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Devon Doctors & Somerset OOH

Registrar Welcome Pack

Version 6

Updated July 2018

GP Reg Induction Pack Jul 2018 V6 of 53

Part 1 – Introduction to Devon Doctors

1. Who are we?

We are a Social Enterprise, not-for-profit organisation running one of the country’s first

integrated clinical assessment services.

We are recognised and affiliated with the NHS.

We are owned by GP practices across Devon.

We have been providing out-of-hours care since 1996, when we started as a GP co-

operative.

Our Board of Directors is made up of GPs representing each area of Devon. We have

been high-lighted as an example of “good practice” by the National Audit Office, and placed

in the top 10% of out-of-hours providers nationally.

We took over as a step-in provider for Somerset Out of Hours in April 2018

We take calls for patients in Devon and Somerset.

There is an ‘intranet’ service available to staff, accessible from Treatment Centres called

SharePoint

Part 2 – Useful Contacts

Chief Executive Dr Justin Geddes [email protected]

Medical Director (Devon Doctors) Dr Mark Eggleton [email protected]

Financial Accountant Stuart Williams [email protected]

Acting Director of Operations Ryan Hewitt [email protected]

Heads of Operations Martin Cordy Andy Ridpath

[email protected] [email protected]

Regional Locality Manager Jill Sanders [email protected]

Clinical Assessment Service (CAS) Managers

Jane Wilks (Devon) Chris Newman (Somerset)

[email protected] [email protected]

See ‘intranet – HQ Contacts’ for further contacts, including e-mail addresses and telephone

numbers.

Operational Team Managers

Jayne Collard [email protected]

Tiverton, Honiton, CAS & Exeter

Sarah Nosworthy [email protected]

Derriford, Torquay, Newton Abbot & Totnes

Antony Barnes [email protected]

Barnstaple & Okehampton

Shelley Fenton [email protected]

Taunton, Bridgwater & Minehead

Adam Warden [email protected]

Shepton Mallet & Yeovil

mailto:[email protected]



CAS Team Manager / Shift Manager – 01392 823174 (OOH only)

Admin: 01392 823636

Rota Team: 01392 823159 (0900 – 1700hrs Mon-Fri) - [email protected]

Governance Dept: 01392 822340 (0900 – 1700 Mon-Fri) - [email protected]

I.T Dept: 01392 822341 (in hours only) - [email protected]

OOH problem contact CAS Team Manager

EPCC’s (Palliative Care Team) 01392 823157 (0800-1800hrs every day)

Devon Primary Link Team: 01392 822344 (0700-2300hrs every day)

Part 3 – How does Devon Doctors work?

1.

Patient/caller rings 111

2.

Call is prioritised by NHS Pathway

If Pathway outcome identifies Clinician input required, call is transferred to Devon Doctors via link

3.

Call despatched

To Treatment Centre for Clinician to triage.

4.

GP/Nurse/Paramedic/Pharmacist

Ring patient/caller to give advice over phone, invite patient to attend local Treatment Centre, or visit (by GP, District Nurse or Home Visiting Paramedic).


See below for Treatment Centre times, Clinician manning levels e.g. whether there is a mobile GP

at the base and if there is overnight cover. Please check this carefully if triaging for another area.

This information is found on Sharepoint >Treatment Centre>TC times and GP cover


Useful maps via Adastra. Click on ‘Map of Devon & Somerset’

From here you will be able to access Sharepoint (intranet)

The below map will appear, signposting all the places we have Treatment Centres across Devon &

Somerset including GP cover available at each base


Select a particular base and more information will appear

Part 4 – Telephone Consultation – time frames Initial triage – See table over, local target column for when patient can expect their telephone call to be returned. The time on the clock starts ticking as soon as the call is put into Adastra. Visits Urgent visits: Patient should be visited within 2 hours (local target) Routine visits: Patient should be visited within 6 hours (local target) Telephone consultation – points to remember

Advice – can I deal with this particular call with advice for the patient over the telephone?

Prescribing – can I prescribe for the patient over the phone and fax prescription to the nearest pharmacy? Is there someone able to pick the prescription up? (CHECK which pharmacy is open – your Operational Assistant/ Driver will know where to find this information for you).

Treatment Centre – I want to invite patient to attend Treatment Centre. Think! whichTreatment Centre is it best for patient to attend? Points to think about to help you decide – time of day you are speaking to patient, urgency of health problem presented.


See Intranet for opening times of Treatment Centres. Is there is only 1GP in Treatment Centre? (See Intranet on how to deal with the call). Be clear where patient is to attend, or if they are to expect a call back.

Visit – ‘home visit guidance’ on Intranet. Advise patient when likely to be visited (see Intranet if triaging for another area).

999 – if you feel an ambulance is required, please dial an ambulance yourself.

District Nurse required? These are contacted via the Control Centre, who will be able to advise if there is District Nurse cover in the area that you are triaging in.

CMHP - cover at weekends/Bank Holidays in the Control Centre between 10:00 – 22:00 (Devon Only)

Crisis Resolution Teams - Refer to Intranet

Specialist Palliative Care Nurse Advice - Refer to Intranet

Intermediate & Domiciliary Care Teams - Refer to Intranet

Triage – points to assist

Un-triaged calls have a risk! What appears to be benign can be urgent or even life

threatening.

If you call but get no answer – We have a very robust call back protocol which asks you

to attempt contact three times. If still unsuccessful then next steps are covered in the

protocol.

TC/MIU and ward patients will already have been clinically triaged (by phone or nurse)

therefore wherever possible calls awaiting telephone triage should take priority. When a

ward visit is requested clinicians are encouraged to open the call and type in consultation

‘noted’

If the call has been inappropriately prioritised, re-prioritise using Adastra.

