provided assessment and management that had normally taken place in a hospital in people’s homes. The people who received this service reported that the disease had less of an impact; they had a better quality of life and were achieving the goals that they wanted. As well as being more person centred it resulted in less home visits by GPs, a reduction in hospital admissions and in costs. This approach has been so successful that it is now funded permanently and it s being rolled out elsewhere.

Pamela explained that this service was only possible and worked so well because it was an integrated multidisciplinary team who worked across setting and boundaries. However, people had to get used to the notion that they didn’t always need to see a consultant and although there was one linked to the team for support and decisions in complex cases who stated; ‘I am more than happy to acknowledge there are professions better than me to deal with certain patients’. Central to this approach was that much of it was delivered by Allied Health Professionals (AHPs).

She described who AHPs are and that as a diverse group of highly skilled are key to the delivery of high quality patient-centred services who can provide treatment and care along complete pathways. They are the third largest workforce in NHS and can assess, diagnose, treat and discharge patients who as independent practitioners can offer advanced practice, specialist and generalist skills. They have also role in prevention and in improving health and wellbeing though non pharmacological means in conjunction with more traditional approaches.

Pamela then provided example of and discussed with the group how AHPs could have much wider roles in the management and treatment of other conditions. Evidence had shown that; they can reduce waiting times for clinics and the burden on consultants; and through offering more time to talk and increased patient contact can improve the patient journey. However, for this to happen people need to better understand their role and their needs to be a cultural shift around expectations i.e. wanting to see a doctor as they are considered the experts.

Ian Ritchie thanked Pamela for her presentation and reiterated a point that had been raised several times throughout meetings that unless there was an absolute need hospitals are not the best place to be and in some instances can be detrimental to people’s health and wellbeing. He then facilitated a question and answer session with the Group members who led discussion on a number of topics. Susan started by saying that the team approach is great, it illustrates how it is the appropriate service for the persons needs and that not only fixing the immediate problem, but helping people improve their health is a very positive approach.

Morag Cullen asked about the predicted increase in people living with COPD and could anything be done to limit this and there was discussion about the impact of health improvement, but because people are living longer and diagnosis is better the numbers are going up. Thomas asked how people access the service, or do they need to go via their GP and it was explained that as pilot it was only available in the North East of Glasgow; however it illustrated how conditions can be managed better via a different approach.

Betty said that she had been impressed by the approach and it was good to see it happening and agreed it could be replicated across other conditions in the future, but that the wider public needed to be informed understand that they are seeing the professional that they need when they need it – and that this might not be a doctor. Aileen asked where would services take place and there was discussion that a whole range of settings from people’s homes to community venues and hospitals, but that the traditional hospital based clinic model was outdated and people only need that if the severity of the condition required the range of support services that provides on-site.

Martin spoke about attending a conference a number of years ago when it was presented that AHPs could do more and were frustrated that their skills were underutilised so why aren’t services like this more commonplace. There was discussion that both the wider public and clinical staff needing to let go of long held notions and perceptions of who the experts are and Anne Marie said that more needs done to explain that the doctor isn’t always the best person to see. However it was acknowledged that how other professionals are supported by and communicate with medical experts needs to be demonstrated to provide assurance.

Ian Good asked about funding and if this made good business sense in terms of improved outcomes and a reduction in costs then surely it should be replicated. This led to further discussion about culture within services where doctors take the responsibility for everything and that this needs to change. Thomas said people need to know what’s on offer and this might lead to change through demand. There was then talk about how people currently access most service via their GP who might not refer, but people need to be made aware of what services and specialists they can access, and if not direct access they need to be able to say what they want.

Gordon said this was about education and if people are better informed then they will be empowered to do manage their own health better. Margaret said that the use of case studies and patient experience examples can help do this and provided a personal experience of this. Janet, a retired GP, said that things are changing but people need to be patient as GPs have always been trained that other professionals can do a wide range of things; however have been trained that only doctors can diagnose and this will need to be part of the culture change spoken about. 

 In Attendance

Dr Ian Ritchie (Chair)

NHSGGC Non Executive Director

Liz Porterfield (Co-Chair)

NHSGGC - MFT Core Team

John Barber (Facilitator)

NHSGGC - MFT Core Team

   

Presenting

Mr Mike McKirdy  

NHSGGC - Consultant General Surgeon

Pamela Vaughan

NHSGGC - Advanced Respiratory Pysiotherapist

 

Patient, Service User and Carer Representatives

Aileen Hills

 

Anne Marie Kennedy

 

Betty Graham

 

George Brown

 

Gordon McInnes

 

Helen Morgans-Wenhold

 

Ian Good

 

Janet Nicholls

 

Janice Woodburn

 

Karen Haldane

 

Margaret Telfer

 

Martin Brickley

 

Morag Cullen

 

Morag McIntosh

 

Stacey Highfield

 

Susan McDonald

 

Thomas Cassidy