Ilkeston Hospital DTC – Extending the Role of Community Hospitals

Paula Clark - Erewash PCT

Starting Point

Traditional community hospital – large & modernGP beds and GP led medical coverOne existing day case theatre with visiting Consultant teamsNew Outpatient FacilityX-ray and ultrasoundMinor injuries unit 90 bedsCatchment population up to 120,000

Committed staff, GPs and local population

Acute local providers with significant developments

Primary care “at the edge” – workload and morale

PCT wanting early wins and identity for itself and its constituents

A few “champions” and track record for innovation – nurses, visiting Consultants and GPs

The Environment

Strategic contextPlans for shift of care from secondary to primary careConcern re growth rates of referrals and non-elective admissions vs capacity and workforcePrimary care access targets vs workforce shortages

PCT contextDesire to provide services close to home for patientsRecognition of need for modernisation

The Vision

To move away from the traditional community hospital image by creating a

modern hospital for the people of Erewash PCT that:

Provides real choice and quality for patients & GPsRetains investment within the PCT & creates opportunities for income generationProvides opportunities for staff to enhance their skills and hence improve recruitment and retentionProvides a test bed where new ways of working could be trialed on a small scale

First StepsWhere were our pressures?

Financial, Primary Care Access, Social Services

What were we doing well now? Could we do more?

Extended nurse roles, GPwSI, daycase surgery, inpatient care, rehabilitation, palliative care

What would we like to do?Provide more for patients locally, repatriate investment, fill in service “gaps”, push the boundaries!

What were others doing?Community Hospitals Association, leading edge PCTs, day case surgery review

What Could Be Done Differently?

Changing clinical leads

Changing clinical roles

Changing care management pathways

Changing scope of services

The Hurdles

Safety concerns from acute providers

Day case rates

Shifting money

Consultant sign up

Workforce

Capital availability

Moving AheadChanging Clinical Leads

ENP led minor injuries unit with GPwSIExtending nurse role on wards

Changing Clinical RolesENPs – carpal tunnel injectionsPhysiotherapy triageGPwSI – cardiology, dermatology

Changing Care Management PatternsRepatriation of rehab patients from across Erewash

Changing Scope of ServicesDiagnostic and Treatment Centre

Ilkeston Hospital DTC

Two day case theatres – up to 4,000 day cases & 1,000 more outpatients (added to 14,000)

Two scoping rooms – urology, hysteroscopy and endoscopy

Echo-cardiography service

16 day beds

Under Construction!

Optometrists with Special Interest

GPwSI – plastic surgery and dermatology day cases

PCT held waiting lists in orthopaedics and ophthalmology from April 1st

Day rehab with Social Services

Radiographer endoscopists

23 hour beds to extend day surgery

Further income generation for PCT

The LessonsUnderstand the local strategic context

Build evidence to support your plans – what are your strengths and what has been learned elsewhere

Support the clinical champions and give them the headroom they need

Ensure sign up from all stakeholders

Ensure clinical governance and risk aspects are covered

Understand and agree how funds will shift or what the call will be on growth