Commencement of Clinical Telephone Consultation: We have identified that consultation

times are not always being recorded accurately. Clinicians tend to fall into two camps; some

preferring to complete the clinical notes during the telephone consultation and others

preferring to do so afterwards.


This information is essential from the point of view of governance, reporting our

performance against the National Quality Requirements, and feeding back to you in your

quarterly profile. Therefore we ask all clinicians to show diligence in recording the

consultation start and end times on the Adastra system, either by entering some text in the

clinical notes field at the start of the consultation or by changing the start and end times to

reflect the correct times upon completion of the consultation as per the on-screen prompt

within Adastra.

If you wish to highlight something to the Senior Management Team, ring the control team

Centre Manager on 01392 823174 and ask for it to be put in the Highlight Report. This is

looked at daily by all senior Managers.

Best Practice for Clinicians

ID Badge – Please always wear your ID Badge. Recorded Line – remember to always use a recorded line when triaging calls.

Introduce yourself on phone, elicit reason for call.

Identify patients’ concerns, identify if emergency, or serious situation. A solid history and

examination, appropriate investigations and good clinical records go a long way in avoiding complaints and dealing with them if they occur.

Identify relevant PMH/DH (including drug allergy). Record in notes on Adastra.

Involve patient in decision making. Demonstrate good listening skills – develop rapport with caller. Is patient happy with the consultation?

Safety netting – keep patient fully informed and make sure they are aware of exactly what to expect next. Give clear and specific advice about when to ring back.

Note keeping – record accurate notes. Adastra records are passed to patient’s own surgery by 8am next working day. Please be aware that patients may request access to their notes at any time.


Special Patient Messages – please see next two pages for how to input Special Patient Messages. These notes are then available when patient uses Devon Doctors for all clinicians to see.

Clinical Responsibility – to keep yourselves up to date with NICE guidelines, UK Resus Council and BMA – available on the Intranet

Confidentiality

Be aware of those around you when talking to patients or their relatives/ representatives.

Never leave confidential information lying around

Shred all patient identifiable / confidential documents.

Lock the computer when leaving the room (use ‘control, alt + L’ to lock the screen when you are in the Adastra screen). To log back in enter your username and password and press enter. Log off the computer when out visiting and when you finish your shift.

Courtesy

A patient’s impression of the treatment they are receiving may depend upon your attitude. You will probably meet many different people whilst at work, so please treat patients and other members of staff with kindness, courtesy and professionalism.

Internet and e-mail

Employees have a responsibility to ensure that they use the Internet, Intranet and e-mail in a professional, ethical and lawful way at all times.

You and Your Safety For EACH Treatment Centre you work in, ensure you are aware of:-

1. First Aid, firefighting equipment, alarm points and emergency exits. Location of

assembly points.

2. Local procedure for alerting emergency resuscitation teams (Crash Teams) and location of resuscitation trolleys (if available).

3. Location or means of contacting porters/ security staff.

4. Location of panic buttons.

5. Location of all DDOC drug storage including Controlled Drugs and Registers.

6. Resus/Cardiac Teams assistance.

7. Location of Resuscitation Trolley/Equipment.

You and Your Work For EACH Treatment Centre you work in, ensure you are aware of:-


1. Procedures in the event of an accident or breakdown – Major Contingency Plan

(see Intranet).

2. Manual Procedure – see Intranet.

3. List of Mobile/TC Equipment.

For your support The Medical Director is here to support and assist you should you have any clinical issues. His e-mail address is on the first page of this booklet.

Other Training we provide:-

Telephone Triage training workshops

Supervisory training with the Deanery

Intermediate Life Support

Paediatric Resus Training

Safeguarding Children and Vulnerable Adults

Useful Guidance of what is available on the Intranet (SharePoint):-

Language Line and Interpretation Services

Relay Text

Visiting guidelines

Medicines Management and Clinical Guidance

Prison Guidance

Infection Control

Information Governance

Safeguarding Children and Vulnerable Adults

Copy of Formulary

Top 10 Prescribing Tips

Managing your Shifts You will be provided with log in details and a password for the Rotamaster website. Rotamaster

means that you have better access to rotas than ever before as you can bid from work, your own

home or even when you are out of the Country on holiday!

Unforeseen absence or sickness


In the event of unforeseen sickness, always ensure you speak to a Member of the Rota Team – tel 01392 823159, or Duty Shift Manager, tel 01392 823174. Do not call the patient line.

NEVER leave a message on an answerphone, as there is a danger that the call will be missed and therefore, your shift will not be covered.

Handback – cover cannot be guaranteed if less than 28 days’ notice given. If less than 28 days’ notice given, the shift will remain your responsibility unless cover found.

Further details on the Rotamaster website are on the Intranet, including verifying shifts. Kim Palmer is the Rota Design Manager, her contact details are on the Intranet should you need further clarification. If you are interested in covering other areas e.g. if you can only bid for Barnstaple, but would be happy to work in Exeter, please contact Kim and she can open up Rotamaster to enable you to bid and then work in other areas.


Guidelines to help when managing the Adastra screen to keep within the National

Quality Requirements

CONSULTATION TYPE

PRIORITY

URGENT ROUTINE

NQR 9 (Telephone assessment)

ADVICE

20 MINUTES

60 MINUTES

HEALTH PROFESSIONAL

30 MINUTES

MIU/WARD/WIC

30 MINUTES

AMBULANCE / EMERGENCY

3 MINUTES (from receipt of call)

REPEAT PRESCRIPTIONS

UP TO 12 HOURS

NQR 10

WARD VISIT

2 HOURS

6 HOURS

WALK IN – with prior appointment No drop in service Available – to go via NHS 111

20 MINUTES

60 MINUTES

NQR 12 (face to face consultation)

VISIT

2 HOURS

6 HOURS

TREATMENT CENTRE

2 HOURS

6 HOURS

WITHIN TARGET

5 MINUTES OR LESS BEFORE TARGET

2 MINUTES OR LESS BEFORE TARGET

OVER TARGET

Targets start from when the initial call is answered.

Targets finish when the clinician results the call.

Advice calls will go black if a clinician makes no notes in the call.


Department of Health Quality Standards

Our out-of-hours GP services must meet the Department of Health’s quality standards. In Devon we have agreed our own, higher standards with the Devon Primary Care Organisation.

Key operational standards we must meet:

Control Centre

Department of Health

No more than 0.1% calls engaged

No more than 5% calls abandoned

All calls answered within 60 seconds

All life threatening calls passed to the ambulance service within 3 minutes

At the end of the assessment, the patient must be clear of the outcome, including (where appropriate) the timescale within which further action will be taken

Our own standard

All calls for patients receiving palliative care given an ‘urgent’ priority

Telephone assessment


All urgent calls must receive definitive clinical assessment (triage) within 20 minutes

All other calls must receive definitive clinical assessment (triage) within 60 minutes

Our own standard

All palliative care calls triaged within 20 minutes

Face-to-face assessment


All urgent walk-in patients must receive definitive clinical assessment (triage) within 20 minutes

All routine walk-in patients must receive definitive clinical assessment (triage) within 60 minutes

At the end of the assessment, the patient must be clear of the outcome, including (where appropriate) the timescale within which further action will be taken

All emergencies seen within one hour of the definitive clinical assessment

All urgent cases seen within two hours of the definitive clinical assessment

All other cases seen within six hours of the definitive clinical assessment

Our own standards

All urgent cases seen within one hour (including palliative care cases) of the definitive clinical assessment

All other cases seen within two hours of the definitive clinical assessment

Other

Patients unable to communicate effectively in English will be provided with an interpretation service within 15 minutes of initial contact. The service must also make appropriate provision for patients with impaired hearing or impaired sight

For more information visit the Department of Health’s commentary on the national out-of-hours quality requirements.

Key Meet compliance 95% & above Partial 90 – 94% Not compliant 89 – 90%

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4091212

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4091212


Call priority Patient’s Symptoms

CC Called Emergency Ambulance

Immediate threats to patient’s life (this list is not exhaustive)

Sudden collapse

Severe breathlessness

Unconscious

Severe or sudden onset of chest pain – especially when pt has

history of heart problems, (sweaty, tingling in arms, especially

the left. (see guideline ‘Chest Pain – What to look out for’)

Severe abdominal pain

Very heavy on-going bleeding or haemorrhage

Very unwell with spreading blotchy purplish rash

Diabetics who have been confused / drowsy / unconscious

Sudden severe back pain with collapse

Fitting if the pt has never had a fit before

On-going seizures/fits

Stroke (CVA) symptoms

Head Injury with loss of consciousness (LOC) and/or vomiting

and/or drowsy

Vomiting ‘coffee granules / black liquid’ – child or adult

Unrousable/won’t wake up

Floppiness in a small child

Throat/tongue swelling – allergic reaction

Lips going blue

Overdose / accidental poisoning – if unsure if substance is

toxic seek Team/Shift Manager advice

Urgent pt called within 20 minutes

Not necessarily life threatening but still a high priority

Pregnant women experiencing palpitations, abdominal pain etc

Very high anxiety level even without apparent reason

Terminal patients in pain / distress

Scalds and burns

Insulin diabetic run out of insulin

3 Fits/seizures in last 24 hours

Palpitations and known heart condition

Routine called

within 1 hour

All other calls

Repeat Px (pt called within 12 hrs)

Repeat prescriptions


Health Professional (20 mins)

Calls from district nurse/ambulance crew/midwife/ CPN in the

community

MIU/Ward/WIC/A & E/ Surgery (Called within 30 mins)

Caller is a health professional at their place of work

Dental Call

Call is dealt with by Devon Primary Link Team

Information Call


Non Conveyed Call


District Nurse

Calls from patient’s requesting DN

Torbay Dressing Clinic

Call is dealt with by Devon Primary Link

Community Mental Health Practitioner

At weekends a CMHP operates from CC (please refer to rota /

Team Manager)


Level of supervision – RED

Includes trainees attending their first or second shift. Most ST3s with previous recent

experience may enter at Amber. Trainees undertaking a remedial training extension would

start here. In practice, many supervisors supervising an unknown trainee will perform a

brief session of observation at the beginning of a shift, before the trainee progresses to

consult independently for the majority of the shift (amber or green)

Supervision- DIRECT (joint surgery format)

1. Trainee observes Supervisor

2. Trainee progressively takes clinical responsibility for a caseload initially under direct

observation (to include face-to-face consults and telephone triage)

3. Trainee consults separately reporting to Supervisor to agree a management plan prior to

completing consult

Leaning Goals: Clinical

1. Gain a basic understanding of the management of common medical / surgical / psychiatric

conditions OOHs (see RCGP statement 3.03 Care of Acutely Ill People)

2. Understand the basic organisational aspects of NHS OOH care (From Induction)

3. Reflect on patient referrals and contacts with other health professionals and discuss with

Supervisor/Trainer on case by case basis.

4. Strengthening communication skills with emphasis on effective telephone triage

5. Understand call priorities, to include local and national targets 20 minutes and 1 hour call

back.

6. Awareness of personal time and stress management

7. Common sense approach to personal security and awareness of security risks to others

OOHs

Learning Goals: Logistical

Login to OOH computer system using personal login

Understand how to open, input clinical data, forward and result calls.

