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Profile: Practice nurse sets up minor injuries unit

Responsible for a range of community care initiatives, Philomena Potts has significantly helped to reduce pressure on A&E and GP services.

Awarded practice nurse of the year for two years running, Philomena Potts has made significant contributions to community care and reduced pressures on A&E through her role in establishing a minor injuries services unit (MIU) and other innovative community care services in Wirral. Philomena who qualified as a nurse in 1979 and is married with two grown-up sons won practice nurse of the year at the General Practice Awards held by Cogora last year, and the same award the year before at a regional awards ceremony in Merseyside held by the Royal College of General Practitioners (RCGP).

The MIU is a nurse-led service catering for members of the public who cannot get a GP appointment at short notice and who can be treated outside of A&E. The “mother ship,” as Philomena calls it, is based at Miriam Medical Centre, where Philomena is also partner, and run alongside its normal surgery. There are also two satellite services held in Parkfield Medical Practice and Homelands Medical Centre.

“As you know, inappropriate attendances are taking place all across the country, and people are turning up with minor problems to A&E, and the more appropriate significant problems are being delayed because people are turning up with sore fingers and chest and urine infections.  With some extra training, nurses are more than capable of dealing with that.”

Furthermore, with a lot of practice nurse time in surgeries being taken up with chronic disease management, this service enables patients to get same-day treatment to address any concerns they may have.

With the MIUs located in quite socially deprived areas, Philomena says: “We are in a deprived area, and I want to know that patients feel confident that they can say anything to us and they can turn up with the silliest of problems and we will deal with them as appropriate.”

The service started five years ago when the local primary care trust put out a request to all the practices on the Wirral to put in a bid to set up an MIU. After Miriam Medical Practice won the bid, Philomena turned “nurse recruiter” to find nurses with the appropriate skills.

Describing the kind of skills that are relevant Philomena said that although it's very helpful to have nurses with an A&E background, nurses with varying skill sets including pediatrics care and district nursing are also very welcome due to the large number of young patients and people that need wound dressing treatments who turn up at the MIU.

Philomena however highlighted the importance of personality saying, “We've got a very strong can-do attitude in our practice, and it's important to have a fairly go ahead motivated attitude and a good attitude with patients as well.”

She said that although she did a three-day minor injuries course as a precursor to starting up the unit, there was nothing that she didn't know from practice nursing, which provides a lot of exposure to varying problems. Philomena also did a clinical examination and nurse prescribing course, which nurses who work in the MUI are also required to do. The course for the exams takes six months.

The MIU has grown from having two nurses at one MIU to the current number of 18 nurses that work across the three MIUs. Though to begin with the MIU hours were just a few days a week from 12-5pm, due to their popularity, the hours have now been extended to 10-8pm, and the MIU based in Miriam Medical Centre is open seven days a week. Up to 70 patients drop in each day, and last year alone, Philomena said that they saw 17,000 patients.

“It was myself and another nurse to start off with. People started trickling in to begin with, but very quickly, once patients got wind of the fact that they could drop in without an appointment and see somebody, the patients liked that, and of course through word of mouth it started taking off.”

Patients are usually seen within 20-30 minutes, and the range of problems the MIU are presented with are similar to what GPs would see including a lot of sore throats, childhood rashes, urinary tract infections, chest infections, lip injuries and the elderly falling off busses or shopping trolleys. They also deal with a lot of dressings for people coming out of hospitals, such as removal of sutras.

The nurses are able to prescribe any medicines that GPs can although Philomena asks them to only prescribe in their area of competence:

“Nurses are seen to be safe prescribers because we think twice about what we're doing. We follow local antibiotic guidelines and we're very much in tune with what we should or should not be doing.”

Though it is a nurse-led service across the board, with being based at the surgery, they can call on doctors if they're on the premises and there are outstanding concerns. However, Philomena says that across the three practices, this only happens about once a day.

Philomena says they also deal with a lot of signposting. So, for example, when people come in with fractures or when parents bring in unregistered babies with a chest infection, the MUI team will make sure that the parents get their child registered at the practice and will send them to the pediatric unit or A&E if necessary.

“We would never let anyone leave without being assessed by a qualified nurse who's giving advice and making sure this is safe,” says Philomena.

According to Philomena, they can deal with 94% of what comes through, and although in the absence of the service, not all the patients would have ended up in A&E, a large proportion certainly would have and it would have been inappropriate.

“We can deal with about 94% of what comes through which is a high figure really and that's a) taking a lot of pressure off GPs, and secondly, hopefully off A&E,” says Philomena.

As the MIU has become increasingly popular and helped ease pressure off GPs, other services including a teledermatology and an ECG service have been incorporated in it.

In the first instance, nurses take pictures of dermatological problems patients have such as a lump, wart or a mole, with a special camera attached to an iPhone. This is then sent through to a consultant dermatologist, who provides an opinion as to whether the patient needs further hospital assessment, usually within 24 hours. For the ECG service which takes referrals from GPS across the Wirral, nurses will do ECGs of patients who are of concern, tape it and send the recording down the phone to a heart centre in Manchester where a specialist is available to read the recording and tell them immediately if the patient needs a referral or not. Future plans for the MIU include allocating a specific block of time during the day for dressings to streamline the service a bit more.

With a hugely varied nursing career spanning over 30 years which has seen Philomena take up nursing roles all over the world, her work has ranged from nursing people in their villas in the South of France, working at the oncology unit in the US, and carrying out drug testing and urine testing on ships around the Hong Kong islands to later starting up her own nursing agency there.

Philomena has been able to bring her wealth of experience to help set up other innovative nurse-led services in the community including an admissions preventions service and a home care service.

The home care service which was set up about four years ago enables patients who require it to receive total parenteral nutrition at home rather than as inpatients in hospitals where they would have stayed for up to 18 months.

The admissions prevention service, which was taken over last year from a service provider takes referrals from doctors who don't think the patients need to be admitted to hospital.

The nurses who have the support of occupational therapists, physiotherapists, social workers as well as access to care agencies will put together a care package for the patient who will then be treated at home, in a residential home or receive respite care. There is also an admissions prevention unit within the A&E of their local hospital.

With virtually 100% of those referred avoiding a hospital admission, Philomena says that a lot of the time, it's about the need for correct signposting rather than immediate admission to a hospital:

“As long as we are identifying the correct person with the correct problems, then we can manage it. A lot of the time, just because an elderly person has had a fall or an injury and they don't have extended family, people think it's going to have to be the hospital as a default option. But if a fracture's been ruled out, and they just need support and care, we can do that. If it's social, which a lot of it is with the elderly, they may have just never had a package of care in the past or social workers may have not been aware of them… the beauty of these services is that they're out in the general practice and in the community, so people aren't taking up space unnecessarily in hospitals or having to travel up. They're out in the community which is what we've discovered is where people want to go.”