Tutorial 4 - Team around the Patient

Question 1

list 10 members of the primary healthcare team

Answer 1

1. GP partners
2. GP assistants and other salaried doctors
3. GP registrars
4. Practice nurses
5. Practice managers
6. Receptionists
7. Community nurses
8. Midwives
9. Health visitors
10. Nurse practitioners

Question 2

describe the role of the GP partner

Answer 2

• first point of contact for most patients.
• bulk of work = consultations + home visits
• most are independent contractors to NHS (responsible for providing adequate premises to practise from and employing own staff)

1. provide complete spectrum of care in community - dealing with problems often with physical, psychological and social components
2. help patients take responsibility for their own health.
3. work in teams with other professions

Question 3

describe the role of the practice nurse

Answer 3

Work as one of several or on their own.

May be involved in most aspects of patient care, including:

blood samples, ECGs, wound management (eg leg ulcers), travel health advice + vaccinations, child immunisations, family planning, women’s health (including cervical smears), men’s health screening, sexual health, smoking cessation.

(GP nurses may have direct supervision of healthcare assistants at the practice)

Question 4

describe the role of the district nurse

Answer 4

Visit people in own homes:

1. Direct patient care - Assess healthcare needs ⇒ provide complex care ⇒ monitor quality of care
2. Teaching and support role - enable patients to care for themselves or teach family how to care

District nurses help keep hospital admissions lower + ensure patients return home as soon as possible

-

(Note: they are accountable for their own patient caseloads)

Question 5

describe the role of the midwife

Answer 5

provide care during all stages of pregnancy, labour and early postnatal period.

1. Community based - at home, clinics, children’s centres, GP surgeries.
2. Hospital based - antenatal, labour, postnatal wards, neonatal units.

Question 6

describe the role of the health visitor

Answer 6

Qualified nurse or midwife working in community with families to give pre-school-age children best possible start in life.

1. Visit parentswithnew babies/young children in own home
2. Child + family health services (pregnancy-5 yrs)
3. Additionalservices forvulnerable children/families
4. Safeguarding + protecting children

Question 7

describe the role of a macmillan nurse

Answer 7

specialise in cancer + palliative care

support patients/relatives/carers from diagnosis onwards either in hospital, at home or a local clinic:

Roles include:

pain/symptom control, emotional support, info re cancer treatments/side effects, advising other MDT members (e.g. district nurses), co-ordinated care between hospital and patient’s home, advice on other forms of support, including financial help.

Question 8

describe the term ‘allied health professionals’ and give 6 examples

Answer 8

Professions distinct from nursing and medicine

1. Physiotherapy
2. Occupational Therapy
3. Dietetics
4. Podiatry
5. Pharmacy
6. Counselling

Question 9

describe the role of the pharmacist

Answer 9

Expert in medicines

Work in a pharmacy (hospital, community, primary care) to:

1. Ensure patients receive maximum benefit from them
2. Advise medical + nursing staff on appropriate use

Note: can undertake additional training to be able to prescribe for specific conditions.

Question 10

describe the role of the dietitcian

Answer 10

Help people make informed choices about food/lifestyle

• Most employed in NHS - (hospital or community)
• Some work in food industry, education, research or freelance

Wide range of responsibilities including:

working with people with special dietary needs, informing general public about nutrition, offering unbiased advice, evaluating and improving treatments, educating patients/clients, other healthcare professionals and community groups.

Question 11

describe the role of the physiotherapist

Answer 11

Treat people with physical problems caused by illness, accident or ageing.

• See movement as central to health - maximising through health promotion, preventive healthcare, treatment, rehabilitation.
• Appreciate - psychological, cultural, social factors

Core skills: manual therapy, therapeutic exercise, electro-physical modalities.

Question 12

describe the role of the occupational therapist

Answer 12

Assessment + treatment of physical/psychiatric conditions ⇒

1. Prevent disability
2. Help overcome effects of disability (physical, psychological, accident)
3. Promote independent function in all aspects of daily life.

​**Work may include:

physical rehabilitation, mental health, learning disability, primary care, paediatrics, environmental adaptation, care management, equipment for daily living

Question 13

describe the role of a care manager

Answer 13

Help people identify goals + locate specific support services to enhance wellbeing:

1. Help find solutions when faced with many choices/challenging decisions
2. Advise on social + financial support services (highly trained social workers)

Question 14

give a few other examples of professions involved in health

Answer 14

Complimentary therapists - acupuncture, homeopathy

Social services - social workers, social care workers

Health promotion - gyms, education

Question 15

describe 2 political pressures on the PHCT

Answer 15

Reduce cost of treatments.