Prescribe safely and appropriately using the OOH computer system

Understands importance of using recorded telephone line

Know where to seek advice re: systems( lost passwords / if forwarded case wrongly etc)


Level of supervision- AMBER

Includes the majority of ST1/2 shifts and initial two ST3 shifts. Trainees undergoing a

remedial extension to training might require this level of supervision for longer than other

ST3s.

Supervision –CLOSE

1. Trainee consults separately, with supervisor immediately available for discussion of

cases and progression to joint consultation where appropriate ( includes visits)

2. Trainee is observed for some consultations/ telephone triage calls for learning

3. Trainee may consult independently with access to advice on organisational aspects of

OOH care which may be provided by non-supervisors

Leaning Goals: Clinical

1. Gain an increasing understanding of, and competency in the management of common

medical, surgical and psychiatric emergencies OOHs and develop skills in how to manage

some of these in the OOH setting

2. Explain the common organisational aspects of OOH care, to include:

a. Location / set up and staffing of bases and how to find out if unsure

b. MDT available in OOH e.g. MIU / Psychiatric support / District Nurses / Rapid

Response and Pharmacies and how to access them

c. How communication is made to GP surgeries the following day

3. Demonstrate enhanced consulting skills in telephone triage, to include:

a. Establishing rapport, eliciting patient’s ‘ICE’, use of appropriate language.

b. Appropriately managing communication with third party

c. Exercise communication skills for assessing the ‘urgency’ of a presentation

d. Recognition and management of clinical red flag symptoms and signs

e. Performing ‘safety netting’, an awareness of telephone triage ‘risk’ and its

management

f. What to do when a call is going ‘wrong’

g. Managing failed calls- patient engaged or not answering

h. Forwarding calls for visits / TC / DN input

4. Recognise factors involved in the safe and appropriate referral of patients in the OOH

setting drawing on discussion with supervisor

5. Demonstrate appropriate delegation to allied professionals for dressings / social care.

6. Operate safe prescribing: to include controlled drugs and drugs of abuse

7. Recognise the importance of time and stress management working OOHs, during shifts and

when planning shifts. Awareness of EWTD.


Largely competent in use of OOH computer systems with occasional questions as to

logistics etc

Knowledge of base ‘geography’ to include location of emergency equipment and stock

medications

Demonstrate issuing of stock medications


Level of supervision – GREEN

Includes the majority of ST3 shifts and all ST4 shifts. An exceptional ST2 may also perform

some shifts at this level.

Supervision: ‘LIGHT’

1. Trainee manages caseload independently

2. Supervisor available for discussion of problem cases (rarely joint consultations)

3. Trainee observed in joint consultations/telephone triage for learning when time available

4. Trainee generally able to operate all the organisational aspects of care

5. Trainee may perform visits ‘solo’, with supervision from base. The decision to go ‘solo’ is the

supervisor’s decision and must be based evidence of competence.

Learning Goals: Clinical

1. Competent in managing common medical, surgical, paediatric, obstetric and psychiatric

emergencies in OOH, including:

a. Developing competence in the management of patients with Palliative care needs

(RCGP curriculum statement 3.09 – End of Life Care)

b. Verification of expected and unexpected deaths

2. Good understanding of Organisational aspects of OOH care; demonstration of the use of

available resources effectively and efficiently

3. Performs and records reflective accounts on the safe and appropriate referral of patients to

hospital and other allied professions

4. Competent in telephone triage and developing further telephone triage skills to include:

a. The negotiation of TC attendance where appropriate

b. Managing patient expectations and reaching a shared agreement

c. Handling frequent callers appropriately

d. Understanding how geography and workload influence triage outcomes (999 /

Urgent Visit / TC)

e. Triaging out of area – establishing who and what’s available

f. Management of telephoned pathology results

g. Managing logistical issues such as when a patient cannot be contacted

5. Consult competently under pressure with awareness of own limits of competence and

seeks help accordingly

6. Develop awareness of situations where security may be threatened for self and others and

takes appropriate actions to minimise risk:

Managing the angry patient whilst being mindful of patient safety issues

Knowledge of ( and exercising of when appropriate), systems covering the abusive

patient

Appropriate collaboration with the ‘team’ (driver, shift manager, other healthcare

staff) for advice and support



Good understanding of logistics of OOH organisation, which might include: characteristics

of different bases, the geographical spread of bases, allied agencies and teams, role of

Pharmacies and how to access this information.

Competent and confident in using OOH computer system to include prescribing, locking

patient files, accessing patient special notes etc.

Assessment: Gaining competency in WPBA through OOH experiences

This final judgement concerns Work Place Based Assessment (WPBA) and draws on the

evidence gathered during the trainees OOH and in-hours experiences, it is NOT just about

ensuring the required number of OOH sessions have been logged on the e-portfolio. The

Trainer in making this judgement will draw on reports from the OOH Supervisor (recorded

on the trainee OOH Record Sheet and focussed on the relevant learning goals), knowledge

of the trainee’s previous experience, their exam performance and their own experiences

working with the trainee in-hours. For a trainee to be judged competent in their WPBA,

there should be evidence that they have reached the above learning goals many of which

may have been demonstrated in-hours. Evidence may be obtained from a number of

sources:

OOH Record Sheet

COTs – in-hours and OOHs

CbDs – in-hours and OOHs

E-portfolio

Informal discussion

Tutorials

Joint surgeries

Examination results

If a Trainer doesn’t think that sufficient evidence is available to make a judgement

concerning WPBA and that additional OOH sessions are required to generate this

evidence, then the Trainee may be required to complete additional sessions. In these

circumstances the WPBA requirements would need to be clearly stated and the number of

additional sessions appropriate. In all such circumstances the local Associate GP Dean

would be consulted.

