There are so many clinics, which surgeries could do, and not many do all the ones listed below – (The bold ones indicate clinic services usually offered in most of the surgeries):
- Adult Immunisations;
- Post and Antenatal – A double appointment required – sometimes by mid-wives;
- Asthma; Diabetes; Hypertension;
- Cervical Smear;
- Check-ups for the Elderly;
- Child Health Surveillance – in conjunction with the Health Visitors;
- Child Immunisation – Arranged by computer recall from the surgery;
- Cryosurgery (treatment for warts);
- Dietician – with a Doctor’s Referral – by Health Visitors;
- Family Planning;
- Health Promotion – anti-smoking, asthma, weight reduction, diabetes, and well-person checks;
- Minor Surgery – including treatments for skin lesions, ingrown toenails and verruca’s; A double appointment is necessary;
- Mother & Baby;
- Phlebotomist (Blood Tests);
- Physiotherapist – with musculo-skeletal problems – provides for first referral and follow-up consultations;
- Travel Clinic – holiday immunisations for patients registered with the practice;
- Vasectomies with GPs referral;
- Well Person Clinics; New patient Clinics – once registration is confirmed, attend clinic with the Health questionnaire and a urine sample (bottle available at the Reception);
The PHCT has developed nurse run clinics to provide most of the care: –
- Hypertension clinic
- Cholesterol clinic
- Chronic heart failure clinic (including domiciliary care and a hospital discharge system)
- Stopping smoking clinic
- Diabetic clinic
There must be evidence-based guidelines, which all members of the PHCT must sign up to and have ownership of. Nurses cannot run clinics if doctors are all using different guidelines and medications.
Structured computer records
Structured computer records are essential so that everyone has easy access to information and the setting of standards and auditing of results is possible.
Initially, the estimated time to see each diabetic patient is about 20 min.
Consequently, a maximum of 6 patients needs to be booked for the clinics.
PCT Nurse will notify any increase in number to receptionists and practice nurse.
As PCT Nurse – H Grade nurse is able to do the clinic with no involvement of the GP’s except for any discussions pertaining to fine-tuning of medication, it is imperative that their time is utilized more effectively and the practice nurses and receptionists do the preparatory and finishing work in-house.
The protocols for the clinic have been provided by Computer System provider – for each clinics e.g. diabetes, the various screens will appear one after another once the details for each screen is input.
The PCT Nurse will see all diabetic patients in the clinics. The details of insulin dependent patients, who are seen by hospitals and under their monitoring, will be entered in the computer. GP’s roles are to utilize hospital services and follow hospital consultant’s recommendations. (New Contract stipulates what factors to be assessed and reported and does not expect GP’s to do it).
Blood Test results needed prior to giving appointments to PCT Nurse:
The details required to be determined, and recorded are:
- Fasting Lipid Profile
If the details are not available, then a blood test has to be done and results obtained prior to giving clinic appointment with PCT Nurse.
Patients are invited to come and pick up the blood test forms to be taken to the hospital. Practice nurse has to identify such patients and the receptionists have to telephone/contact them to come to surgery and pick up the blood test forms.
Once the results are obtained, then practice nurse has to put the data in the computer ‘ASAP’.
- All patients to give sample for urine test – to be done on the day (prior to clinic appointment) with PCT Nurse.
Nurse’s Folder for any referral as required:
The following need to be provided in a folder for the PCT Nurse:
- Referral form for Dietician
- Referral form for Chiropodist
- Referral form for Retinopathy evaluation – nearest Optician (Hammonds Eye Clinic – 546 High Road, Tottenham).
- Diabetic Protocol – MS Rebecca Cheatle – PCT Nurse will assist with proving such a protocol.
Essential equipment and test units:
- Micro-albumin Test strips – need to be available in the consulting room
- Electronic BP equipment.
Inviting patients – steps to follow by practice nurse:
Initially patients not seen for over 1 year
Check whether the patient has had blood test results with all the relevant details listed in ‘5’ above.
If yes – then make appointment for the PCT Nurse.
If not, then arrange for blood test as stated in ‘5’ above.
Make a list of patients with name, surname and Dob and telephone number and give to the Senior Receptionist to arrange for appointments with PCT Nurse on the appropriate dates for the clinic.
Initially max. 6 patients per clinic (see 1 above).
Once patients not seen over 1 year have been called, then patients not seen over 6 months need to be called
Practice Nurse with GP and PMgr will have to assess the monthly performance for the diabetic clinic and make recommendations on improvements so as to meet the set targets and reach quality points predicted.
For full details of each clinical guideline and its associated publications please check via Google. Some topics are given below: