Free patient transport service eases social isolation for over 75s

An innovative practice project is using a transport service to reduce social isolation for its most vulnerable patients

Reeth Medical Centre covers the area of Swaledale and Arkengarthdale in North Yorkshire and has a patient population of 1,600. Around 10% of the practice’s patients are over 75, and there is a higher than national average prevalence of chronic disease.

A practice review of district nursing home visits over a 12-month period found that 86% of calls were generated due to patients not having access to transport to attend the practice for routine checks, tests and vaccinations.

The practice came up with the idea of offering a free patient transport service to enable patients to attend the practice and get out in the community. Working together with South Tees NHS Foundation Trust, Hambleton, Richmondshire and Whitby Clinical Commissioning Group, and Reeth and District Community Transport (a charitable transport initiative) – the free patient transport service launched in October 2015.

The practice uses an existing wheelchair-friendly community bus. The practice’s only expenditure was the purchase of a wheelchair for the transport bus to use.

Rural location

The district nursing team is based at The Friary Clinic in Richmond and cover nine GP practices. The village of Reeth is situated around 11 miles west from their location.

'We go up to the Yokrshire Dales twice a week as we have a regular caseload of housebound patients and it takes around 20 minutes to get from our base to the practice in Reeth,' says South Tees NHS Foundation Trust district nursing sister, Penny Hutchinson. Many of the practice’s patients live a 30-minute drive from the practice so home visits can be time-consuming for the nurses.

'Part of the route to Reeth also involves travelling along winding country roads,' says Ms Hutchinson. 'It is not too uncommon for us to be held up by becoming stuck behind a tractor, for example. We have one patient who lives a 40-minute drive from our base and the home visit is a short one, it takes us about ten minutes.

'The patient transport service enables him to attend the practice and that is brilliant for the team, as it is about a 90-minute round trip. One of the main benefits for the team is the close-working relationship we have with the practice. We are able to share and exchange skills as there are aspects of care that the practice nurse does that we do not and vice versa. It is about saying to one another, what skills have you got? Let’s swap.'

Patients using the transport service typically see the practice nurse. They can use the bus to see the GP, attend physiotherapy or podiatry appointments or collect medicines. They may also be seen by the practice’s designated district nurse. This is a unique type of arrangement with the practice due to its remote location. The district nurse holds a two-hour clinic at the practice twice a month. One example of how nurses have shared clinical skills is that the district nurse has learned how to carry out a diabetes check from the practice nurse.

'We are a small, single-handed GP practice and it keeps the district nurse in touch with practice nursing,' says Reeth Medical Centre’s managing partner Marie Brookes.

'It is also helping to improve her skills base as district nurses may be unfamiliar with some of the long-term conditions. For example, if they are going out to see a diabetic patient, they may not be familiar with doing a foot check or asking some of the extra questions about lifestyle. Both nurses are providing care at that same level now so when the district nurse goes out into the community to do a diabetes check, she has that additional knowledge.'

The community bus is used to provide a weekly medicine delivery to seven of the practice’s most vulnerable patients. It is resulting in improved compliance and concordance, says Ms Brookes.

Impact

After the first year of the patient transport service, there was a 42% reduction in home visits. Latest figures from the practice covering the period from September 2016 to end of February 2017 reveal that 43 referrals for the district nursing team have been dealt with by the community transport service. This represents a travel time saving of around 64.5 hours for the team.

It is hoped that there may be interest in offering the community transport service to patients who are registered at other practices in the Reeth Medical Centre area. This would enable the district nursing team to see those patients at the practice and may help to further reduce travel time to and from their Richmond base.

Julie Penfold is a freelance journalist