Grantham medical practices are praising the role of highly qualifed nurses who are helping them to deliver healthcare to patients at home.
The practice care co-ordinators are based at local practices and work closely with their neighbourhood teams with the aim of supporting people to be able to stay in their homes while receiving treatment.
This helps health trusts to reduce unplanned admissions to hospital and is helping people to be discharged from hospital with no unnecessary delays.
The practice care co-ordinators have regular contact with their patients, visiting them in their homes and are able to provide longer appointment times. They also undertake joint visits with other providers of health and care services, ensuring the patient only has to tell their story once.
Currently there are 16 practice care coordinators in the area covered by the South West Lincolnshire Clinical Commissioning Group. The aim is to create 19 of these roles so there will be one in every practice in the area.
The Grantham Neighbourhood Team brings together local health and social care professionals from different specialities who may have been looking after the same patient individually into a single patient-focused team. The aim is also to give patients more personalised care than ever before, helping them to live independently, live longer and enjoy better and more fulfilled lives.
Dr David Baker, GP at Vine Street Surgery in Grantham, said: “Previously, we were only able to treat those patients with complex needs for their medical conditions, however we were aware that they had other needs. In many cases patients were either living alone, had no support or they needed to be admitted into hospital, but were reluctant to go.
“By introducing the practice care co-ordinator role we have been able to get proactively involved, signposting patients to services and putting care packages together jointly, with input from the patient.”
Elizabeth Reader, practice care co-ordinator at St Peters Hill Surgery, added: “As practice care co-ordinator I work with the most vulnerable people in their own homes/care homes to monitor and liaise with multi disciplinary teams to keep them safe and well as able.
“My aim is to keep people in their own environment for as long as possible. I am the link nurse between primary and secondary care so patients have continuity of care. I am also their named nurse so they feel supported and reassured, I can be contacted at the surgery during normal working hours.”