Specialist hospital based services |
(1) Sexual health services | Population: asylum seekers and immigrant populations |
| Evidence of unmet need: local service data suggested relatively low uptake of services by ethnic minority populations |
| Intervention: to develop appropriate information leaflets about services |
| Proposed outcome: increased use of services by these patient groups |
| Progress: established multidisciplinary working group to develop materials |
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(2) Termination of pregnancy services | Population: any pregnant woman requesting referral |
Evidence of unmet need: high rates of relatively late termination identified by external audit and anecdotal evidence of delays in referral pathway |
| Intervention: to simplify referral pathway allowing direct referral by family planning clinics |
| Proposed outcome: reduced time from first contact to appointment with service |
| Progress: developed proposal for revised pathways which was being negotiated with both referring clinicians and termination service providers |
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(3) Services for looked after children | Population: children in care with drugs and alcohol related problems. |
Evidence of unmet need: both local and national data suggesting high level of problems, lack of accessible local services for young people |
| Intervention: to create referral pathways to new specialist service |
| Proposed outcome: appropriate referrals to specialist service |
| Progress: new service being established, to be located in community venues |
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(4) Cardiology appointment system | Population: patients referred to cardiology outpatients clinic |
Evidence of unmet need: local audit showing high proportion of patients either not making an appointment or not attending when appointment was sent |
| Intervention: contacting patients not seen in clinic by telephone or visit |
| Proposed outcome: reduced “did not make appointment” and “did not attend” rates |
| Progress: attempts to contact patients revealed that patients frequently unavailable at the telephone number or address available to the service and led to attempts to (1) improve accuracy of contact information and (2) contact patients sooner after initial referral to explain need to make appointment |
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Community based services |
(5) Practice nurse led clinic | Population: people with chronic disease in employment |
Evidence of unmet need: local anecdotal evidence that working population less likely to attend clinics in normal working hours than other age groups |
| Intervention: Saturday morning clinics |
| Proposed outcome: increased attendance rates for routine review |
| Progress: some patients attending for chronic disease management reviews on Saturdays, overall attendance for reviews increased |
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(6) Macmillan drop-in clinic | Population: patients with cancer and carers in rural areas |
Evidence of unmet need: Scottish study suggests cancer services less accessible to rural populations10 |
| Intervention: to increase use of a cancer support drop-in service by directly advertising through local general practices |
| Proposed outcome: use of service by more patients and from a wider geographical area |
| Progress: increase in attendance rates from a wider catchment area |
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(7) Asthma management in primary care | Population: patients with asthma not attending routine review |
Evidence of unmet need: Hospital Episode Statistics showing high rates of emergency admission for asthma from many practices serving deprived populations, feedback from practice nurses involved in the local asthma collaborative that patients they knew to be at higher risk were often the ones not attending for review |
| Intervention: use of NHS Direct to contact non-attenders and identify patients with poor control |
| Proposed outcome: to increase routine review and to reduce emergency admissions |
| Progress: no change in Hospital Episode Statistics for emergency asthma admissions but participating practices report a higher proportion of their asthma patients undergoing routine review |
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(8) COPD management in primary care | Population: people with COPD |
Evidence of unmet need: local survey indicated that practice COPD registers were often absent or inaccurate which concurred with national evidence that COPD is often undiagnosed or misdiagnosed |
| Intervention: development of general practice registers for COPD |
| Proposed outcome: regular routine review for all patients |
| Progress: COPD coordinator appointed to support practices in developing COPD registers and to ensure the appropriate use of spirometry for diagnosis and monitoring. Participating practices now have robust mechanisms for diagnosing and monitoring COPD patients |