Many thanks to:

Dr Adrian Pett for his input and the ‘OOH Learning Checklist’

Dr Robin Hollands and the Cheltenham Trainers Group for their ‘Detailed Competency

Guide to Supervision Progression’ (Severn Deanery Website)

COGPED Out of Hours (OOH) Training for GP Specialty Registrars, Revised Position

Paper 2010

The RCGP Curriculum Statement 3.03 ‘Care of the Acutely Ill Patient’.


ADASTRA CLINICIAN GUIDE

Internal Contact Numbers: ** ADD SOMERSET **

Co-Ordinators Area Covered Ext & Number

CAS Team Manager

North Co-Ordinator

Barnstaple 01392 823174

Internal Ext. 1101

East Co-Ordinator Tiverton, Exeter, Honiton, Okehampton 01392 823172

Internal Ext.1102

West Co-Ordinator Plymouth 01392 823171

Internal Ext. 1103

South Co-Ordinator Newton Abbot, Torquay, Totnes 01392 823178

Internal Ext. 1104

Definitions:

CAS - Clinical Assesment Service – Out of Hours ‘Hub’

IUCS - Intergrated Urgent Care Service – combined Out-of-Hours and NHS111 Service

TC – Treatment Centre

CMHP – Community Mental Health Practitioner

GIS – Gap in Service – Additional shifts to cover services not in core IUCS contract

IVR – Interactive Voice Response – calls to this are via 111

SPA – Single Point of Access – these numbers have been circulated to appropriate providers

SPA / IVR (Via the CAS) Number

Community Hospital SPA 01392 269495

Ambulance Support SPA 01392 823633

Emergency Department SPA 01392 269488

Healthcare Professional IVR 0845 504 8997

Return Calls (Call-backs) IVR 01392 269473

Dental IVR 0333 006 3300

MIU SPA 01392 269482

WIC SPA 01392 269476


Appointments & Visits:

If you wish to book an appointment / organise a visit you need to forward the case to the

CAS (shown below in Referring for Onward Care). Please explain to the patient or

representative that a receptionist will call them back with an available appointment time

and location.

The CAS will manage the bookings directly. Please advise patients to expect a call back from the

co-ordinator within 20 minutes. However safety netting patients on the 111 call back procedure

would be recommended.

There will be three 15 minute appointment slots per hour available at the following bases mid-

week 18:30 – 22:00 depending on appointment location.

Exeter [Royal Devon and Exeter Hospital]

Newton Abbot [Newton Abbot Community Hospital]

Derriford [Derriford Hospital, Plymouth]

Barnstaple [North Devon District Hospital]

Honiton [Honiton Community Hospital] [GIS Only]

Torquay [Torbay Hospital] [18:30-21:30 GIS Only]

The following bases will have appointment slots at the weekend 08:30 – 22:15 depending on

appointment location:

Exeter [Royal Devon and Exeter Hospital] [07:00 start]

Newton Abbot [Newton Abbot Community Hospital]

Derriford [Derriford Hospital, Plymouth] [07:00 start]

Barnstaple [North Devon District Hospital] [07:00 start]

Honiton [Honiton Community Hospital]

Totnes [Totnes Community Hospital]

Torquay [Torbay Hospital] [07:00 start]

(Please be aware that the fourth available appointment slot will be for emergencies only & where

single clinician working from TC no specific appointment slots, [Tiverton & Okehampton] but will

be by local agreement as per current practice).

Who can book these appointment slots?

Vocare (111)

Area Co-Ordinators

Apart from those appointments allocated to 111 / Vocare all appointments will be booked via the

Area Co-Ordinators. The Co-ordinators can be reached in the CAS on their own extension

numbers highlighted at the start of this guide.

Clinicians are not able to book patients directly into appointment slots, ALL patients should be

referred for onward care and an area coordinator will call back and arrange an appointment ASAP.


CAS Clinician – This is what you will see

When logging into Adastra you will now be presented with IUCS Clinical Monitoring screens.

These will be a complete overview of all clinical cases across the whole Devon IUCS service.

Awaiting Advice - My Location: Overview of all cases waiting for you to triage.

Awaiting Advice – Devonwide: Overview of all cases which are awaiting a consultation.

Clinical Overview: Overview of the whole IUCS Devon service. This is the screen that the CAS

Clinicians will be monitoring throughout the shift. It is similar to the ‘Tracking Screen’. If Cases

require a TC Appointment or Visit, these will have to be passed to the CAS Co-Ordinators through

the ‘Referring for Onward Care’ button.

TC Booked: Overview of all cases which have been booked into the TC’s.

Visit Pending: Overview of all cases which are awaiting a visit. These calls will be held at the CAS

by the coordinators.

CHMP: Overview of all outstanding cases for the CMHP. [Available weekends 10:00 – 22:00]

Repeat Prescriptions: Overview of all cases awaiting a repeat prescription.

TC Clinician – This is what you will see

When logging into Adastra you will now be presented with an additional appointment screen ‘On-

line Clinician - Booked Appointments for My Location’.

This will display a list, similar to the one below, of patients which have been booked into available

appointment slots. These are split up into, routine TC appointments, urgent TC appointments and

GIS appointments.


You will have be able to view date and time of the appointment in the Appointment Date column

and you will also be able to see the patient arrival time in the Arrival Time column.

The TC Clinicians will then be expected to see the patients in the order they are booked by the

appointment date and time. The appointments are not broken down and allocated to each

clinician, so the team of clinicians at the bases will be expected to work through the appointments

in order they are booked in.

Use of Read Coding:

We are now asking GPs to record clinical coding in the same way as you would in hours. This is to

assist us in monitoring and evaluating the service. This will be a mandatory process that will need

to be coded before cases are completed or sent for onward care.

On the right-hand side of the Online Clinician screen is the ‘Clinical Coding’ section.

