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LIVING WELL – SELF MANAGEMENT PROGRAMME – A PATIENT’S FEEDBACK

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Dear GP,

I usually write to you to request a prescription. When I have an appointment, I usually talk to you about my ailments – about what is not good. Nowadays that relates to chronic illness.

Today I write to share positive: the privilege of participating in LIVING WELL – the self management programme that aims to help live with long term health conditions – group engagement with individuals who combine together a broad age group with a broad range of illness. I gained from it; I enjoyed it! I use the word enjoy because we shared the experience of illness in the context of our everyday living and although suffering was there, morbidity was nowhere!

Upon first encounter I was amazed to learn that regardless of age and condition, we all shared a similar experience which presents itself in what we have identified as the ‘symptom cycle’, such as the never ending loop of pain, difficult thoughts and emotions, poor sleep, physical limitations …. I gained tools to help manage and ‘break the cycle, to gain more better moments than moments that feel unmanageable. This was nice. Some of the tools are familiar, ones we put to use in our everyday – at work or at home, such as problem solving, decision making, communication (with doctors, for example), however, it became evident to me that we don’t always identify this so we don’t necessarily put our management tools to use in an effective way in the course of an illness in the everyday.

Hey, one doesn’t train to be a patient!

LIVING WELL encapsulates this and in an intense 6 session period, equips us with a toolbox that we can dig into at any given moment. Practice starts together; the work, we each have to continue to apply later. LIVING WELL is a lesson in responsibility and ownership of one’s condition. True, everything is good in ‘class’ and like learning to swim, you might get the moves when you’re in the pool having a lesson but next time you step into the water on your own, you might still feel you are going to drown. I do know it takes time to master tools but I also know that I have been equipped with a framework. I also now know that there is a strength from experiencing a group face to face.

LIVING WELL has enabled me to form a sense of community thanks to caring instructors who themselves experience long term health conditions and have participated in a course prior to becoming the guide. This is also thanks to an amazing group of people who, like me, may have had a sleepless night last night and not because we were out clubbing but because the challenges to go out to ‘a club’ can be immense. ‘Club’ here merely symbolises engaging with life in the everyday. I have learned new strategies that others use on how they may cope with a sleepless night, I hope they have learned something from me. So, we have gained and you do too. As we have learned about responsibility and ownership of how we engage with our long term health conditions,

LIVING WELL demonstrates how we can better engage with our doctors. You have come to know me overtime through my condition. You can understand the importance of this course for me. I strongly hope there will be future opportunities for existing groups to meet again in session for further learning.

But,without patients wanting to participate in the first place there will be no LIVING WELL. I am apprehensive that the course has now ended; someone else might be apprehensive about starting. Can you please continue to promote the LIVING WELL programme in your surgery to your patients, and amongst your colleagues so their patients can ‘LIVE WELL’ too? It has been a privilege,

Sincerely,

Grateful patient

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Posted by on October 20, 2015 in Training and Advice

 

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UPDATE ON EALING SELF MANAGEMENT PROGRAMME.

As a follow up of the blog posted recently which explains this scheme we can now give more details:-

https://wordpress.com/post/52087738/2868/

Long Term Conditions – Self Management Programme for Ealing!
This programme is available to Ealing residents living with a long-­term condition such as:
Diabetes
Arthritis
Heart Disease
Pain conditions
Neurological condition
Asthma
Epilepsy
Pulmonary Rehab
High blood pressure

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EXPERT PATIENT PROGRAMME (EPP) COMES TO EALING

The Expert Patients Programme (EPP) is a self-management programme for people living with a chronic (long-term) condition. The aim is to support people by:

  • increasing their confidence
  • improving their quality of life
  • helping them manage their condition more effectively

What is an expert patient?

Many GPs who care for people with chronic condtions say that the patient often understands the condition better than they do. This is not surprising – many patients become experts as they learn to cope with their chronic conditions.

There is evidence that, with proper support, people with a chronic condition can take the lead in managing their condition. This helps improve their health and quality of life, and reduces their incapacity.

