Phase One


Older Persons’ Unit (OPU)

The OPU provides GPs and other health care professionals such as EMAS and ED staff with an alternative method of obtaining a comprehensive geriatric assessment as opposed to admission to the acute sector for patients who are perceived as being pre-hospital admission. Nursing homes can also make direct referrals to the OPU.

The service offers clinical assessment and support which is initially provided by an Advanced Nurse Practitioner specialising in older people and a Consultant Geriatrician.

At the unit, the patient receives a comprehensive geriatric assessment including diagnostic testing such as bloods and x-rays. Patients requiring further diagnostics such as ultrasound will be referred as appropriate.

The service is available Monday to Friday – 9am-5pm (excluding bank holidays)

Link to Handbook

Link to the model (See Rapid Assessment for Older People)

Link to the case study reports:

http://media.wix.com/ugd/85c759_8231abd25b14426686dbad0389940180.pdf

http://media.wix.com/ugd/85c759_e702d44cdff04d929a3e367105537f39.pdf

 

Integrated Crisis Response Service 24/7 – Overnight Nursing

Leicestershire Partnership Trust’s (LPT’s) enhanced Overnight Nursing Assessment Service provides four virtual beds and a roving night team, providing home visits, and overnight support in patients’ own homes.

The service complements existing Community Health Services unscheduled care and social care crisis response services to provide 24-hour unscheduled care.

It incorporates nursing assessment and therapeutic intervention, including the identification and management of low-level social care needs to ensure patients are safe at home.

The service is available seven nights a week from 10pm to 8am and is a fully integrated part of LPT’s community health services so that the needs of patients are met over 24 hours. It operates across Leicestershire County and Rutland and is available to patients registered with a Leicestershire County or Rutland GP.

Link to the handbook

Link to the model

Link to the case study reports:

http://media.wix.com/ugd/85c759_d4447a095978429b8f2bbfccdfca7ead.pdf

http://media.wix.com/ugd/85c759_18568cfc8f834be0a452c5d1060bb805.pdf

 

Rapid Response falls service

A comprehensive non-conveyance pathway whereby potential admissions due to falls are assessed by paramedics on scene, using a Falls Risk Assessment Tool (FRAT).

If further follow up is needed urgently in the home, but the patient does not need conveying to hospital the paramedics have dedicated referral pathways to local Integrated Crisis Response team for community nursing and social care support.

Link to the handbook

Link to the model

Link to the case study reports:

http://media.wix.com/ugd/85c759_77f4cf36712247e98f35cc1fc052c2b3.pdf

http://media.wix.com/ugd/85c759_7278f823e0184075a57b30fa865538e7.pdf

 

Seven day services in Primary Care

During 2015/16 the two CCGs in Leicestershire piloted seven day services for specific cohorts of patients.

Models of care included acute visiting in the home and appointment based services at specific primary care facilities

Due to the pilot nature of this work, and evaluation processes in GP practice, some of the models were adjusted in year, as well as informing a fundamental review of how to approach this in 2016/17 onwards.

Link to the handbook

Link to the model

Link to the case study report:

http://media.wix.com/ugd/85c759_d3f2af3f1b7746a0bc8f62cc11439717.pdf