There are several ways to search for a code to add to the case:

(a) Type a word into the search box at the bottom of the section and click on the Search button


For example – If the word ‘head’ was entered into the search field, the following results would be displayed:

There are three tabs available within this screen:

• Search

• Filtered

• Full List

Search: A search may be performed on a word entered into the search field. Type a word that is relevant to the desired code and click on the search button. The available codes will be displayed in a list:


Filtered: This tab will offer a list of codes filtered by the results entered into the clinical templates. For example, results may be filtered to display only the ‘head and neck’ category

Full list: This tab will display a complete list of all the available codes grouped into categories.


The clinical codes are structured in an expandable list. To view the sub-categories of the main list items, click on the + symbol to the left of the relevant option. Use within the History, Examination, Diagnosis and Treatment boxes: Highlight and right-click on a word or sequence of text in one of the consultation fields

Select ‘Lookup Clinical Code’ from the options. The relevant codes will be displayed:

Adding a clinical code: Click on a code in the list to view a brief description in the box below to help determine when to use it.


Either double-click on the code or highlight it and click on the Add Code button. [Please note - If you are triaging a case, where an onward referral of care is needed, i.e. Treatment Centre or a Visit and are not comfortable with coding at the completion of the triage as you are not able to make a final diagnosis on the case, the Read-Code option “Other” can be selected]


Clinical Templates

Within the Online Clinician screen, there are several clinical templates which can be used for

recording specific clinical information. When the questions are answered within these templates,

consultation notes are automatically populated with the recorded information. Calculations are also

completed automatically i.e BMI.


Referring for Onward Care:

The ‘forward’ button used previously has now been replaced with ‘Refer for Onward Care’.

This will then open the following options:


- Return to CAS for Advice: This will be returned for the Area Co-Ordinators for onward

advice.

- Return to CAS for TC: This will be returned for the Area Co-Ordinators to contact patients

and book appointment slots.

- Return to CAS for Visit: This will be returned for the Area Co-Ordinators to allocate to the

correct visiting team

- Return to CAS for District Nurse: Referring to the District Nurses for onward care.

- Return to CAS for CMHP: This will be returned to the CAS for the Area Co-Ordinators to

allocate to an external agency providing Community Mental Health Practitioner (CMHP)

cover.

- Return to CAS for Dental OOH: This will be returned to the CAS Dental OOH team for

referral to Access Health Dentists.

- 999 Ambulance: This will need to be used when you have called 999 for an emergency

ambulance.

- District General Hospital: This will need to be used when you are referring direct to a

speciality within a DGH i.e Surgery, Medicine (AMU), ENT etc.

- Non-District General Hospital: This will need to be used when you are referring direct to a

speciality within a Non-DGH i.e Ward.


- Minor Injury Unit: This will need to be used when you are referring to a an MIU.

- Hospice Team: Provides available team and contact numbers dependent on area.

- Crisis Response Team: Provides available team and contact numbers dependent on area.

Referrals for onward care will be displayed in a referral box similar to the one below.

Differences will include: distances to the location, phone numbers and other available

services.


Treatment Centre Patients

(Cases can only be closed by a clinician)

What should you do if they did not attend?

Try to make contact with the patient The clinician will contact the patient using the telephone number that is shown in the “Contact”

field of the Adastra case. If the clinician is not successful with that number, then they are to try the

remaining numbers (if any) that is on the Adastra case. If the clinician is unable to make contact

with the patient using any of the numbers on the Adastra case then the clinician needs to record

on Adastra that they have attempted to make contact with the patient (see “Recording a failed

contact on Adastra”).

A failed contact can be caused by a number of factors including:

Wrong contact number recorded by call taker.

The patient’s telephone line is busy.

No answer from the patient (constantly ringing / goes to answerphone).

If it is a mobile phone it could be out of signal or there could be battery issues.

Patient not able to get to the phone before the clinician has rung off.

With the Adastra case open, click on the telephone button.


This will open the “Patient contact attempts” box. If there have been any previous failed contacts,

then these will be displayed in this box. To add a failed contact to this case, click on the “Add…”

button.

This will open another box, which requires specific details to be completed.

Click on the number you have tried to contact.

You will now be presented with a message, to proceed click on the “OK” button.


If you wish to add any additional comments then you can enter them into the comments box and

then click on one of the actions on the right hand side.


You will now be taken back to the “Patient contact attempts” page and all failed contacts will be

displayed.

Please note, if you click on the record it will show what comments (if any) have been entered. To

complete this process click on the “OK” button.

You will then be returned to the main case details page and the telephone icon colour will change

from grey to orange to indicate that the case has now got a failed contact against it.

To exit the record click on the X in the top right hand corner.


You will now return to the “On-line Clinician” page. You see in the last failed contact time column,

will be the last time someone has tried to contact the patient.


Closing the case in Adastra

When resulting a case for a patient that did not attend the TC, you will be presented with the following

screen.

Please select the most relevent option before closing the case.

Deferring a patient until the following day:

If a patient is booked into an appointment slot for the following day the current case be

amended and a new case will not be created. This is managed by the area co-ordinators.

If a patient needs a further same day follow up – these calls can be deferred by the Area

Co-Ordinators only and kept on base screens.

Other:

Prescriptions:


Clinicians working in the CAS should only produce scripts that can be faxed for collection from a

pharmacy as patients are unable to attend the Clinical Assessment Centre to collect a

prescription.

Prescriptions that need to be collected should be triaged by the local clinician at the TC where the

patient will attend.

Safety Netting:

When clinicians advice the patient or representative that a receptionist will call back with a suitable

appointment time. Please remember to reiterate if they haven’t heard, or symptoms worsen to use

the 111 call back option [option 3] when dialling 111.


