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How a nurse-led GP liaison service has helped to streamline the patient journey   

Service manager and community liaison Sally Shaw explains how she helped develop a service to improve communication with local GPs

Service manager and community liaison Sally Shaw explains how she helped develop a service to improve communication with local GPs

Sally Shaw

When I was given the chance to take a six-month secondment from my community nursing role to develop a new model of working that would streamline the way GPs could refer patients for same-day hospital assessment I saw it as a great opportunity. Now, 11 years on, Luton’s GP Liaison Service – believed to be the only nurse-led service of its kind in the country – handles around 650 referrals a month covering four clinical commissioning groups (CCGs). 

Initially, I was joined by another band 6 nurse to deliver this service funded by the primary care group as part of our funding contract; now we are an integral part of the integrated discharge team (IDT) run by Cambridgeshire Community Services NHS Trust. Being based at the Luton and Dunstable Hospital but employed by a community trust is beneficial as the team have a ‘foot in both camps’ with a ‘can do and if not, why not?’ attitude.

The journey to this service, which provides a fast and effective pathway through the hospital and back into the community for patients, many with highly complex needs, began in April 2007. Before this, GP referrals for same-day acute medicine and general surgical assessments came through the main hospital switchboard and were discussed and accepted by the hospital ward nursing staff. It was recognised that a designated referral process with a broader knowledge of community services and acute pathways might reduce inappropriate hospital attendance.

As a registered district nurse who had worked in the IDT and in the community, I understood what was required and what could be possible. The GP liaison service was born, but was not without its initial teething problems.


Watch: GP Liaison and Integrated Discharge team 

 

 


Communication problems

The pilot began with locum GPs supporting the service. Our local GPs did not want to further discuss their referrals with a medical peer. However, discussions with senior nurses were acceptable. To help us make a clinical decision as to where the appropriate place of care should be, we requested details of basic observations, pulse, blood pressure and so on. The request for a temperature elicited many excuses such as the ‘thermometer is broken’, ‘the patient feels hot’ or ‘I don’t believe in temperatures’. Today, these observations are given readily.

‘Routinely, on receiving a referral, we consider what community services are available, if advice from a consultant would be useful, and whether we can use the day unit to prevent a hospital admission’

As the service developed, we received complaints that GPs were facing long waiting times to get through the hospital switchboard to the team. In desperation, they would advise their patients to attend emergency care which, in turn, had an impact on the hospital meeting the government’s four-hour target for treating and admitting or discharging patients. To address this concern, in November 2015, Luton CCG commissioned a private communications company, Consultant Connect, to support referrers. 

Each Luton GP surgery was given a specific telephone number to dial in directly to mobile phones carried by the team. This allowed the team to respond within 20 seconds on almost 98% of occasions. Five months later, GP surgeries in South Bedfordshire were brought on board along with an acute trust paediatric service. In addition, we handle an extra 100 calls a month from Hertfordshire and Buckinghamshire via the hospital switchboard as GPs in these areas are not yet commissioned to join our telephone system. Advice and guidance from an on-call paediatrician and referral to the hospital’s paediatric assessment unit is now available as well.

Integrated team

The GP liaison service operates Monday to Friday, 8am to 6.30pm, mimicking current GP surgeries’ opening hours. The data we collect are shared monthly with Luton CCG and support the community admission avoidance work. 

Out of hours referrals continue to be made directly to the on-call specialist teams, via the hospital switchboard bleep system. The number of referrals received does not highlight a need for extending the team’s working hours, but this is constantly under review.

‘We will input as much information as we can for the consultants and link in with specialist nurses to let them know patients are being referred to the hospital and back into the community to keep continuity among the services’

When this service launched, we took an average of 250 referrals a month. Today the team of three band 6 nurses and a band 7 service lead share the role of liaison sister. We have to know about community service provision in four CCG areas. This can be challenging, but it leads to development across our local services and good practice being shared. 
  
Over the years, the team has developed several pathways including dealing with outpatient blood transfusions and access to a consultant advice line to support nurses. Routinely, on receiving a referral, we consider what community services are available, if advice from a consultant would be useful, and whether we can use the day unit to prevent a hospital admission.

Continuity of communication is vital when caring for complex patients and being able to share the information in a timely manner is essential for smooth, safe and appropriate discharge planning. Patients highlighted by the GP liaison sister are followed up the next day on the ward by the ‘back end’ team. Working as part of the integrated team, sitting with local authority colleagues, ensures that patients can be discharged as soon as is appropriate and safe to do so.

Close relationships

Streamlining the patient journey was a major factor in developing this service and this is an area that we are constantly reviewing with our CCG, community and acute trust colleagues. Collaborative working across all of our partners has allowed the team to develop close working relationships and to be able to support each other.

We are working with the acute trust to develop single checking of patients. Patients arriving at the hospital’s emergency unit will be seen and assessed by one person. We have responsibility for adding our referred patients to the ‘on call’ take list recording patient details. We will input as much information as we can for the consultants and link in with specialist nurses to let them know patients are being referred to the hospital and back into the community to keep continuity among the services.

We also support the acute trust with the early detection of sepsis so that we can provide an early alert across the system. We use the NEWS2 tool, which supports assessment of sepsis risk. At the same time, we work with ambulatory care to support the development of their criteria and pathways.      

This year, we have received two prestigious national awards, and were shortlisted for one last year. 

The team is committed to providing a professional service but also maintaining its ‘can do and if not, why not?’ attitude. Our journey continues. 


Sally Shaw is service manager, lead nurse and community liaison in the integrated discharge team, Cambridgeshire Community Services

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