Manager Practice


Practice manager Jackie Ireland (centre) and the


team at the Miriam Medical Centre in Birkenhead


Philomena Potts and other nurse


practitioners based at the Birkenhead Medical Building (right)


of the first practices in the Wirral to introduce chronic disease clinics for conditions like hypertension and diabetes with patients able to see consultants and other specialists on the doorstep rather than having to go to hospital. The practice also invested in IT early on and became “paperless”. “That little building was like a Tardis inside,”


says Jackie. “We had so many extensions and add-ons because he brought so many new services into the practice.”


EMPOWERING STAFF Miriam occupied its old premises for 23 years before making the welcome move to the Birk- enhead Medical Building. Here practice patients share the waiting area with those attending for the minor injury and illness clinic. “At the moment I have about 12 or 13 nurses who primarily do minor injuries and around 11 have achieved their nurse prescribing status,” says Philomena. “The practice has supported this and the nurses have benefitted from train- ing budgets at the CCG and through bursaries. This attracts good nurses.” Making use of skilled practice nurses in this


way has met with some resistance, admits Dr Mantgani. “A few of our colleagues challenge the ethos of what we are doing because their view is that care should all be centred around the GP in terms of triage and delegation. If we had enough GPs in the NHS to do that it would be fine. But


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“


IF YOU EMPOWER NURSES AND PROVIDE SUPPORT TO TAKE THINGS FORWARD YOU CAN DELIVER A HIGH-QUALITY SERVICE


” Dr Abhi Mantgani


what we have demonstrated here is that if you empower nurses and provide support to take things forward you can deliver a high-quality service which is economical and scalable. This may be one model that can help to meet the unrelenting demand for access in primary care.” In addition to the minor injury and illness


service Miriam also provides Wirral CCG with other nurse-led services, including one for hospital admissions avoidance. The Kings Fund has reported that over 80 per cent of emer- gency admissions staying for more than two weeks are patients aged over 65, and other studies have shown that older people admitted to an acute hospital setting are more likely to stay and suffer life-threatening infections, falls and delirium. The Admissions Prevention and Facilitated Discharge (APFD) service in the Wir- ral (along with a second similar scheme) aims to reduce hospital admissions and also facilitate a discharge process for those who may already be languishing in hospital.


Patients are referred to the service by their GP or a district nurse or social worker. A senior nurse clinician then works closely with health and social care multi-disciplinary teams to sup- port home care or other solutions such as long- term care placements within nursing homes. “The admission prevention nurses are a sepa-


rate team from minor injuries,” says Philomena. “But I try and get them trained so they can step into any role if ever there is a shortage in one area. They like the variety and it enhances their knowledge and their skills.” Philomena joined the practice 13 years ago


with a varied background in nursing and also a stint working as a pharmaceutical rep. Four years ago, having been instrumental in developing the expanded services at Miriam, she was invited by Dr Mantgani to become a partner in the practice, which is unusual for a practice nurse. Last year she also won the Nurse of the Year at the 2013 General Practice Awards for her efforts on the Wirral.


Philomena says she would like to see more


practice nurses taking on a greater role in devel- oping and delivering enhanced services to make the NHS more efficient. “There is a large workforce of nurses out


there and they do want to be empowered and up-skilled.”


Jim Killgore is an associate editor at Practice Manager


11


PHOTOGRAPHS: COLIN MCPHERSON


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