Somerset CAS Guide

Background

Somerset Out of Hours was provided by Vocare Ltd until 30th April

2018

Vocare and Somerset CCG mutually agreed to terminate contract

Devon Doctors has been employed as a step in provider until at

least April 2019

Dispatch operations will be run from Osprey House, Exeter


Treatment Centres

Addresses

• Taunton – Musgrove Park Hospital, Parkfield Drive, Taunton, TA1 5DA

• Bridgwater – Bridgwater Community Hospital, Bower Lane, Bridgwater, TA6 4GU

• Yeovil – Yeovil District Hospital, Higher Kingston, Yeovil, BA21 4AT

• Shepton Mallet – Shepton Mallet Community Hospital, Old Wells Road, Shepton Mallet, BA4 4LP

• Minehead – Minehead Community Hospital, Mart Road, Luttrell Way, Minehead, TA24 6DF

Opening Times

Weekdays Weekends Overnight Bank Hols

Taunton 7pm – 11pm 24hrs 11pm – 8am 24hrs

Bridgwater 7pm – 11pm 24hrs 11pm – 8am 24hrs

Yeovil 7pm – 2am 7pm – 2am Until 2am 7pm – 2am


Shepton 7pm – 11pm 24hr 11pm – 8am 24hr

Minehead Closed 8am – 4pm Closed 8am – 4pm

Home Visiting Paramedics

Background:

Role being developed and refined

Paramedics visit on behalf of Devon Doctors

Assess patients

Verify death

ECPs can work from PGDs, not currently paramedics

Once seen patient they discuss the case with a GP and decide on next action (Decided by GP in d/w

Paramedic), eg:

o See and treat

o Needing script (GP to generate)

o Needs admission

o Needs GP visit

o etc

Exclusion criteria:

No palliative care, unless discussed (ie verbal order for JIC Meds)

No pregnant women

No mental health

No obvious intoxicated or violent patient (lone working)

No under 2s (due to insurance)

No unexpected deaths (but can verify expected deaths)


Visits Procedure

Triage call and use Adastra as you would triage a Devon call

It would be helpful if you could indicate if suitable for a HVP

The dispatch team will allocate the nearest resource

Ensure you safety net and advised to call back if deteriorates

Treatment Centre Procedure


Explain the administration team will contact them and arrange an appointment

Unlike Vocare, you do not need to select which treatment centre to dispatch the call to

Give safety netting advice and advise what to do if things deteriorate

District Nurse Procedure


Explain the administration team will pass the call to the District Nurses

To save issues down the line it worth documenting alternative action if DNs are not able to perform what

you are requesting, for example:

o “Expected death, please can DN verify, if DN unable to verify please arrange Home Visit”

o “If DN not able to visit urgently to give JIC meds, please arrange urgent Home Visit”

District Nurse Contacts

Via Single Point of Access 0300 323 0122

Twilight 17:30 - 22:00: 07824 543790

West Weekend 08:00-18:00 (North Sedgemoor, Bridgwater Bay Health, West Somerset, Taunton): 07825

755046

East Weekend 08:00- 18:00 (West Mendip, East Mendip, Central Mendip, South Somerset, Chard, Crewkerne

& Ilminster): 07795 046286

Overnight 21:45- 08:15 (Taunton, West Somerset, Bridgwater Bay): 07813 676351

Overnight 21:45- 08:15 (East Mendip, West Mendip, Central Mendip, North Sedgemoor): 07795 640446


Overnight 21:45- 08:15 (South Somerset, Chard, Ilminster, Crewkerne): 07966 306217


Community Hospitals

MIU Ward(s)

Bridgwater 8am – 9pm Yes

Burnham 10am – 6pm Yes

Chard 8am – 9pm Yes

Crewkerne Yes

Dene Barton Yes

Frome 8am – 9pm Yes

Minehead 24hrs*

*Paramedics Overnight

Yes

Shepton Mallet 8am – 9pm Yes

South Petherton Yes

St Andrews, Wells Yes *Psychiatric

Wellington Yes

West Mendip (Glastonbury) 8am – 9pm Yes

Williton Yes

Tiverton, Devon 8am – 1pm Yes

Please note, patients must arrive at least 30 mins before closing time

Minor Injury Unit Contacts


Telephone Number

Frome 01373 454740

Shepton 01749 341101

West Mendip (Glastonbury) 01458 836454

Minehead 01643 701715

Chard 01460 238229

Burnham on Sea 01278 773100

Bridgwater 01278 436555

Somerset Primary Link

Referral service run by SomPar for acute admissions, community admissions, home care & pathways (ie DVT)

Take referrals for all major hospital or service in Somerset and will arrange transport etc

Will only take referral from clinicians, not admin

Open 10am – 7pm daily

SPOA number 01749 836700 (phone) & 01749 836528 (fax)


A&E Departments

Musgrove Park Taunton 24hrs

Yeovil District Hospital 24hrs

Royal United Bath 24hrs

Weston General Hospital Closed Overnight

Royal Devon & Exeter Hospital 24hrs

Ambulatory Care

Based at Frome Community Hospital

Nurse led service providing ambulatory care for patients requiring day care treatments.

o Blood transfusions

o Care of venous lines

o Intravenous drug administration

o Wound dressings

o Catheter care/changes

o Vacuum assisted closure (VAC) THERAPY

o Provision of full ankle brachial pressure index (ABPI) assessment for lymphedema patients.

The service is available 7 days a week. Ongoing treatments may be provided where applicable at weekends.

Saturday, Sunday and bank holidays 09.00-13.00.