Provide more treatments closer to where patients live

Question 16

give 2 examples of the expanding roles of some members of the PHCT

Answer 16

Pharmacist: extended role of in medicines management and minor illness

Nurse: prescribing and triage.

Question 17

give 2 problems posed by the growing number of ageing patients on the PHCT.

Answer 17

more long term conditions

greater demand for healthcare generally

(both of these are managed largely in primary care)

Question 18

What was formed as a result of a joint initiative between the Royal Pharmaceutical Society, the British Medical Association, the Royal College of Nursing, the National Pharmaceutical Association and the Royal College of General Practitioners?

Answer 18

The Forum on Teamworking in Primary Healthcare

Outlines recommendations for establishing a successful PHCT.

Question 19

The recommendations for establishing a successful PHCT are laid out in the ‘Forum on Teamworking in Primary Healthcare’ - describe up to 14 of these.

Answer 19

1. Recognise patient/carer as essential member of PHCT
2. Establish common agreed purpose
3. Agree set objectives + monitor progress towards them.
4. Agree teamworking conditions, including process for resolving conflict
5. Members acknowledge skills of team colleagues.
6. Importance of communication
7. Ensure practice population understands how team works within community
8. Select team leader for leadership skills (rather than on status, hierarchy, availability)
9. Include in the membership of the team all the relevant professions serving a practice population.
10. Promote teamwork
11. Evaluate teamworking initiatives on basis of sound evidence
12. Ensure sharing of patient information within team complies with current legal requirements.
13. Take active steps to facilitate inter-professional collaboration and understanding through joint conferences, education and training initiatives.
14. Be aware of other measures involving national organisations, educational measures, research and general guidance which impact on teamworking.

Question 20

define the ‘health and social care team’ and explain why it is called this

Answer 20

There is an NHS team around the patient but also carers/social care

Scottish Government recognised need for both to work together so launched a program to i__ntegrate Health and Social Care.

The PHCT is often now referred to as the Health and Social Care Team.

Question 21

describe the 2 primary aims of the new integrated agenda

Answer 21

Reduce:

1. Unnecessary admissions
2. Delayed discharges.

(Integration makes more effective use of limited resources and improves outcomes for patients)

Question 22

In 2011, the Scottish Government’s plan to integrate adult health and social care was announced.

what was it called?

Answer 22

THE PUBLIC BODIES (JOINT WORKING) (SCOTLAND) ACT 2014

Question 23

briefly describe 3 of the key points of the THE PUBLIC BODIES (JOINT WORKING) (SCOTLAND) ACT 2014.

Answer 23

1. Created new public organisations (integration authorities) to break down barriers to joint working between NHS boards + local authorities
2. Integration of health/social care budgets by NHS boards/local authorities
3. Form nationally agreed outcomes and requirement on partnerships to strengthen role of care professionals, along with third and independent sectors, in planning and delivery of services.

Question 24

describe the demands of the 2014 act on integrated services

Answer 24

The 2014 Act required NHS boards + local authorities to:

1. Integrate governance, planning and resourcing of adult social care/primary care, community health and hospital services.
2. Jointly submit integration scheme for each area - detailing which functions will be delegated to the integration authority. These schemes are intended to achieve the National Health and Wellbeing Outcomes.

Question 25

the 2014 act set out a framework for creating the integration authorities.

It allowed NHS boards and local authorities to integrate health and social care services in two ways - name them

Answer 25

1. integrated joint board model
2. the lead agency model.

Question 26

describe the ‘Integrated Joint Board’ (IJB) model

Answer 26

NHS board and local authorities delegate responsibility to IJB:

1) Responsibility for planning/resourcing service provision for adult health and social care services.

2) Budgets - IJB then decides how to use the resources.

Question 27

list up to 10 professionals the IJB must include

Answer 27

1. carer representative
2. GP representative
3. nurse representative
4. secondary medical care practitioner
5. service user representative
6. staff-side representative
7. third sector representative
8. officer who is responsible for financial administration
9. the Chief Officer
10. the Chief Social Worker .