An expert patient is someone who:

  • feels confident and in control of their life
  • aims to manage their condition and its treatment in partnership with healthcare professionals
  • communicates effectively with professionals and is willing to share responsibility for treatment
  • is realistic about how their condition affects them and their family
  • uses their skills and knowledge to lead a full life

This week we had an email informing us that this programme is due to start this month

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Our first Expert Patient Programme has now been booked:

Dates:      19th May to 23rd June ( 6 consecutive Tuesday evenings)

Time:        6pm – 8.30pm

Location:  Hanwell Community Centre, Small Meeting Room, Westcott Crescent, Hanwell,

London W7 1PD

Interested participants contact the course provider directly to register interest either calling or emailing as shown above

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GO THROUGH THE STAGES OF LOSS WITH THIS GIRAFFE

Candace also passed on this video as she found it helpful in describing the feelings she has gone through. It illustrates what anyone goes through when experiencing loss, albeit a serious illness, a bereavement or even the break up of a partnership. I am sure many people will identify with this giraffe and perhaps be able to raise a smile at the end!

 

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ARE WE IMPROVING WHOLE PATIENT CARE?

Visiting doctorAs a GP for many years if I visited an elderly person on a Friday or after 3.30pm in the afternoon and although their illnesses could be treated in the home if they were living alone I would often have to admit them into hospital.
Social services would often need 48hrs notice or more to implement social care in the way of carers or meals on wheels etc. We relied on the goodwill of neighbours or relatives dropping everything to travel long distances to the rescue.

Earlier in my career and sometimes latterly there have been occasions when I have made a meal, waited for relatives to come, the neighbours to return from work, rung the Cat Protection League to get the cat sorted out, hung out the washing, visited several times a day and night all simply to keep a person out of hospital. This is what many older GP’s did and in some areas of the country probably still do.

Alas, the situation has changed considerably, in that more older people are isolated with neighbours working longer hours and keeping to themselves and close relatives often scattered around the world as well as people living longer and with more complex medical needs.

Doctors have an increased work load and the consultations needing to encompass health prevention and screening and there an increased need for documentation by computer to record every aspect of the consultation. Also, with the introduction of more medications  and patients surviving severe medical illnesses longer GP’s are now responsible for their management. When the final year students are attached to the practise for 2 months each time they express their surprise of how many complex cases are managed in Primary Care.  Lloyd George fileGone are the days of a scribbling remark in a handwritten file in a packet – the Lloyd George file and the rest of the information being retained in the doctors head and if a patient’s condition became in anyway complex they were whisked away to experience a prolonged hospital admission.

It is a long time since I wrote the following abbreviations in patients notes!

  •       GOK ( God Only Knows)
  •        TEETH – Tried Everything Else; Try Homeopathy
  •        PIN (pain in the neck)
  •        SALT – Same As Last Time.
  •         FLD – Funny Looking Dad.
  •         ATSWWT – Always Thinks Something’s Wrong With Them.
  •         VIPIA – Very Important Pain In the A**.
  •         FFFF – Female, Fat, Forty and Flatulent.

These changes have resulted in more ‘social’ admissions which are often prolonged and can lead to a decrease in a persons independence when they are ready for discharge as the ward they are admitted to does not have the multidisciplinary team to avoid this.
Incredibly health and social care have worked totally independently. I remember when I was a junior doctor (SHO – Senior House Officer – the old nomenclature ) the consultant at the time commented that if I wrote letters for the patient they were rehoused very quickly and what was my trick. “Sir, (as we addressed our seniors in those days) could it be that she signs herself as the Senior House Officer, piped up the Registrar!”

At last this is being addressed and following the formation of the Ealing Clinical Commissioning Group (ECCG) in April 2011 plans implement patient-centred plans to provide the right care at the right time and at the right place for the residents of Ealing.

