On-Call-at-K-Doc-DrO..

Dr. Brendan O’ SheaGP at The Bridge Medical CentreMedical Director at K DocLecturer Dept Primary Care and Public Health TCD

One...two...three....four...five.....‘This is Carrigaholt 5...............’

On taking up a position where you work unsociablehours.......

HALTed..................don’t get

HungryAngryLateTired

‘‘.....at least we’re ahead of the priests’

General Practice Out of Hours Care

On Call in Kildare• From 1:2 rota towards 18 hrs per quarter• Development of real infrastructural support• Larger Rotas / Deputising Bureau / Co Operative

K Doc 2000‐2010• 67 to 110 Members• Population coverage c 220,000• Handles c 42,000 consultations p/a• High Patient satisfaction levels• Continual service development• Clinical governance• Patients and Doctors appear to respect and like it !!

K Doc OOH Structure & Operations• 2‐7 GPs on call (+/‐ GP Registrars)• Principal TC + 2 Satellites TC• Two Mobile Units• Administrators / Drivers / Receptionists• OOH + K Clinic Services• IT / Communications infrastructure

K Doc Infrastructure• IT: Adastra; used directly by c 95% Members• Episodic care• Highly Reliable / Reasonably Flexible• Communications; robust / sophisticated telephony• Principal Treatment Centre at Naas

Your Process• Arrive on time please (how to get there...)• Bus Eireann or Dublin Coach (ex The Red Cow luas)• Train to Sallins, Taxi to K Doc• Naas; 5‐7 minute walk from town centre• Ask for Naas Hopsital• As you approach Naas Hospital, keep the lake to LHS• K Doc at Vista Primary Care (underground car parking)

Getting there by road• Take N 7 to Exit 10, into Naas• Follow Naas signs past Lidl (RHS)• Take a Right at Pedestrian Lights (Aldi in front ofyou)• Follow arterial road through 3 rndbts, take a left.• Vista / K Doc on your LHS• If lost, ask directions for Naas Hospital

Your Process• Arrive on time please (how to get there...)• Check in with The Nursing Supervisor• Short visit – 6‐ 10 pm weekday evening• Treatment Centre or Mobile Unit.....• Present professionally....neat / tidy / stethoscope• Oxford Handbook of General Practice (3 rd Edition)

Your process• Introduce yourself.....how good are we at this ?• Observe process / sit in waiting area / at reception• Observe call handling at Call Centre• Sit in with Driver; observe checking process• Sit in with Consulting GP and engage generally

Clinical Experience• Regular caseload in The Treatment CentreAnxious, sore, distressed People,consulting strange Doctors.Acute presentations of minor / major illnessesDecompensating chronic diseaseMinor TraumaMental Health Care in the Community

Clinical Experience• In the Mobile UnitEndstage Palliative CareCare of the ‘Old Old’ in Nursing Homes / HousecallsAn Garda SiochanaSerious Acute PsychiatryDead PatientsThe GP and The Driver

Self Care on the Job....• Washrooms• Restaurant (closed OOH !) with snacks available• Staff room (good for brown bagging !)• Be punctual and organised – far less stressful• Report to Nursing Supervisor on arrival• Report back to the Nursing Supervisor beforedeparture• Report any difficulties to the Nursing Supervisor

Key Questions• Is this a safe, secure, effective system of care ?• Is it truly patient centred ?• Is the Treating Team well supported and happy ?• Would you be happy to be treated here ?• Would you be happy to work here ?• What would you change about it ?• Suggestions greatly appreciated.....

Task List• Discussion with Driver• Observe call handling in the Call Centre• Sit in Waiting Area• Sit in with a Patient from arrival at Reception to d/c• Check Vital Signs• Check your own Pulse Ox• Sit with TC Nurse / GPs• Bring Stethoscope / Diagnostic Set / OxfordHandbook of GP• Feedback Sheets

Before you go.....• Orientation and Feedback Sheet• Thank people, if its deserved• Leave no questions unanswered• Feedback Sheet• Don’t forget to come back sometime.......