Frome Community Hospital Tel: 0300 3230030 or 07500 990723 or email [email protected]

mailto:%[email protected]


Hospital Switchboards

Musgrove Park Taunton 01823 334444

Yeovil District Hospital 01935 475122

Royal United Bath 01225 428331

Weston General Hospital 01934 636363

Royal Devon & Exeter Hospital 01392 404060

Yeovil Hospital

Please note that Yeovil, do not have:

ENT

Vascular (nearest centre = RUH, Taunton, Bristol or Exeter)

Neurosurgery (nearest = Bristol)

Ophthalmology (Taunton, Dorchester or Exeter)

Cathlab (nearest = Taunton, Exeter or Bristol)

Reminder Weston Super-Mare do not admit paediatric emergencies

Pharmacies

You can now search online for the nearest open pharmacy:

https://beta.nhs.uk/find-a-pharmacy/

There are several 100hr opening pharmacies including:

Cranleigh Gardens, Bridgwater

Midsomer Norton Pharmacy

Boots Babylon Hill, Yeovil

Many supermarkets open until 10pm





Mental Health Crisis Teams

Taunton Deane

Foundation House

Wellsprings Road

Taunton

TA2 7PQ

Tel : 01823 368398

Fax : 01823 368560

Somerset Coast

Glanville House

Church Street

Bridgwater

TA6 5AT

Tel : 01278 720292

South Somerset

Holly Court

Summerlands

Preston Road

Yeovil

BA20 2BN

Tel : 01935 411605

Fax : 01935 411612

Mendip

The Bridge Priory Health Park

Glastonbury Road

Wells

BA5 1TH

Tel : 01749 836722

Fax : 01749 836723

OOH Crisis Team 01823 333438 (direct), or 01823 368244 (main / public)

St Andrews Ward

In patient psychiatric unit may require visit to section a patient

Nurse puts patient on Section 5(4) and GP must visit within 6 hours to convert to 5(2), which lasts 72hrs until

a MHA can be arranged

Paperwork on the ward

CAMHS

CAMHS West ( Taunton Deane, Sedgemoor and West Somerset) Tel: 01823 368368 Fax: 01823 368554

CAMHS Mendip Tel: 01749 836561, Fax; 01749 836563

CAMHS South Somerset Tel: 01935 384140, Fax: 01935 411723

On The Level Tel: 01749 836727, Fax: 01749 836728

ND CAMHS ( Specialist Deaf Service) Tel: 01823 368373, text 07798 667966, Fax: 01823 368552


Emergency Dentist

The dental helpline and email is 0300 123 7691 or [email protected].

Patients will need to provide their name, telephone number and a description of the dental problem on the

answerphone.

The call or email should be returned within one hour.

Maxfacs is available in Musgrove Park only. There is no Maxfacs at Yeovil.

Hospice

Provided by St Margaret’s

Inpatient units in Taunton and Yeovil

24 hour helpline for patients and clinicians 0800 070 8910

Drugs & Alcohol

SDAS is a countywide service for both young people and adults.

It has six main hubs across Somerset

24 hour helpline for patients and clinicians 0300 303 87 88

Cross Border Arrangements

It maybe quicker and operationally easier for patients to attend treatment centres in Devon or BaNES

For patients wishing to attend Devon TCs, ie Honiton or Tiverton please put this in your triage notes and the

dispatch team will sort

For patients wishing t attend treatment centres outside the area for example BaNES, Bristol, Bath or Dorset.

Please speak to the team leader on 01392 823174

If patients have a Somerset GP (ie Milbourne Port) and live in Dorset, will see.



Social Services

Urgent referrals should be made via the Emergency Duty Team which covers Somerset, during the out of

hours period. Their number is 0300 123 2327

On Saturday between the hours of 9am and 4pm they can be contacted on: 0300 123 2224

Adult Safeguarding

Urgent Concerns, contact Adult Protection Duty Team on 0300 123 2327 or 999

Complete the following online form:

http://www.somerset.gov.uk/adult-social-care/safeguarding/report-an-adult-at-risk/

Child

Urgent referral to Emergency Duty Team on 0300 123 2327

In situations where you feel the need to remove the child immediately to hospital, refer direct to paediatrics

and/or involve the police on 101 or 999 depending on urgency.

More information can be found at:

http://www.somerset.gov.uk/childrens-services/safeguarding-children/report-a-child-at-risk/

Domestic Violence

In an emergency always dial 999

Somerset Integrated Domestic Abuse Services (SIDAS)

0800 694 9999 is a single point of contact for confidential advice and support to any person concerned about

domestic abuse in the Avon and Somerset area.

National Domestic Violence Helpline - 0808 200 0247

Men's Advice Line and Enquires (MALE) - 0808 801 0327.

National LGBT Domestic Abuse Helpline – 0800 999 5428

Elder Abuse - 0808 808 8141

Victim Support (Somerset) - 0300 303 1972

National Domestic Violence Helpline - 0808 200 0247

NSPCC (National Society for the Prevention of Cruelty to Children) Helpline - 0808 800 5000






Useful numbers

Team Manager 01392 823174

Somerset Dispatcher 01392 269455

Ambulance Control 0300 3690096

Public Health England 0300 303 8162

Somerset Care 0800 988 4333

Somerset Primary Link 01749 836700

EDT – Adult 01823 368244

EDT – Child 0300 123 2327

Medical Director on Call Via Team Manager

Treatment Centres

Telephone Number Fax Number

Bridgwater 01278 436553/436555 07976 757206 (base) 07976 803450 (car)

01278 436556

Musgrove Park 01823 344907 07976 756597 (base) 07979 803313 (car)

01823 344908

Minehead 07976 757214 (base) 01643 701716

Yeovil 01935 384319 07976 756942 (base) 07970 648746 (car)

01935 384270

Shepton 01749 342931 07976 756743 (base) 07976 803102 (car)

01749 330045

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