The ECCG launched these plans on 16.05.2012 in a document:-

Better Care, Closer to Home (2012 – 2015)

http://www.ealingccg.nhs.uk/media/633/NHS%20Ealing%20CCG%20-%20Out%20of%20Hospital%20Strategy.pdf

A three-year strategy for coordinated, high quality care out of hospital
Our objective is to provide the right care at the right time and at the right place for the residents of Ealing. This was carefully thought out by a comprehensive team of people from all social and health disciplines lead by Dr Mohini Palmer an experienced GP
In their document they quoted:-
“Our vision is to ensure that our health care system keeps patients well and at home and, when patients do become unwell, provides cost- effective, evidence based and timely care at the right place appropriate to their needs.
As demand rises with increasing health needs and the development of new treatments, we need to respond to the challenges while delivering the highest quality of care. We need to build and preserve what we do well and continue to look for new developments to deliver the best standards of care.

There are times when we use hospitals to provide care for patients when that care could be provided closer to their home and in the community. Developing the right care outside hospital is a key part of how we will continue to maintain the provision of quality and cost effective care for the residents of Ealing.

This is our three-year strategy to design and deliver out of hospital care.

To achieve this, our out-of-hospital initiatives will be:​

  • Inclusive: We want our services to be inclusive and for this to happen we will involve patient and public groups in our proposals. As we develop our initiatives it should be clear to all users how we are developing our plans.
  • Integrated: We will work with all our stakeholders who provide out of hospital care e.g. primary care, community services, social care, nursing homes, voluntary groups to provide joined up care.
  • Sustainable: Our approach will be sustainable and we will invest when we need to deliver the care.

Our strategy aims to improve quality and efficiency across the system, the experience of all patients, and make the best use of our resources.
We recognise this is a different and substantial shift from how we deliver health today. In the coming months we will be meeting with patient and public groups to explain our plans and to fully involve you as we develop our initiatives.
We need to continue to respond to the challenges we face and to evolve to deliver the best sustainable health care for the residents of Ealing.”
As demand rises with increasing health needs and the development of new treatments, we need to respond to the challenges while delivering the highest quality of care. We need to build and preserve what we do well and continue to look for new developments to deliver the best standards of care.

There are times when we use hospitals to provide care for patients when that care could be provided closer to their home and in the community. Developing the right care outside hospital is a key part of how we will continue to maintain the provision of quality and cost effective care for the residents of Ealing.

We need to change the way we deliver care. At present access to care and the quality of care are variable across the borough. Improving the access, quality and scope of out of hospital services will require new ways of coordinating services, investment and greater accountability. Exhibit 1 sets out reasons for transforming out of hospital care.”

Further details are found in NHS North West London’s Shaping a Healthier Future programme in the following document:-

 

http://www.healthiernorthwestlondon.nhs.uk/sites/default/files/documents/Factsheet_for_Ealing_residents_0.pdf
How have we delivered better care, closer to home?

The examples of the initiatives:-

*Urgent Care Centre: this is already providing 24 hour urgent care to patients at Ealing hospital
*111 and single point of access
*Improving access to GPs – at our surgery we have cooperated by
– providing extra slots for emergency appointments
– providing a later surgery ( Wednesday evening until 8pm)
– introduced by Ealing CCG. If you feel unwell on Saturdays and Sundays, you can call NHS 111 for medical help and advice. If the trained adviser thinks you need to see a GP, they will direct you to the practice in your area that is open. We are part of the rota of GP’s

*Integrated Rapid Response Service: started in July 2012 and provides a response to patients to provide care in their home and to support them on discharge from hospital.

*A new service started in October 2012 called ICE (or Integrated Care Ealing) which cares for patients at home if they are not sick enough to be admitted to hospital but are too unwell to stay at home without extra care. The service provides nurses, physiotherapists, and health care assistants, under the clinical leadership of Ealing Hospital Consultants. In 2013/4 there has been an increase in the number of staff and types of clinical conditions that the service manages.
Dr Livingston and I have used this service on many occasions and proved it to be extremely useful and helped in avoiding unnecessary hospital admissions.

*We also have a GP wards – Rosemary and Magnolia Wards at Ealing hospital totally geared to manage the acute condition eg urinary tract infection, which although treatable in the home can present with confusion, which settles after 24-48hrs and admitting a patient for 1-2 days and then discharging with a care package saves a prolonged admission. We also have the ICE team who are a multidisciplinary team with nurses, physiotherapists again linked to social services.

*We have Community Matrons allocated to each network  and they coordinate the multidisciplinary team to attend patients with complex medical problems.
* All  patients older than 75years of age now have an allocated named GP who oversees their holistic management.
* In our practise we have seen many of elderly and formulated care plans which not only look at their physical and mental health needs but their social  aswell. These patients are reviewed at monthly intervals to note any significant changes in their status. It is also a chance to look at future planning particularly ‘end of life care’ so that whilst a patient is reasonably well they can have a say in their advanced care planning. Many people have welcomed this whilst others want to discuss it with their families or simply want to take life as it comes but at least they have a choice.

* Children’s nursing service: Ealing CCG have developed a children’s nursing service to provide care for children closer to and in a more convenient location for them and their families.

* Palliative care service: ECCG are working with the Marie Curie service to provide a rapid response team to assist and support those people who wish to die at home. We are able to get urgent access to McMillan nurses until 8pm so that a visits can bee arranged.

* Psychiatric liaison: ECCG have funded a psychiatric liaison service at Ealing hospital to provide a rapid response to patients who need this care. Dr livingston and myself have been working very closely with the appointed Community Psychiatric liaison Psychiatrists to achieve greatly improved outcomes especially with our complicated psychiatric patients – improving their care aswell improving our own learning needs in this challenging aspect of medicine.
We as GP’s have much improved access to psychiatric services aswell as a range of psychological services using:-
The Ealing IAPT (improving access to psychological therapies) service offers support for common mental health problems such as depression, anxiety and panic. Referrals can made by:-
– making a request to a GP or another health professional
– self referral by calling us directly on 020 3313 5660

How we are working together

The ECCG have identified better coordination of services as a priority in order to improve care. For example:
Ealing GPs now work in six Health Networks ensuring care is clinically led and consistent across GP practices
Within our six geographical multi-disciplinary groups, the Integrated Care pilot to provides integrated care across health and social care
We now work closely with partners in community and social services to support patients to use health and social care services effectively
A service providing coordinated and joined up care to Ealing residents who are in nursing homes evolved last year so that a group of GP’s take responsibility for their care and are accountable to the CCG.

We as practise and part of a network ( a group of nearby practises which are part of the commissioning group which includes Ealing, Acton ,Southall and Northolt have been actively taking part in many initiatives to improve patient care. Healthcare and social care professionals are working together much more closely.

We are actively seeking out patients that have complex medical/social problems and discussing how we can improve their care. We can now contact social services much more easily and over longer hours to effect urgent social care.

We are improving our liaison with hospital consultants including mental health and this has brought about an ongoing and active improvement in management of care as well sharing and educating each other about the management of common medical problems eg heart failure, anticoagulation, chronic obstructive pulmonary disease in the community.

We have a community diabetic team who liaise with GP’s to provide improved care for our large number of diabetics aswell as providing management they provide patient education.

We have increased our communication with social services gathering around a table to discuss these types of patients and share the problems and understand each other’s way of dealing with health problems with social issues.
Now we can access social services at weekends and late in the afternoon and it works! It is sad that it has taken an economic crisis and a need to save money to promote these changes. There have been many years of struggling, stamping feet and despairing to get social support to avoid hospitalisation of a patient who often took up an acute medical or surgical bed for weeks.

How has change been supported

* employing and having advice from experts
* peer to peer reviews – GP’s getting together in their networks for planning and using the expertise in a network to formulate initiatives.
* change of IT systems to to improve working together and monitoring progress of performance
* liaising with the public to establish needs of the geographical area by public meetings
* improving health education by liaising with Ealing council
* the right contracts and incentives to improve care, to underpin the new ways of working have been put in place.

These are many of the challenging initiatives that have been commenced in the last three years. Aswell as the superb work of our CCG governing body there has been a lot of work from many hard working GP’s and practice managers who attend meetings after their surgery’s in an attempt to improve our services.

As I wrote this I felt quite uplifted by what has been achieved and feel that in Ealing every effort is being made to shape a healthier future.

If you want to find out more about Ealing CCG and how it is evolving and to see what is in store for the future log in to website:-
http://www.ealingccg.nhs.uk

 

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